Magnetic Resonance Imaging Score and Classification System (AMADEUS) for Assessment of Preoperative Cartilage Defect Severity (original) (raw)
Related papers
Radiology, 2014
To describe a scoring system for quantification of cartilage lesions (Cartilage Lesion Score [CaLS]), to determine its reproducibility, to examine the association of CaLSdetected longitudinal change with known risk factors for osteoarthritis (OA) progression by comparing a group of subjects with OA risk factors with a group of subjects without OA risk factors, and to compare the CaLS system with the established semiquantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Boston-Leeds Osteoarthritis Knee Score (BLOKS) systems in terms of detection of cartilage defect progression. Materials and Methods: All subjects provided written informed consent, and the local institutional review board approved this HIPAAcompliant study. Fifty-two subjects with and 25 subjects without risk factors for knee OA were randomly selected from the Osteoarthritis Initiative. Inclusion criteria were age of 45-60 years, body mass index of 19-27 kg/m 2 , and no knee pain or OA on radiographs at baseline. Baseline and 24-month follow-up right knee 3-T magnetic resonance images were analyzed with WORMS, BLOKS, and CaLS systems. Progression of cartilage lesions with each scoring system was compared by using multilevel mixedeffects linear-regression models. k values were calculated to determine reliability. Results: Intraclass coefficient values for inter-and intraobserver reliability of the CaLS system were 0.86 and 0.91, respectively. Interobserver k value range for individual features was 0.81-0.94. The CaLS system enabled significantly higher detection of cartilage lesion progression than did WORMS or BLOKS systems (P , .001); 51.8% (56 of 108), 17.6% (19 of 108), and 13.0% (14 of 108) of the lesions progressed when analyzed with the CaLS, WORMS, and BLOKS systems, respectively. With the CaLS system, subjects with OA risk factors had significantly higher odds of progression than did subjects without risk factors (odds ratio, 2.78; P = .005). Conclusion: The CaLS system is a reproducible scoring system for cartilage lesions that yields an improved detection rate for monitoring progression when compared with detection rates of semiquantitative WORMS and BLOKS systems.
Preoperative Measurement of Cartilage Defects by MRI Underestimates Lesion Size
Cartilage, 2011
Anecdotal evidence suggests that MRI frequently underestimates the size of cartilage defects when compared with final lesion size after debridement of all degenerated tissue. This has potential implications for the choice of cartilage repair technique since most treatment algorithms are primarily driven by defect size. We conducted an investigation comparing size estimates based on preoperative MRI with final defect size after debridement. Our aim was to provide surgeons with more objective data to assist in predicting true defect size based on MRI scanning. Patients were included in this retrospective study if they had undergone preoperative MRI and open cartilage repair within 12 months to minimize potential confounding by defect progression on MRI. Defect sizes measured after debridement were obtained from surgical notes and compared with MRI size estimates by 2 musculoskeletal radiologists. Thirty-eight patients were enrolled with a median age of 37 years, median number of 1.7 d...
The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score and Atlas
CARTILAGE
Objective Since the first introduction of the MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) score, significant progress has been made with regard to surgical treatment options for cartilage defects, as well as magnetic resonance imaging (MRI) of such defects. Thus, the aim of this study was to introduce the MOCART 2.0 knee score — an incremental update on the original MOCART score — that incorporates this progression. Materials and Methods The volume of cartilage defect filling is now assessed in 25% increments, with hypertrophic filling of up to 150% receiving the same scoring as complete repair. Integration now assesses only the integration to neighboring native cartilage, and the severity of surface irregularities is assessed in reference to cartilage repair length rather than depth. The signal intensity of the repair tissue differentiates normal signal, minor abnormal, or severely abnormal signal alterations. The assessment of the variables “subchondral lami...
