title: Quadriceps intramuscular fat fraction rather than muscle size is associated with knee osteoarthritis.
abstract: OBJECTIVE
  To compare thigh muscle intramuscular fat (intraMF) fractions and area between people with and without knee radiographic osteoarthritis (ROA); and to evaluate the relationships of quadriceps adiposity and area with strength, function and knee magnetic resonance imaging (MRI) lesions.
  
  
  METHODS
  Ninety six subjects (ROA: Kellgren-Lawrence (KL) > 1; n = 30, control: KL = 0, 1; n = 66) underwent 3-T MRI of the thigh muscles using chemical shift-based water/fat MRI (fat fractions) and the knee (clinical grading). Subjects were assessed for isometric/isokinetic quadriceps/hamstrings strength, function Knee injury and Osteoarthritis Outcome Score (KOOS), stair climbing test (SCT), and 6-minute walk test (6MWT). Thigh muscle intraMF fractions, muscle area and strength, and function were compared between controls and ROA subjects, adjusting for age. Relationships between measures of muscle fat/area with strength, function, KL and lesion scores were assessed using regression and correlational analyses.
  
  
  RESULTS
  The ROA group had worse KOOS scores but SCT and 6MWT were not different. The ROA group had greater quadriceps intraMF fraction but not for other muscles. Quadriceps strength was lower in ROA group but the area was not different. Quadriceps intraMF fraction but not area predicted self-reported disability. Aging, worse KL, and cartilage and meniscus lesions were associated with higher quadriceps intraMF fraction.
  
  
  CONCLUSIONS
  Quadriceps intraMF is higher in people with knee OA and is related to symptomatic and structural severity of knee OA, whereas the quadriceps area is not. Quadriceps fat fraction from chemical shift-based water/fat MR imaging may have utility as a marker of structural and symptomatic severity of knee OA disease process.
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: Deepak.kumar@ucsf.edu.
authors.forename: D
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany. Electronic address: dimitrios.karampinos@tum.de.
authors.forename: D C
authors.initials: DC
authors.lastname: Karampinos
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: toran.macleod@ucsf.edu.
authors.forename: T D
authors.initials: TD
authors.lastname: MacLeod
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: Wilson.lin@ucsf.edu.
authors.forename: W
authors.initials: W
authors.lastname: Lin
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: Lorenzo.nardo@ucsf.edu.
authors.forename: L
authors.initials: L
authors.lastname: Nardo
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: xiaojuan.li@ucsf.edu.
authors.forename: X
authors.initials: X
authors.lastname: Li
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: Thomas.link@ucsf.edu.
authors.forename: T M
authors.initials: TM
authors.lastname: Link
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. Electronic address: sharmila.majumdar@ucsf.edu.
authors.forename: S
authors.initials: S
authors.lastname: Majumdar
authors.affiliation: Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA; Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, USA. Electronic address: Richard.souza@ucsf.edu.
authors.forename: R B
authors.initials: RB
authors.lastname: Souza
mesh_terms: D000273:Adipose Tissue / Q000473:pathology*; D050154:Adiposity / Q000502:physiology; D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology / Q000502:physiology; D002358:Cartilage, Articular / Q000503:physiopathology; D016022:Case-Control Studies; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D020370:Osteoarthritis, Knee / Q000473:pathology* / Q000503:physiopathology; D052097:Quadriceps Muscle / Q000473:pathology* / Q000503:physiopathology; D012720:Severity of Illness Index; D013710:Tendons / Q000503:physiopathology; D013848:Thigh / Q000473:pathology
keywords: Cartilage; Hamstrings; Quadriceps strength; Water/fat imaging