Professor of Radiology University of Wisconsin School of Medicine and Public Health Madison, Wisconsin, USA

1. Richard Kijowski, MD
Osteoarthritis Imaging:
2018 Year in Review
Professor of Radiology
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, USA

2. Disclosure Statement
Speaker Name: Richard Kijowski. M.D.
Research Support Provided by GE Healthcare
Consultant for Boston Imaging Core Lab
No Discussion of Off-Label or Investigational Devices

3. Literature Search
Pubmed Database Used to Search for All Articles
Published Between April 1, 2018 and March 31, 2019

4. Literature Search
Pubmed Database Search Terms
“Osteoarthritis”, “OA”
“Radiography”, “X-Rays”, “Magnetic Resonance Imaging”, “MRI”,
“Ultrasound”, “US”, “Computed Tomography”, “Dual Energy X-Ray
Absorptiometry”, “DEXA”, “CT”, “Nuclear Medicine”, “Scintigraphy”,
“Single-Photon Emission Computed Tomography”, “SPECT”,
“Positron Emission Tomography, “PET”, “PET-CT”, “PET-MRI”

5. Published OA Imaging Articles
1257 Articles Identified from Pubmed Search
256 Articles Deemed Relevant to OA Imaging

6. Published OA Imaging Articles
Imaging Modality Number of Articles Proportion
Conventional MRI 164 64.6%
Compositional MRI 31 12.2%
Ultrasound 16 6.3%
Radiographs 14 5.5%
CT 14 5.5%
PET 9 3.5%
DEXA 6 2.4%
Imaging Modality

7. Published OA Imaging Articles
Joint Imaged Number of Articles Proportion
Knee 223 87.8%
Hip 18 7.1%
Hand 7 2.8%
Spine 3 1.2%
Shoulder 2 0.8%
Elbow 1 0.4%
Joint Imaged

8. Knee OA Versus Normal Aging

9. • Changes in knee degeneration on X-ray and MRI over 96
months investigated in 244 subjects from OAI without knee OA
– Increasing moderate prevalence of MRI defined OA and
increasing low prevalence of X-ray defined OA over time
– Modest overlap between X-ray and MRI defined OA and knee
pain, especially in subjects without OA risk factors
Knee OA Versus Normal Aging
Magnuson, et al. Osteoarthritis Cartilage. 26(11):1447, 2018

10. “Structural Changes Without Associated Symptoms Should
Probably Not be Considered OA Per Se But Rather as Risks
Factors for Developing Clinically-Relevant Disease”
Knee OA Versus Normal Aging
Magnuson, et al. Osteoarthritis Cartilage. 26(11):1447, 2018

11. Prediction of Knee OA Progression

12. • Medial TF cartilage loss on MRI over 24 months in 1014
subjects from OAI classified as stable, moderate, and substantial
– WOMAC pain scores, family history of TKA, obesity, radiographic
medial JSN, and less than 1 year pain duration associated with
moderate and substantial cartilage loss over time
Prediction of Knee OA Progression
Deveza, et al. Osteoarthritis Cartilage. 27(2):257, 2019

13. • TF cartilage loss on MRI over 24 months compared between
150 KL-0 knees with contralateral KL-0 knees and 678 KL-0
knees with contralateral KL>2 knees from OAI
– KL-0 knees with contralateral KL-3 or KL-4 knees had greater
cartilage loss over time than KL-0 knees with contralateral KL-0
or KL-2 knees
Prediction of Knee OA Progression
Eckstein, et al. Osteoarthritis Cartilage. 27(2):273, 2019

14. • Varus and Valgus Malalignment on X-Rays
Macri, et al. Osteoarthritis Cartilage. 27(3):459, 2019
• Effusion and Synovitis on MRI
Wang, et al. Rheumatology. 1(58):246, 2019
McFarlane, et al. Arthritis Rheumatology. 71(1):73, 2019
Heilmeier, et al. Skeletal Radiology. 48(1):89, 2019
Prediction of Knee OA Progression
Risk Factors for Tibia-Femoral OA Progression

