Osteoarthritis of the Knee: Comparison of MR Imaging Findings with Radiographic Severity Measurements and Pain in Middle-aged Women

PURPOSE: To prospectively compare magnetic resonance (MR) imaging–defined abnormalities of osteoarthritis (OA) of the knee with radiographic severity measurements of OA of the knee and self-reported pain.

MATERIALS AND METHODS: This study was approved by the institutional review board of University of Michigan. Informed consent was obtained for this HIPAA-compliant study. Knee MR imaging was performed in 117 women (mean age, 46 years; range, 32–56 years) from a community-based arthritis study (n = 1053) with 30 women in each of four categories: (a) no pain and no OA of the knee, (b) no pain and OA of the knee, (c) pain and no OA of the knee, and (d) pain and OA of the knee. OA of the knee was defined from radiographs. Two hundred thirty-two eligible knees had Kellgren-Lawrence scores for OA of the knee as follows: grade 0, 115 (49.6%); grade 1, 33 (14.2%); grade 2, 66 (28.4%); grade 3, 17 (7.3%); and grade 4, one (0.4%). MR images were assessed for location and severity of defects of cartilage, bone marrow edema (BME), osteophytes, subchondral cysts, sclerosis, meniscal and/or ligamentous tears, joint effusion, synovial cysts, and synovitis. MR imaging findings were compared with radiographic severity of OA of the knee (Kellgren-Lawrence scale) and self-reported pain with analysis of variance, t tests, and contingency table analyses.

RESULTS: Defects of cartilage (higher than grade IIA) were found in 75% of knees; BME was found in 57% of knees (<1 cm, 41%; >1 cm, 16%). Large BME lesions were common in the pain and OA of the knee group (P = .001); this group was significantly more likely to have defects of cartilage (P = .001); meniscal tears (P = .001); and osteophytes, subchondral cysts, sclerosis, joint effusion, and synovitis (P < .001). Defects of cartilage, osteophytes, sclerosis, meniscal or ligamentous tears, joint effusion, and synovitis were strongly related to increasing Kellgren-Lawrence grade (P < .001).

CONCLUSION: In middle-aged women, there were significant associations between pain, radiographic severity of OA of the knee, and seven MR imaging–identified parameters.

