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Abstract
Objective. To determine the diagnostic performance of standing computerized tomography (SCT) of the knee for osteophytes and subchondral cysts compared with fixed-flexion radiography, using MRI as the reference standard. Methods. Twenty participants were recruited from the Multicenter Osteoarthritis Study. Participants’ knees were imaged with SCT while standing in a knee-positioning frame, and with postero-anterior fixed-flexion radiography and 1T MRI. Medial and lateral marginal osteophytes and subchondral cysts were scored on bilateral radiographs and coronal SCT images using the OARSI grading system and on coronal MRI using Whole Organ MRI Scoring. Imaging modalities were read separately with images in random order. Sensitivity, specificity and accuracy for the detection of lesions were calculated and differences between modalities were tested using McNemar’s test. Results.Participants’ mean age was 66.8 years, body mass index was 29.6 kg/m2 and 50% were women. Of the 160 surfaces (medial and lateral femur and tibia for 40 knees), MRI revealed 84 osteophytes and 10 subchondral cysts. In comparison with osteophytes and subchondral cysts detected by MRI, SCT was significantly more sensitive (93 and 100%; p < 0.004) and accurate (95 and 99%; p < 0.001 for osteophytes) than plain radiographs (sensitivity 60 and 10% and accuracy 79 and 94%, respectively). For osteophytes, differences in sensitivity and accuracy were greatest at the medial femur (p = 0.002). Conclusions. In comparison with MRI, SCT imaging was more sensitive and accurate for detection of osteophytes and subchondral cysts than conventional fixed-flexion radiography. Additional study is warranted to assess diagnostic performance of SCT measures of joint space width, progression of OA features and the patellofemoral joint.
Acknowledgements
The authors thank the participants of the Multicenter Osteoarthritis Study (MOST) who volunteered their time as well as Tricia Feldick and Natalie Glass for essential assistance with recruitment and data collection. The MOST study was funded by the National Institutes of Health through the National Institute on Aging: Felson (Boston University) – AG18820, Lewis (University of Alabama at Birmingham – AG18947, Torner (University of Iowa) – AG18832 and Nevitt (University of California at San Francisco) – AG19069.
Declaration of interests
All authors report grants from National Institute on Aging. In addition, NA Segal: editorial honoraria for CME publications (Springer SMB LLC); A Guermazi: President and co-owner of the Boston Core Imaging Lab (BICL), a company providing MRI reading services to academic researchers and to industry and provides consulting services to Genzyme. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.