Reliability and sensitivity to change of IW-TSE versus DESS magnetic resonance imaging sequences in the assessment of bone marrow lesions in knee osteoarthritis patients: Longitudinal data from the Osteoarthritis Initiative (OAI) cohort


Background: Bone marrow lesions (BMLs) are associated with osteoarthritis (OA). We assessed the performance of two commonly used MRI sequences, IW-TSE and DESS, for reliability in the detection of BMLs and sensitivity to estimate change over time. We suggested that the IW-TSE would demonstrate higher sensitivity to change than DESS in the assessment of BML prevalence and change over time. This study was performed using a subset of the Osteoarthritis Initiative (OAI) cohort. Methods: A sub-group of 144 patients was selected from the OAI progression cohort who all had IW-TSE and DESS MRI acquisitions at baseline and 24 months. BMLs were assessed using a semi-quantitative scale in the global knee, medial and lateral compartments, and subregions. Intra-reader reliability was assessed on a subset of 51 patients. Results: Intra-reader reliability was substantial for the global knee ≥ 0.64, medial ≥ 0.70, and lateral ≥ 0.63 compartments for IW-TSE and DESS. The prevalence of BML detected at baseline was only slightly greater for IW-TSE compared to DESS. The mean BML score at baseline was significantly higher (p ≤ 0.006) for the IW-TSE than the DESS. However, mean change at 24 months was similar for both sequences for all regions except the medial compartment (p = 0.034) and medial femur (p = 0.015) where they were significantly higher for DESS than IW-TSE. Moreover, the prevalence of BML change at 24 months was similar in all regions except the global knee (p = 0.047) and the lateral tibial plateau (p = 0.031). Conclusion: This study does not suggest superior sensitivity to change of one sequence over the other for almost all the regions. The only difference is a higher BML mean change over time detected by the DESS sequence in the medial compartment and femur. These data bring into perspective that both sequences seem equivalent regarding their use for the assessment of BML in clinical trials.

Share and Cite:

