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Clinical studies related to bone strength and density. Gene discovery and high throughput technologies. Gene-environment interactions. Contact Us Xincheng Zheng, M. More than half of the studies assessed joint regions or counted the number of total defects noted rather than numbers of total joints or numbers of patients. Due to the number of existing studies fulfilling the inclusion criteria found in our search and their differing approaches, the conclusions we can draw about detailed aspects of OA diagnosis have limitations.

In current clinical practice, diagnostic needs which MRI could theoretically fill are in differential diagnosis e. As this review is focused on studies comparing the diagnostic performance of MRI in detecting OA with other standards of reference, the studies included do not address the question of an expanded differential diagnosis nor creating subcategories of OA.

Reichenbach et al. However, this was only one study and not enough to draw larger conclusions from about pre-OA diagnosis. An important step in developing disease-modifying treatments is to create clear and validated classification criteria for the diagnosis of a pre-OA state.

Pre-OA is defined as the state before clinical symptoms, or conventional radiologic markers of OA appear, but in a patient who will progress to fully developed OA. Clearly such a state cannot be defined with current diagnostic definitions of OA, but can only be detected with newer markers, radiologic, histologic, or otherwise.

Possible evidence of this state has already been found histologically. These markers, which may or may not seem useful currently, could then be measured for diagnostic usefulness against a clinical endpoint years later, such as total knee arthroplasty. Those markers which demonstrate better predictive validity could potentiate a new, MRI-based definition of pre-OA in the future. The capability to designate patients as pre-OA and likewise to follow pre-OA disease activity, would allow testing of disease modifying therapies in this earlier, and hopefully more easily-altered, stage of the disease.

This analysis found that MRI has some potential as a non-invasive method of visualizing OA when compared with standard radiograph, histology, gross dissection and other techniques. However, with an overall sensitivity below that of clinical and radiographic diagnosis and with these more cost-effective diagnostic tools currently used in the clinic there would seem to be no indication for using MRI in routine clinical diagnosis at this time. Given the current lack of disease-modifying therapeutic options available for treating OA and the lack of validated classification criteria for diagnosing early OA, MRI should not be used in a clinical setting for diagnosis of OA.

We recognize the invaluable support of Valorie Thompson for administrative and editorial support and OARSI for their invaluable support of this activity.

We would also like to recognize the invaluable support of Kelly Hirko and Leo Menashe who assisted with the systematic review. David Hunter receives research support from Australian Research Council.

Conflict of interest statement The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Contributions DJH conceived and designed the study, drafted the manuscript and takes responsibility for the integrity of the work as a whole, from inception to finished article. EL and WZ were also involved in the design of the study. All authors contributed to acquisition of the data. All authors critically revised the manuscript and gave final approval of the article for submission. National Center for Biotechnology Information , U. Osteoarthritis Cartilage. Author manuscript; available in PMC Feb Hunter 2, 6.

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David J. Find articles by David J. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Osteoarthritis Cartilage. See other articles in PMC that cite the published article. Abstract Objective Osteoarthritis OA is currently diagnosed using clinical and radiographic findings. Methods A systematic literature search was undertaken to include studies that used MRI to evaluate or detect osteoarthritis.

Results Of 20 relevant studies identified from the literature, 16 reported complete data and were included in the meta-analysis, with a total of patients with OA and without. Conclusion MRI can detect OA with an overall high specificity and moderate sensitivity when compared with various reference standards, thus lending more utility to ruling out OA than ruling it in. Keywords: Osteoarthritis, diagnosis, MRI. Introduction Osteoarthritis OA is a disease of the synovial joint tissues in which there is destruction of synovial joint tissues and active, but ineffective attempts at repair.

Methods 1. Data abstraction Of the preliminary abstracts, were selected for data abstraction of which 22 were pertinent to diagnostic performance Figure 1.

Open in a separate window. Figure 1. Flow chart of the screening process for articles included in the systematic review. Assessment of study quality Quality and bias assessment of the studies was performed using the Downs Methodological Study Criteria. Outcome measures The focus of this analysis was on diagnostic performance. Results We identified 20 studies which met our inclusion criteria and contained relevant diagnostic measure and performance data.

Table 1 Study attributes and population characteristics. Table 2 Measurement used and tissue type imaged by MRI in all 20 studies. Table 3 Reference standard used for MRI technique comparison and synovial joint tissue assessed: number of individual datasets and studies including all 20 studies.

Figure 2. Figure 3. Figure 4. Table 4 Random effects model for all tissue types and all reference standards in the 16 studies with complete data: DerSimonian-Laird.

Figure 5. Funnel plot of sensitivity in the 16 studies with complete data. Figure 6. Funnel plot of specificity in the 16 studies with complete data. Table 5 Random effects model of diagnostic data for all tissue types, using histology as the reference standard 5 datasets from 4 studies : DerSimonian-Laird.

Table 6 Random effects model of diagnostic data for all tissue types, using x-ray as the reference standard 6 datasets from 3 studies : DerSimonian-Laird. Table 7 Random effects model of diagnostic data for all tissue types, using arthroscopy as the reference standard 11 datasets from 7 studies : DerSimonian-Laird.

Discussion This study examines the diagnostic performance of MRI in OA compared with other clinical and research reference standards for viewing synovial joint structural change. Acknowledgements We recognize the invaluable support of Valorie Thompson for administrative and editorial support and OARSI for their invaluable support of this activity. Footnotes Conflict of interest statement The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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