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Perfusion in bone marrow lesions assessed on DCE-MRI and its association with pain in knee osteoarthritis: a cross-sectional study



To investigate the association between pain and perfusion in bone marrow lesions with and without cysts assessed dynamic contrast-enhanced (DCE)-MRI in patients with knee osteoarthritis.

Subjects and methods

In a cross-sectional setting, perfusion in bone marrow lesions was assessed using 3 Tesla MRI and correlated (Spearman’s rank correlation) to pain using the knee injury and osteoarthritis outcome score (KOOS). Bone marrow lesions were assessed across the whole knee with DCE-MRI using heuristic variable and non-contrast-enhanced-MRI using MRI osteoarthritis knee score.


Data were available from 107 participants. The participants had a mean age of 60.8 years, mean BMI of 34.5 kg/m2, mean KOOS-pain of 63.7 (0–100 scale), and mean bone marrow lesion sum score of 6.5 (0–45 scale). The bivariate association between KOOS-pain and the heuristic perfusion variable time to peak in bone marrow lesions containing subchondral cysts showed a statistically significant correlation (r = 0.40; p = 0.002). The perfusion variables were not correlated with KOOS-pain in bone marrow lesions without cysts.


In this cross-sectional study, the rate of perfusion (TTP) in bone marrow lesions containing subchondral cysts was associated with pain in patients with knee OA. DCE-MRI has a potential to be used for separating subtypes of OA.

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Fig. 1
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Fig. 3



Body mass index


Bone marrow lesion


Dynamic contrast-enhanced MRI


Estimated glomerular filtration rate


Initial rate of enhancement


Kellgren Lawrence grade


Knee injury and osteoarthritis outcome score


Maximum enhancement


MRI osteoarthritis knee score


Magnetic resonance imaging

non-CE MRI:

Non-contrast-enhanced MRI




Time to peak


The volume (ml) of voxels with “plateau” or “washout” patterns, i.e., the most perfused voxels


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The authors would like to thank the participants involved in the trial and the staff at the Department of Radiology, Copenhagen University Hospital Bispebjerg-Frederiksberg, Denmark for assisting with image acquisitions, as well as the Image Analysis Group (IAG), London, UK, for providing unrestricted access to use the Dynamika® platform to analyze the DCE-MRI data.


The trial was initiated by the Parker Institute and supported by Cambridge Weight Plan UK and Novo A/S. The Parker Institute is supported by a core grant from The Oak Foundation (OCAY-18-774-OFIL). None of the funders influenced the study design, collection, analysis and interpretation of data, writing, or the decision to submit the manuscript for publication.

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Correspondence to Mikael Boesen.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written and oral informed consent was obtained from each patient. The trial was initiated in November 2016 and terminated in February 2019.

Competing interests

MB is a shareholder and consultant for Image Analysis Group LTD, London, UK. The other authors declare that they have no competing interests.

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Daugaard, C.L., Riis, R.G., Bandak, E. et al. Perfusion in bone marrow lesions assessed on DCE-MRI and its association with pain in knee osteoarthritis: a cross-sectional study. Skeletal Radiol 49, 757–764 (2020).

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