Systematic review and meta-analysis of the reliability and discriminative validity of cartilage compositional MRI in knee osteoarthritis
Open accessAbstract
Objective To assess reliability and discriminative validity of cartilage compositional magnetic resonance imaging (MRI) in knee osteoarthritis (OA). Design The study was carried out per PRISMA recommendations. We searched MEDLINE and EMBASE (1974 - present) for eligible studies. We performed qualitative synthesis of reliability data. Where data from at least two discrimination studies were available, we estimated pooled standardized mean difference (SMD) between subjects with and without OA. Discrimination analyses compared controls and subjects with mild OA (Kellgren-Lawrence (KL) grade 1-2), severe OA (KL grade 3-4) and OA not otherwise specified (NOS) where not possible to stratify. We assessed quality of the evidence using Quality Appraisal of Diagnostic Reliability (QAREL) and Quality Assessment of Diagnostic Accuracy (QUADAS-2) tools. Results Fifty-eight studies were included in the reliability analysis and 26 studies were included in the discrimination analysis, with data from a total of 2,007 knees. Intra-observer, inter-observer and test-retest reliability of compositional techniques were excellent with most intraclass correlation coefficients >0.8 and coefficients of variation <10%. T1rho and T2 relaxometry were significant discriminators between subjects with mild OA and controls, and between subjects with OA (NOS) and controls (P < 0.001). T1rho showed best discrimination for mild OA (SMD [95% CI] = 0.73 [0.40 to 1.06], P < 0.001) and OA (NOS) (0.60 [0.41 to 0.80], P < 0.001). Quality of evidence was moderate for both parts of the review. Conclusions Cartilage compositional MRI techniques are reliable and, in the case of T1rho and T2 relaxometry, can discriminate between subjects with OA and controls.
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Integration of T2 mapping with other quantitative MRI techniques such as T1rho, DTI, and sodium imaging enhances early compositional changes.
“Early compositional changes are enhanced by integration with other quantitative MRI techniques (e.g., T1rho, DTI, sodium imaging) [62].”
From Biomarker-Guided Imaging and AI-Augmented Diagnosis of Degenerative Joint Disease (2025) · cites this paper as [62]
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- Authors
- MacKay, J. W., Low, S. B. L., Smith, T. O., Toms, A. P., McCaskie, A. W., & Gilbert, F. J.
- Affiliations
- University of Cambridge (GB)
- Norfolk and Norwich University Hospital (GB)
- University of East Anglia (GB)
- Corresponding author
- MacKay, J.W.
- Low, S.B.L.
- Smith, T.O.
- Toms, A.P.
- McCaskie, A.W.
- Gilbert, F.J.
- Venue
- Osteoarthritis and Cartilage
- Publisher
- Elsevier BV
- Published
- 2018-09
- Volume
- 26
- Issue
- 9
- Pages
- 1140-1152
- ISSN
- 1063-4584 (ISSN-L)
- OpenAlex
- W2769705592
- Cited by
- 148
- References
- 97
- Citations by year
- 2026: 13 · 2025: 18 · 2024: 18 · 2023: 29 · 2022: 15 · 2021: 20 · 2020: 12 · 2019: 19 · 2018: 3
- FWCI
- 2.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Osteoarthritis and Cartilage (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- National Institute for Health Research Cambridge Biomedical Research Centre
- Topics
- Health Sciences › Medicine › Rheumatology › Osteoarthritis Treatment and Mechanisms
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Medicine › Surgery › Hip disorders and treatments
- Keywords
- knee osteoarthritis, T2 relaxometry, diagnostic accuracy, inter-rater reliability, test-retest reliability, cartilage composition, Kellgren-Lawrence grade
- MeSH terms
- Aged, Cartilage, Articular, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Reference Values, Sensitivity and Specificity, Severity of Illness Index, Reproducibility of Results, Case-Control Studies, Osteoarthritis, Knee
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