15. • Mucinous Changes in ACL on MRI
Kwee, et al. Radiology. 287(3):912, 2018
• Bone Marrow Edema Lesions on MRI
Heilmeier, et al. Skeletal Radiology. 48(1):89, 2019
• Higher Cartilage T2 Values on MRI
Heilmeier, et al. Skeletal Radiology. 48(1):89, 2019
Prediction of Knee OA Progression
Risk Factors for Tibia-Femoral OA Progression

16. • Trabecular Microstructure Deterioration on MRI
Lo, et al. Seminars Arthritis Rheumatology. 48(2):155, 2018
• Decreased Bone Mineral Density on DEXA
Lo, et al. Seminars Arthritis Rheumatology. 48(2):155, 2018
• Increased Thigh Muscle Fat on MRI
Kemnitz, et al. Osteoarthritis Cartilage. 26(9):1190, 2018
Prediction of Knee OA Progression
Risk Factors for Tibia-Femoral OA Progression

17. • Meniscus Tear and Extrusion on MRI
Hart, et al. Osteoarthritis Cartilage. 26(7):912, 2018
• Patella Alta on MRI
Culvenor, et al. Arthritis Care Research. Epub Ahead of Print
• Increased Tibia Tuberosity to Trochlea Distance on MRI
Haj-Mirzaian, et al. European Radiology. 28(11):4669, 2018
• Superolateral Hoffa’s Fat Pad Edema on MRI
Haj-Mirzaian, et al. European Radiology. 28(10):4134, 2018
Prediction of Knee OA Progression
Risk Factors for Patellar-Femoral OA Progression

18. Physical Activity and Knee OA

19. Physical Activity and Knee OA
Halilai, et al. Osteoarthritis Cartilage. 26(6):1517, 2018
• Changes in TF cartilage T2 over 48 months correlated
with physical activity levels assessed using accelerometer
in 19 male subjects without knee OA from OAI
– High correlation (r=0.82) between time spent in different
activity intensity ranges and regional cartilage T2 changes
– Higher levels of sedentary time and vigorous activity but
NOT higher levels of light activity associated with greater
medial-lateral differences in cartilage T2 changes

20. Obesity and Knee OA

21. • Changes in knee degeneration on MRI over 12 months
investigated in 75 obese subjects with substantial weight loss
– No difference in changes in cartilage thickness, bone marrow
edema lesions, cartilage defects, and synovitis over time
between subjects with and without more than 20% weight loss
Obesity and Knee OA
Jafarzadeh, et al. Osteoarthritis Cartilage. 26(6):775, 2018

22. • Changes in knee cartilage T2 on MRI over 96 months
compared between 380 obese subjects with stable weight
and 380 obese subjects with weight loss from OAI
– Weight loss due to diet alone and diet and exercise but NOT
weight loss due to exercise alone associated with slower
increase in cartilage T2 over time compared to no weight loss
Obesity and Knee OA
Gersing, et al. Osteoarthritis Cartilage. Epub Ahead of Print, 2019

23. • Changes in knee degeneration on MRI over 96 months
compared between 260 overweight or obese women without
knee OA with stable weight, 43 women with weight gain, and
44 women with weight loss from PROOF study
– Women with weight gain showed greater progression of
synovitis, PF cartilage defects, and PF bone marrow edema
lesions over time compared to women with stable weight
Obesity and Knee OA
Landsmeer, et al. Osteoarthritis Cartilage. Epub Ahead of Print, 2019

24. Diabetes and Knee OA

25. • Changes in knee cartilage T2 on MRI over 24 months
compared between 196 subjects with diabetes and 196
matched control subjects without diabetes from OAI
– Diabetic subjects showed greater increases in mean
cartilage T2 in all subsections of TF joint over time
compared to non-diabetic subjects
Diabetes and Knee OA
Neumann, et al. Osteoarthritis Cartilage. 26(6):751, 2018

