Differences between X-ray and MRI-determined knee cartilage thickness in weight- bearing and non-weight-bearing conditions M. Marsh, R.B. Souza, B.T.

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Differences between X-ray and MRI-determined knee cartilage thickness in weight- bearing and non-weight-bearing conditions M. Marsh, R.B. Souza, B.T. Wyman, M.-P. Hellio Le Graverand, K. Subburaj, T.M. Link, S. Majumdar Osteoarthritis and Cartilage Volume 21, Issue 12, Pages 1876-1885 (December 2013) DOI: 10.1016/j.joca.2013.09.006 Copyright © 2013 Terms and Conditions

Fig. 1 Schematic representation of the custom-made MR compatible device used to load knee joint during scanning. Right: first scan is acquired with no loading on leg. Left: weight applied to the device outside the scanner is transferred through pulleys to the foot plate, simulating standing, and the second scan is acquired. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 2 Joint space width splines (magenta and blue) and mJSW (red), indicated by arrow. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 3 The short spline marks the location of the medial spine of the tibia (magenta). The location of the mJSW is represented by the red line; the distance between these two points was measured to find the distance from the medial spine of the tibia to the location of the mJSW. The long spline was drawn across the width of the tibia and its length was used to normalize the change in the mJSW location from unloaded to loaded. mJSW_loc_diff was expressed as [(Distprone − Diststanding)/Width]*100%. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 4 Segmentation of MRI images (one slice shown), delineating the cartilages of the medial femoral condyle and the medial tibial plateau. The thickness was calculated for each segmentation at each point along the spline at the articular surface. Thicknesses for all slices yielded a mean thickness of the medial tibial cartilage and a mean thickness of the cartilage of the medial femoral cartilage, which were added together to get meMFT_th. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 5 The normalized absolute mJSW_loc_diff separated according to whether the subject was a control or an OA patient. The diamonds represent mean values. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 6 mJSW and MFT_th values plotted against one another. There was a strong correlation between X-ray and MRI measures of joint space when both were loaded (blue points). The r-value was lower when the X-ray was loaded and the MRI was unloaded (red points), but not by a statistically meaningful amount. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 7 Bland–Altman plots of loaded vs unloaded values for (a) meMFT_th, (b) mJSW, and (c) mMFT_dist. All plots show the negative bias that is to be expected given that the unloaded values are consistently higher. Additionally, the variance for meMFT_th is clearly smaller than that for mJSW or mMFT_dist. Note that the y-axis scale is different for mMFT_dist than for the others because of some very negative outliers. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 8 Bland–Altman plots of mJSW absolute difference compared with (a) mMFT_dist absolute difference and (b) meMFT_th absolute difference. The 95% CI for the mean difference in Fig. 8(a) is −0.044 to 0.452 mm, and for the mean difference in Fig. 8(b) is −0.138 to 0.168 mm. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions

Fig. 9 Bland–Altman plots of loaded mJSW compared with (a) unloaded meMFT_th with a 95% CI of 0.208–0.717, (b) loaded meMFT_th with a 95% CI of 0.368–0.820, (c) unloaded mMFT_dist, with a 95% CI of −0.228 to 0.246, and (d) loaded mMFT_dist with a 95% CI of 0.099–0.589. Note the proportional bias present especially in plots (a) and (b), which is likely due to the fact that mJSW is much larger than meMFT_th. Osteoarthritis and Cartilage 2013 21, 1876-1885DOI: (10.1016/j.joca.2013.09.006) Copyright © 2013 Terms and Conditions