title: Considerations in measuring cartilage thickness using MRI: factors influencing reproducibility and accuracy.
abstract: OBJECTIVE
  The primary goal of this study was to describe and evaluate conditions that could influence the precision and accuracy of measuring in vivo cartilage thickness in the weight bearing regions of the knee from magnetic resonance imaging (MRI).
  
  
  METHODS
  Three-dimensional (3D) models of the femoral cartilage were created from segmented MR images. The weight bearing regions on femoral cartilage were selected for the portion of the tibiofemoral joint that sustains contact during walking. Six regions of interest (three on each condyle) were located on the femur. Average cartilage thickness was calculated over each region. The sensitivity of the precision of the measurements to observer variability was evaluated using intra- and inter-observer reproducibility tests of cartilage thickness measurements from the MRI-derived 3D models. In addition, the quantitative influence of a rule-based protocol for segmentation was evaluated using the inter-observer reproducibility protocol. Accuracy tests were conducted on porcine knees by comparing 3D models from MR images and laser scans across weight bearing and non-weight bearing regions.
  
  
  RESULTS
  The precision was substantially better for the intra-observer tests (Coefficient of variation (CV) = 1-3%) than the inter-observer tests. Adding a rule-based protocol reduced variability in inter-observer tests substantially (CV = 6.6% vs 8.3%). Accuracy tests showed that the central and weight bearing regions on each condyle were more accurate than boundary and non-weight bearing regions. In addition, these results indicate that care should be taken when determining cartilage thickness of weight bearing regions with cartilage degenerations, since the thickness of thinner cartilage can be systematically overestimated in MR images.
  
  
  CONCLUSIONS
  A rule-based approach can substantially increase inter-observer reproducibility when measuring cartilage thickness from multiple observers. This improvement in inter-observer reproducibility could be an important consideration for longitudinal studies of disease progression. In quantifying cartilage thickness, central and weight bearing regions on each condyle can provide more accurate measurement than boundary and non-weight bearing regions with average accuracy of +/-0.2-0.3 mm. An important finding of this study was that the weight bearing regions, which are usually of the greatest clinical interest, were measured most accurately by sagittal plane imaging.
authors.affiliation: Biomechanical Engineering, Department of Mechanical Engineering, Stanford University, Stanford, CA, USA. skoo@stanford.edu
authors.forename: S
authors.initials: S
authors.lastname: Koo
authors.forename: G E
authors.initials: GE
authors.lastname: Gold
authors.forename: T P
authors.initials: TP
authors.lastname: Andriacchi
mesh_terms: D002358:Cartilage, Articular / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016138:Walking; D016474:Weight-Bearing