title: Development of a rapid knee cartilage damage quantification method using magnetic resonance images.
abstract: 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.
  
  
  RESULTS
  Determination of the CDI took on average14.4 minutes (s.d. 2.1) per knee pair (baseline and follow-up of one knee). Repeatability was good (intra- and inter-tester reliability: intraclass correlation coefficient >0.86). The mean CDI scores related to all four measures of osteoarthritis severity (JSN grade, KL score, JSW, and knee alignment; all p values < 0.05). Baseline JSN grade and knee alignment also predicted subsequent 24-month longitudinal change in the CDI (p trends <0.05). During 24 months, knees with worsening in JSN or KL grade (i.e. progressors) had greater change in CDI score.
  
  
  CONCLUSIONS
  The CDI is a novel knee cartilage quantification method that is rapid, reliable, and has construct validity for assessment of medial tibiofemoral osteoarthritis structural severity and its progression. It has the potential to addresses the barriers inherent to studies requiring assessment of cartilage damage on large numbers of knees, and as a biomarker for knee osteoarthritis progression.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Driban
authors.forename: Lori Lyn
authors.initials: LL
authors.lastname: Price
authors.forename: Daniel
authors.initials: D
authors.lastname: Harper
authors.forename: Grace H
authors.initials: GH
authors.lastname: Lo
authors.forename: Eric
authors.initials: E
authors.lastname: Miller
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ward
authors.affiliation: Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111, USA. tmcalindon@tuftsmedicalcenter.org.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: McAlindon
mesh_terms: D000368:Aged; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results; D012720:Severity of Illness Index
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