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Morphological MRI of knee cartilage: repeatability and reproducibility of damage evaluation and correlation with gross pathology examination

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess the performance of a morphological evaluation, based on a clinically relevant magnetic resonance imaging (MRI) protocol, in scoring the severity of knee cartilage damage. Specifically, to evaluate the reproducibility, repeatability, and agreement of MRI evaluation with the gross pathology examination (GPE) of the tissue.

Methods

MRI of the knee was performed the day before surgery in 23 patients undergoing total knee arthroplasty. Osteochondral tissue resections were collected and chondral defects were scored by GPE according to a semi-quantitative scale. MR images were independently scored by four radiologists, who assessed the severity of chondral damage according to equivalent criteria. Inter- and intra-rater agreements of MRI evaluations were assessed. Correlation, precision, and accuracy metrics between MRI and GPE scores were calculated.

Results

Moderate to substantial inter-rater agreement in scoring cartilage damage by MRI was found among radiologists. Intra-rater agreement was higher than 96%. A significant positive monotonic correlation between GPE and MRI scores was observed for all radiologists, although higher correlation values were obtained by radiologists with expertise in musculoskeletal radiology and/or longer experience. The accuracy of MRI scores displayed a spatial pattern, characterized by lesion overestimation in the lateral condyle and underestimation in the medial condyle with respect to GPE.

Conclusions

Evaluation of knee cartilage morphology by MRI is a reproducible and repeatable technique, which positively correlates with GPE. Clinical expertise in musculoskeletal radiology positively impacts the evaluation reliability. These findings may help to address limitations in MRI evaluation of knee chondral lesions, thus improving MRI assessment of knee cartilage.

Key Points

• MRI evaluation of knee cartilage shows moderate to strong correlation with gross pathology examination.

• MRI evaluation overestimates cartilage damage in the lateral condyle and underestimates it in the medial condyle.

• Education and experience of the radiologist play a role in MRI evaluation of knee chondral lesions.

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Abbreviations

3D:

Three-dimensional

AD:

Absolute difference

FSE:

Fast spin echo

GPE:

Gross pathology examination

MR:

Magnetic resonance

MRI:

Magnetic resonance imaging

RD:

Relative difference

TKA:

Total knee arthroplasty

TRUFI 3D:

Three-dimensional true fast imaging with steady-state free precession

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Acknowledgments

The authors are grateful to the technical staff of the Division of Diagnostic Radiology at Rovereto Hospital for assistance in collecting MR data.

Funding

The study has been supported in part by the Healthcare Research and Innovation Program (IRCS) of the Autonomous Province of Trento (Healthcare Research and Innovation Program IRCS-HTA 2016) and by the Fondazione Cassa di Risparmio di Trento e Rovereto (EviVa project, 2011).

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Author notes

  1. Alessandro Marinetti and Francesco Tessarolo contributed equally to this work.

Authors and Affiliations

  1. Division of Diagnostic Radiology, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy

    Alessandro Marinetti, Luisa Ventura, Andrea Falzone, Marinella Neri & Sabino Walter Della Sala

  2. Department of Industrial Engineering, University of Trento, via delle Regole, 101, I-38123, Mattarello, Trento, Italy

    Francesco Tessarolo, Marta Rigoni & Giandomenico Nollo

  3. Healthcare Research and Innovation Program (IRCS-FBK-PAT), Bruno Kessler Foundation, Trento, Italy

    Francesco Tessarolo, Marta Rigoni, Michela Masè & Giandomenico Nollo

  4. Department of Laboratory Medicine, Azienda Provinciale per i Servizi Sanitari, Trento, Italy

    Federico Piccoli

  5. Division of Orthopaedics and Traumatology, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari, Trento, Italy

    Fabrizio Cortese

Authors
  1. Alessandro Marinetti
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Correspondence to Francesco Tessarolo.

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The scientific guarantor of this publication is Dr. Sabino Walter Della Sala.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (MR) has significant statistical expertise (got a PhD in biomedical statistics).

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Written informed consent was obtained from all subjects in this study.

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Marinetti, A., Tessarolo, F., Ventura, L. et al. Morphological MRI of knee cartilage: repeatability and reproducibility of damage evaluation and correlation with gross pathology examination. Eur Radiol 30, 3226–3235 (2020). https://doi.org/10.1007/s00330-019-06627-5

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