Association between quantitative MRI and ICRS arthroscopic grading of articular cartilage
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2014
To investigate the association of quantitative magnetic resonance imaging (qMRI) parameters with arthroscopic grading of cartilage degeneration. Arthroscopy of the knee is considered to be the gold standard of osteoarthritis diagnostics; however, it is operator-dependent and limited to the evaluation of the articular surface. qMRI provides information on the quality of articular cartilage and its changes even at early stages of a disease. qMRI techniques included T 1 relaxation time, T 2 relaxation time, and delayed gadolinium-enhanced MRI of cartilage mapping at 3 T in ten patients. Due to a lack of generally accepted semiquantitative scoring systems for evaluating severity of cartilage degeneration during arthroscopy, the International Cartilage Repair Society (ICRS) classification system was used to grade the severity of cartilage lesions. qMRI parameters were statistically compared to arthroscopic grading conducted with the ICRS classification system. qMRI parameters were not li...
2012
Objective: In order to increase sensitivity to detect longitudinal change, recording of within-grade changes was introduced for cartilage morphology and bone marrow lesion (BML) assessment in semiquantitative magnetic resonance imaging (MRI) scoring of knee osteoarthritis (OA). The aim of this study was to examine the validity provided by within-grade scoring. Design: The Multicenter Osteoarthritis (MOST) study is a longitudinal study of subjects with or at risk of knee OA. Baseline and 30 months MRIs were read according to the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) system including within-grade changes for cartilage and BMLs. We tested the validity of within-grade changes by whether the 30-month changes in cartilage and BML assessment were predicted by baseline ipsi-compartmental meniscal damage and malalignment, factors known to affect cartilage loss and BMLs, using ordinal logistic regression. Results: 1867 Knees (from 1411 participants) were included. Severe medial meniscal damage predicted partial grade (adjusted odds ratio (aOR) 4.4, 95% confidence interval (95% CI) 2.2, 8.7) but not !full grade (aOR 1.3, 95% CI 0.8, 2.2) worsening of cartilage loss and predicted both, partial grade (aOR 9.6, 95% CI 3.6, 25.1) and !full grade (aOR 5.1, 95% CI 3.2, 8.2) worsening of BMLs. Severe, but not moderate, malalignment predicted ipsi-compartmental within-grade (medial cartilage damage: aOR 5.5, 95% CI 2.6, 11.6; medial worsening of BMLs: aOR 4.9, 95% CI 2.0, 12.3) but not full grade worsening of BMLs and cartilage damage. Conclusions: Within-grade changes in semiquantitative MRI assessment of cartilage and BMLs are valid and their use may increase the sensitivity of semiquantitative readings in detecting longitudinal changes in these structures.
Development of a rapid knee cartilage damage quantification method using magnetic resonance images
BMC Musculoskeletal Disorders, 2014
Background: Cartilage morphometry based on magnetic resonance images (MRIs) is an emerging outcome measure for clinical trials among patients with knee osteoarthritis (KOA). However, current methods for cartilage morphometry take many hours per knee and require extensive training on the use of the associated software. In this study we tested the feasibility, reliability, and construct validity of a novel osteoarthritis cartilage damage quantification method (Cartilage Damage Index [CDI]) that utilizes informative locations on knee MRIs. Methods: We selected 102 knee MRIs from the Osteoarthritis Initiative that represented a range of KOA structural severity (Kellgren Lawrence [KL] Grade 0 -4). We tested the intra-and inter-tester reliability of the CDI and compared the CDI scores against different measures of severity (radiographic joint space narrowing [JSN] grade, KL score, joint space width [JSW]) and static knee alignment, both cross-sectionally and longitudinally.