© RSNA, 2005


  • 1 From the Centers for Disease Control and Prevention. Prevalence and impact of arthritis among women—United States, 1989–1991. JAMA 1995; 273: 1820–1821. Crossref, MedlineGoogle Scholar
  • 2 Praemer A, Furner S, Rice DP. Musculoskeletal conditions in the United States. Park Ridge, Ill: American Academy of Orthopedic Surgeons, 1992. Google Scholar
  • 3 Spector TD, Hart DJ, Huskisson EC. The use of radiographs in assessing the severity of knee osteoarthritis. J Rheumatol Suppl 1991;27:38–39. MedlineGoogle Scholar
  • 4 Altman RD. Criteria for classification of clinical osteoarthritis. J Rheumatol Suppl 1991;27:10–12. MedlineGoogle Scholar
  • 5 Brandt KD, Fife RS, Braunstein EM, Katz B. Radiographic grading of the severity of knee osteoarthritis: relation of the Kellgren and Lawrence grade to a grade based on joint space narrowing, and correlation with arthroscopic evidence of articular cartilage degeneration. Arthritis Rheum 1991;34:1381–1386. Crossref, MedlineGoogle Scholar
  • 6 Hannan MT, Felson DT, Pincus T. Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee. J Rheumatol 2000;27:1513–1517. MedlineGoogle Scholar
  • 7 Peterfy CG. Imaging of the disease process. Curr Opin Rheumatol 2002;14:590–596. Crossref, MedlineGoogle Scholar
  • 8 McAlindon TE, Watt I, McCrae F, Goddard P, Dieppe PA. Magnetic resonance imaging in osteoarthritis of the knee: correlation with radiographic and scintigraphic findings. Ann Rheum Dis 1991;50:14–19. Crossref, MedlineGoogle Scholar
  • 9 Chan WP, Lang P, Stevens MP, et al. Osteoarthritis of the knee: comparison of radiography, CT, and MR imaging to assess extent and severity. AJR Am J Roentgenol 1991;157:799–806. Crossref, MedlineGoogle Scholar
  • 10 Broderick LS, Turner DA, Renfrew DL, Schnitzer TJ, Huff JP, Harris C. Severity of articular cartilage abnormality in patients with osteoarthritis: evaluation with fast spin-echo MR vs arthroscopy. AJR Am J Roentgenol 1994;162:99–103. Crossref, MedlineGoogle Scholar
  • 11 Bergman AG, Willen HK, Lindstrand AL, Pettersson HT. Osteoarthritis of the knee: correlation of subchondral MR signal abnormalities with histopathologic and radiographic features. Skeletal Radiol 1994;23:445–448. MedlineGoogle Scholar
  • 12 Fernandez-Madrid F, Karvonen RL, Teitge RA, Miller PR, Negendank WG. MR features of osteoarthritis of the knee. Magn Reson Imaging 1994;12:703–709. Crossref, MedlineGoogle Scholar
  • 13 Drape JL, Pessis E, Auleley GR, Chevrot A, Dougados M, Ayral X. Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees. Radiology 1998;208:49–55. LinkGoogle Scholar
  • 14 Felson DT, Chaisson CE, Hill CL, et al. The association of bone marrow lesions with pain in knee osteoarthritis. Ann Intern Med 2001;134:541–549. Crossref, MedlineGoogle Scholar
  • 15 Link TM, Steinbach LS, Ghosh S, et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 2003;226:373–381. LinkGoogle Scholar
  • 16 Boegard TL, Rudling O, Petersson IF, Jonsson K. Magnetic resonance imaging of the knee in chronic knee pain: a 2-year follow-up. Osteoarthritis Cartilage 2001;9:473–480. Crossref, MedlineGoogle Scholar
  • 17 Pessis E, Drape JL, Ravaud P, Chevrot A, Dougados M, Ayral X. Assessment of progression in knee osteoarthritis: results of a 1 year study comparing arthroscopy and MRI. Osteoarthritis Cartilage 2003;11:361–369. Crossref, MedlineGoogle Scholar
  • 18 Felson DT, McLaughlin S, Goggins J, et al. Bone marrow edema and its relation to progression of knee osteoarthritis. Ann Intern Med 2003;139:330–336. Crossref, MedlineGoogle Scholar
  • 19 Peterfy CG, Guermazi A, Zaim S, et al. Whole-Organ Magn Reson Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004;12:177–190. Crossref, MedlineGoogle Scholar
  • 20 Kornaat PR, Ceulemans RY, Kroon HM, et al. MRI assessment of knee osteoarthritis: Knee Osteoarthritis Scoring System (KOSS)—inter-observer and intra-observer reproducibility of a compartment-based scoring system. Skeletal Radiol 2005;34:95–102. Crossref, MedlineGoogle Scholar
  • 21 Sowers M, Lachance L, Hochberg M, Jamadar D. Prevalence of radiographically defined osteoarthritis of the hand and knee in a population of pre- and perimenopausal women. Osteoarthritis Cartilage 2000;8:69–77. Crossref, MedlineGoogle Scholar