Raynauld, J. , Wildi, L. , Abram, F. , Moser, T. , Pelletier, J. and Martel-Pelletier, J. (2013) Reliability and sensitivity to change of IW-TSE versus DESS magnetic resonance imaging sequences in the assessment of bone marrow lesions in knee osteoarthritis patients: Longitudinal data from the Osteoarthritis Initiative (OAI) cohort. Journal of Biomedical Science and Engineering, 6, 337-345. doi: 10.4236/jbise.2013.63A043.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Wilson, A.J., Murphy, W.A., Hardy, D.C., et al. (1988) Transient osteoporosis: Transient bone marrow edema? Radiology, 167, 757-760.
[2] Carrino, J.A., Blum, J., Parellada, J.A., et al. (2006) MRI of bone marrow edema-like signal in the pathogenesis of subchondral cysts. Osteoarthritis and Cartilage, 14, 1081-1085. doi:10.1016/j.joca.2006.05.011
[3] Raynauld, J.P., Martel-Pelletier, J., Berthiaume, M.J., et al. (2008) Correlation between bone lesion changes and cartilage volume loss in patients with osteoarthritis of the knee as assessed by quantitative magnetic resonance imaging over a 24-month period. Annals of the Rheumatic Diseases, 67, 683-688. doi:10.1136/ard.2007.073023
[4] Wildi, L.M., Raynauld, J.P., Martel-Pelletier, J., et al. (2010) Relationship between bone marrow lesions, car-tilage loss, and pain in knee osteoarthritis: Results from a randomised controlled clinical trial using MRI. Annals of the Rheumatic Diseases, 69, 2118-2124. doi:10.1136/ard.2009.127993
[5] Hayashi, D., Guermazi, A., Kwoh, C.K., et al. (2011) Semiquantitative assessment of subchondral bone marrow edema-like lesions and subchondral cysts of the knee at 3T MRI: A comparison between intermediate-weighted fat-suppressed spin echo and Dual Echo Steady State se- quences. BMC Musculoskeletal Disorders, 12, 198. doi:10.1186/1471-2474-12-198
[6] Beltran, J. and Shankman, S. (1994) Magnetic resonance imaging of bone marrow disorders of the knee. Magnetic Resonance Imaging Clinics of North America, 2, 463- 473.
[7] Felson, D.T., Chaisson, C.E., Hill, C.L., et al. (2001) The association of bone marrow lesions with pain in knee osteoarthritis. Annals of Internal Medicine, 134, 541-549.
[8] Felson, D.T., McLaughlin, S., Goggins, J., et al. (2003) Bone marrow edema and its relation to progression of knee osteoarthritis. Annals of Internal Medicine, 139, 330- 336.
[9] Hunter, D.J., Zhang, Y., Niu, J., et al. (2006) Increase in bone marrow lesions associated with cartilage loss: A longitudinal magnetic resonance imaging study of knee osteoarthritis. Arthritis and Rheumatism, 54, 1529-1535. doi:10.1002/art.21789
[10] Roemer, F.W., Guermazi, A., Javaid, M.K., et al. (2009) Change in MRI-detected subchondral bone marrow lesions is associated with cartilage loss: The MOST Study. A longitudinal multicentre study of knee osteoarthritis. Annals of the Rheumatic Diseases, 68, 1461-1465. doi:10.1136/ard.2008.096834
[11] Sowers, M.F., Hayes, C., Jamadar, D., et al. (2003) Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and X-ray-defined knee osteoarthritis. Osteoarthritis and Cartilage, 11, 387-393. doi:10.1016/S1063-4584(03)00080-3
[12] Kornaat, P.R., Kloppenburg, M., Sharma, R., et al. (2007) Bone marrow edema-like lesions change in volume in the majority of patients with osteoarthritis; associations with clinical features. European Radiology, 17, 3073-3078. doi:10.1007/s00330-007-0711-1
[13] Davies-Tuck, M.L., Wluka, A.E., Wang, Y., et al. (2009) The natural history of bone marrow lesions in community-based adults with no clinical knee osteoarthritis. Annals of the Rheumatic Diseases, 68, 904-908. doi:10.1136/ard.2008.092973
[14] Lo, G.H., McAlindon, T.E., Niu, J., et al. (2009) Bone marrow lesions and joint effusion are strongly and independently associated with weight-bearing pain in knee osteoarthritis: Data from the osteoarthritis initiative. Osteoarthritis and Cartilage, 17, 1562-1569. doi:10.1016/j.joca.2009.06.006
[15] Raynauld, J.P., Martel-Pelletier, J., Berthiaume, M.J., et al. (2006) Long term evaluation of disease progression through the quantitative magnetic resonance imaging of symptomatic knee osteoarthritis patients: Correlation with clinical symptoms and radiographic changes. Arthritis Research & Therapy, 8, R21. doi:10.1186/ar1875
[16] Scher, C., Craig, J. and Nelson, F. (2008) Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up. Skeletal Radiology, 37, 609-617. doi:10.1007/s00256-008-0504-x
[17] Tanamas, S.K., Wluka, A.E., Pelletier, J.-P., et al. (2010) Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: A longitudinal study. Rheumatology (Oxford), 49, 2413-2419. doi:10.1093/rheumatology/keq286
[18] Leydet-Quilici, H., Le Corroller, T., Bouvier, C., et al. (2010) Advanced hip osteoarthritis: Magnetic resonance imaging aspects and histopathology correlations. Osteoarthritis and Cartilage, 18, 1429-1435. doi:10.1016/j.joca.2010.08.008
[19] Mirowitz, S.A., Apicella, P., Reinus, W.R., et al. (1994) MR imaging of bone marrow lesions: Relative conspi-cuousness on T1-weighted, fat-suppressed T2-weighted, and STIR images. American Journal of Roentgenology, 162, 215-221. doi:10.2214/ajr.162.1.8273669
[20] Eckstein, F., Burstein, D. and Link, T.M. (2006) Quantitative MRI of cartilage and bone: Degenerative changes in osteoarthritis. NMR in Biomedicine, 19, 822-854. doi:10.1002/nbm.1063
[21] Roemer, F.W., Frobell, R., Hunter, D.J., et al. (2009) MRI-detected subchondral bone marrow signal alterations of the knee joint: Terminology, imaging appearance, relevance and radiological differential diagnosis. Osteoarthritis and Cartilage, 17, 1115-1131. doi:10.1016/j.joca.2009.03.012
[22] Altman, R., Asch, E., Bloch, D., et al. (1986) Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis and Rheumatism, 29, 1039-1049. doi:10.1002/art.1780290816
[23] Peterfy, C.G., Gold, G., Eckstein, F., et al. (2006) MRI protocols for whole-organ assessment of the knee in osteoarthritis. Osteoarthritis and Cartilage, 14, A95-A111. doi:10.1016/j.joca.2006.02.029
[24] Peterfy, C.G., Guermazi, A., Zaim, S., et al. (2004) Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthritis and Cartilage, 12, 177-190. doi:10.1016/j.joca.2003.11.003
[25] Landis, J.R. and Koch, G.G. (1977) The measurement of observer agreement for categorical data. Biometrics, 33, 159-174. doi:10.2307/2529310
[26] Stratford, P.W. and Riddle, D.L. (2005) Assessing sensitivity to change: Choosing the appropriate change coefficient. Health and Quality of Life Outcomes, 3, 23. doi:10.1186/1477-7525-3-23
[27] Roemer, F.W., Hunter, D.J. and Guermazi, A. (2009) MRI-based semiquantitative assessment of subchondral bone marrow lesions in osteoarthritis research. Osteoarthritis and Cartilage, 17, 414-415; author reply 416- 417. doi:10.1016/j.joca.2008.07.019
[28] Eckstein, F., Maschek, S., Wirth, W., et al. (2009) One year change of knee cartilage morphology in the first release of participants from the osteoarthritis initiative progression subcohort: Association with sex, body mass index, symptoms and radiographic osteoarthritis status. Annals of the Rheumatic Diseases, 68, 674-679. doi:10.1136/ard.2008.089904
[29] Raynauld, J.P., Martel-Pelletier, J., Bias, P., et al. (2009) Protective effects of licofelone, a 5-lipoxygenase and cyclo-oxygenase inhibitor, versus naproxen on cartilage loss in knee osteoarthritis: A first multicentre clinical trial using quantitative MRI. Annals of the Rheumatic Diseases, 68, 938-947. doi:10.1136/ard.2008.088732

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.