Osteoarthritis and Cartilage, 2003
Objectives: Although accurate spatial measurement of cartilage thickness from MRI is possible, no studies have assessed the accuracy of measuring cartilage defect dimensions from MRI. In addition, current MR grading scales for assessing cartilage lesions have limited categories, and little is known about how well these scales correlate with histological assessment of the lesion. The objective of this preliminary study is to address both these issues. Methods: We performed two experiments on four cadaver knee joints from elderly donors: Experiment 1 assessed the accuracy of measuring controlled defects in cartilage, and Experiment 2 compared MRI grading (Noyes scale) of natural cartilage lesions to histological grading (Mankin scale) of the sectioned cartilage tissue. MRI was performed on 1.5 T clinical scanner (fat-suppressed 3D-SPGR at TR/TE/α=55/ 13.5/45 and 256×256 matrix). Results: The mean difference between defect diameters measured and introduced was less than 0.1 mm, which was statistically insignificant (Pϭ0.754). Defect depth was less accurate at >0.4 mm, significantly under predicting actual defect depth (Pϭ0.004). Correlation between Noyes grading scores and Mankin grading scores of natural lesions was moderately high (rϭ0.7) and statistically significant (Pϭ0.001). Conclusions: Three-dimensional mapping of cartilage thickness shows great promise for the accurate measurement of focal cartilage defects, though improvement is needed. The Noyes grading scale is consistent with histological Mankin grading of cartilage lesions, though enhancement of MR grading scales is needed, and warranted, based on the signal intensity information available from clinical MRI. Integration of these two analyses-focal defect measurement and signal intensity analysis-could potentially result in a valuable clinical tool for early osteoarthritis diagnosis and longitudinal tracking.
Osteoarthritis and Cartilage, 2003
Objective: The aim of this study was to evaluate the reliability of a software tool that assesses knee cartilage volumes using magnetic resonance (MR) images. The objectives were to assess measurement reliability by: (1) determining the differences between readings of the same image made by the same reader 2 weeks apart (test-retest reliability), (2) determining the differences between the readings of the same image made by different readers (between-reader agreement), and (3) determining the differences between the cartilage volume readings obtained from two MR images of the same knee image acquired a few hours apart (patient positioning reliability).
Orthopaedic Journal of Sports Medicine, 2014
Background: Condition-specific questionnaires are important components in evaluation of outcomes of surgical interventions. No condition-specific study methodological quality questionnaire exists for evaluation of outcomes of articular cartilage surgery in the knee. Purpose: To develop a reliable and valid knee articular cartilage–specific study methodological quality questionnaire. Study Design: Cross-sectional study. Methods: A stepwise, a priori–designed framework was created for development of a novel questionnaire. Relevant items to the topic were identified and extracted from a recent systematic review of 194 investigations of knee articular cartilage surgery. In addition, relevant items from existing generic study methodological quality questionnaires were identified. Items for a preliminary questionnaire were generated. Redundant and irrelevant items were eliminated, and acceptable items modified. The instrument was pretested and items weighed. The instrument, the MARK score...
Arthroscopic Assessment of Cartilage Repair: A Validation Study of 2 Scoring Systems
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
Purpose: This study tested the validity and reliability of the International Cartilage Repair Society (ICRS) cartilage repair assessment and the Oswestry Arthroscopy Score (OAS), which have been designed to assess repair of articular cartilage. Type of Study: Prospective validation study of arthroscopic cartilage repair scores. Methods: Arthroscopic videos were assessed by a panel of orthopaedic surgeons specializing in cartilage repair. Scoring was repeated after a 2-month interval. Scorers also answered a questionnaire to assess the face and content validity of the scoring systems. Validity of the 2 systems was compared and reliability and repeatability were measured. Pearson's correlation coefficient was used to measure equivalence reliability. The interclass correlation coefficient (ICC) was used to assess the repeatability and inter-rater reliability of each score, and internal consistency was assessed with Cronbach's alpha. Results: Face and content validity are acceptable for both scores. There is good agreement (equivalence reliability) between the scores (Pearson's correlation coefficient, r ϭ .88; P Ͻ .001). Stability (interobserver reliability) and repeatability (test-retest reliability) are satisfactory for both scores with an ICC Ͼ0.7 for each score. Cronbach's alpha was 0.91 for ICRS and 0.82 for OAS, indicating better internal consistency for the ICRS score. Conclusions: The ICRS and OAS arthroscopic scores have been validated for the assessment of cartilage repair and both have been found to be statistically reliable and repeatable. The ICRS score does not allow for graft hypertrophy and may overscore in this situation, whereas the OAS includes assessment of graft stiffness. Both scores show satisfactory stability and repeatability. Internal consistency is adequate for both scores, although it is higher for the ICRS score. Both the ICRS and OAS arthroscopic scores are effective tools in the evaluation of cartilage repair. Level of Evidence: Level III, diagnostic study of nonconsecutive patients (no consistently applied reference gold standard).