The Journal of Bone and Joint Surgery (American). 2009;91:54-62.
doi:10.2106/JBJS.H.01385
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Plain Radiography and Magnetic Resonance Imaging Diagnostics in Osteoarthritis: Validated Staging and Scoring

Ali Guermazi, MD1, David J. Hunter, MD, PhD2 and Frank W. Roemer, MD1

1 Section of Musculoskeletal Imaging, Department of Radiology, Boston Medical Center, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA 02118. E-mail address for A. Guermazi: guermazi{at}bu.edu
2 Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA 02120

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Osteoarthritis is the most common joint disorder worldwide, and it has an enormous socioeconomic impact both in the United States and throughout the world. Conventional radiography is the simplest and least expensive imaging method for assessing osteoarthritis of the knee. Radiography is able to directly visualize osseous features of osteoarthritis, including marginal osteophytes, subchondral sclerosis, and subchondral cysts, and it is used in clinical practice to confirm the diagnosis of osteoarthritis and to monitor progression of the disease. However, the assessment of joint-space width provides only an indirect estimate of cartilage thickness and meniscal integrity. Magnetic resonance imaging, with its unique ability to examine the joint as a whole organ, holds great promise with regard to the rapid advancement of knowledge about the disease and the evaluation of novel treatment approaches. Magnetic resonance imaging has been applied widely in quantitative morphometric cartilage assessment, and compositional measures have been introduced that evaluate chondral integrity. In addition, magnetic resonance imaging-based validated semiquantitative whole-organ scoring methods have been applied for cross-sectional and longitudinal joint evaluation. This review describes currently applied radiographic and magnetic resonance imaging staging and scoring methods for the assessment of osteoarthritis of the knee and focuses on the strengths and weaknesses of the two modalities with regard to their use in clinical trials and epidemiologic studies.


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