26. Hoffa’s Fat Pad and Knee OA

27. • Increased Fat Pad Signal Associated with Knee OA Incidence
Wang, et al. Arthritis Care Research. 71(1):30, 2019
• Increased Fat Pad Signal Associated with Knee OA Progression
Han, et al. Arthritis Care Research. Epub Ahead of Print, 2018
• Increased Fat Pad Signal Associated with Accelerated Knee OA
Davis, et al. Rheumatology. Epub Ahead of Print, 2018
• Increased Fat Pad Signal Associated with Knee Replacement
Wang, et al. Osteoarthritis Cartilage. 26(10):1345, 2018
• No Association Between Fat Pad Volume and Knee Pain
Steidle-Kloc, et al. Arthritis Care Research. 70(4):550, 2018
Hoffa’s Fat Pad and Knee OA

28. Hand OA

29. • Morphological differences between 22 healthy subjects and
47 subjects with early first CMC OA investigated using
statistical shape modeling of CT images
– Characteristic findings of first CMC OA included…
• Protrusions at volar beak of first metacarpal
• Widening and deepening of articular surface
• Protruding bone growth along concave joint margins
Hand OA
Schneider, et al. Osteoarthritis Cartilage. 26(10):1338, 2018

30. • Structural features on MRI correlated with clinical symptoms
in 202 subjects with first CMC OA from HOSTAS study
– Synovitis, bone marrow edema lesions, and osteophytes
present in 25%, 43%, and 65% of subjects
– Osteophytes more strongly correlated with pain than
inflammatory features
Hand OA
Kroon, et al. Osteoarthritis Cartilage. 25(9):1196, 2018

31. Bone Shape and Knee OA

32. • Changes in femur and tibia morphology using statistical shape
modeling and bone marrow edema lesions on MRI over 24
months investigated in 600 subjects from OAI
– Bone shape vector (deviation from normal shape) showed more
responsiveness to change than bone marrow edema lesions
– Presence of bone marrow edema lesion associated with higher
bone shape vector for femur and tibia at baseline
– Increase in bone marrow edema lesion size associated with
increase in bone shape vector for femur over time
Bone Shape and Knee OA
Dube, et al. Osteoarthritis Cartilage. 26(10):1333, 2018

33. Deep Learning in Knee OA

34. • Segmentation of Bone and Cartilage on MRI
Liu, et al. Magnetic Resonance Medicine. 79(4):2379, 2018
Norman, et al. Radiology. 288(1):177, 2018
Ambellan, et al. Medical Imaging Analysis. 52(2):109, 2019
• Segmentation of Meniscus on MRI
Tack, et al. Osteoarthritis Cartilage. 26(5):680, 2018
Norman, et al. Radiology. 288(1):177, 2018
• Segmentation of All Knee Joint Structures on MRI
Zhou, et al. Magnetic Resonance Medicine. 80(6):2759, 2018
Deep Learning in Knee OA
Fully-Automated Segmentation of Knee Structures

35. • Grading Osteoarthritis Severity on X-Rays
Tiulipin, et al. Scientific Reports. 29(8):1727, 2018
Norman, et al. Journal Digital Imaging. Epub Ahead of Print, 2018
• Detecting Cartilage Lesions on MRI
Liu, et al. Radiology. 289(1):160, 2018
Pedoia, et al. Journal Magnetic Resonance Imaging. 49(2):400, 2019
• Detecting Meniscus Tears on MRI
Pedoia, et al. Journal Magnetic Resonance Imaging. 49(2):400, 2019
Bien, et al. PLOS Medicine. 15(11):e1002699, 2018
Deep Learning in Knee OA
Fully-Automated Detection of Features of Knee Degeneration

36. Thank
You!!
VGG16