  • 22 Sowers MF, Hayes C, Jamadar D, et al. Magnetic resonance-detected subchondral bone marrow and cartilage defect characteristics associated with pain and x-ray-defined knee osteoarthritis. Osteoarthritis Cartilage 2003;11:387–393. Crossref, MedlineGoogle Scholar
  • 23 Kellgren JH, Lawrence JS. Epidemiology of chronic rheumatism. Philadelphia, Pa: Davis, 1963. Google Scholar
  • 24 Harned EM, Mitchell DG, Burk DL, Vinitski S, Rifkin MD. Bone marrow findings on magnetic resonance images of the knee: accentuation by fat suppression. Magn Reson Imaging 1990;8:27–31. Crossref, MedlineGoogle Scholar
  • 25 Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee: an evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am 1998;80:1276–1284. Crossref, MedlineGoogle Scholar
  • 26 Bredella MA, Tirman PF, Peterfy CG, et al. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol 1999;172:1073–1080. Crossref, MedlineGoogle Scholar
  • 27 Lal NR, Jamadar DA, Doi K, et al. Evaluation of bone contusions with fat-saturated fast spin-echo proton-density magnetic resonance imaging. Can Assoc Radiol J 2000;51:182–185. MedlineGoogle Scholar
  • 28 Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH. Accuracy of fat-suppressed three-dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology 1996;198:209–212. LinkGoogle Scholar
  • 29 Gordis L. Assessing the validity and reliability of diagnostic and screening tests. In: Gordis L, ed. Epidemiology. Philadelphia, Pa: Saunders, 1996; 63–81. Google Scholar
  • 30 Noyes FR, Stabler CL. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 1989;17:505–513. Crossref, MedlineGoogle Scholar
  • 31 Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology 2000;215:835–840. LinkGoogle Scholar
  • 32 Boegard T, Rudling O, Petersson IF, Jonsson K. Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint. Ann Rheum Dis 1998;57:401–407. Crossref, MedlineGoogle Scholar
  • 33 Tschirch FT, Schmid MR, Pfirrmann CW, Romero J, Hodler J, Zanetti M. Prevalence and size of meniscal cysts, ganglionic cysts, synovial cysts of the popliteal space, fluid-filled bursae, and other fluid collections in asymptomatic knees on MR imaging. AJR Am J Roentgenol 2003;180:1431–1436. Crossref, MedlineGoogle Scholar
  • 34 Hill CL, Gale DG, Chaisson CE, et al. Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis. J Rheumatol 2001;28:1330–1337. MedlineGoogle Scholar
  • 35 Schweitzer ME, Falk A, Pathria M, Brahme S, Hodler J, Resnick D. MR imaging of the knee: can changes in the intracapsular fat pads be used as a sign of synovial proliferation in the presence of an effusion? AJR Am J Roentgenol 1993;160:823–826. Crossref, MedlineGoogle Scholar
  • 36 Fernandez-Madrid F, Karvonen RL, Teitge RA, Miller PR, An T, Negendank WG. Synovial thickening detected by MR imaging in osteoarthritis of the knee confirmed by biopsy as synovitis. Magn Reson Imaging 1995;13:177–183. Crossref, MedlineGoogle Scholar
  • 37 Crues JV, Mink J, Levy TL, Lotysch M, Stoller DW. Meniscal tears of the knee: accuracy of MR imaging. Radiology 1987;164:445–448. LinkGoogle Scholar
  • 38 Butler WJ, Hawthorne VM, Mikkelsen WM, et al. Prevalence of radiologically defined osteoarthritis in the finger and wrist joints of adult residents, Tecumseh, Michigan, 1962–1965. J Clin Epidemiol 1988;41:467–473. Crossref, MedlineGoogle Scholar
  • 39 McAlindon TE, Snow S, Cooper C, Dieppe PA. Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 1992;51:844–849. Crossref, MedlineGoogle Scholar
  • 40 Bhattacharyya T, Gale D, Dewire P, et al. The clinical importance of meniscal tears demonstrated by magnetic resonance imaging in osteoarthritis of the knee. J Bone Joint Surg Am 2003;85-A:4–9. MedlineGoogle Scholar
  • 41 Berthiaume MJ, Raynauld JP, Martel-Pelletier J, et al. Meniscal tear and extrusion are strongly associated with progression of knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis 2005;64:556–563. Crossref, MedlineGoogle Scholar
  • 42 Burgkart R, Glaser C, Hyhlik-Durr A, Englmeier KH, Reiser M, Eckstein F. Magnetic resonance imaging-based assessment of cartilage loss in severe osteoarthritis: accuracy, precision, and diagnostic value. Arthritis Rheum 2001;44:2072–2077. Crossref, MedlineGoogle Scholar
  • 43 Raynauld JP, Kauffmann C, Beaudoin G, et al. Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees. Osteoarthritis Cartilage 2003;11:351–360. Crossref, MedlineGoogle Scholar
  • 44 Graichen H, von Eisenhart-Rothe R, Vogl T, Englmeier KH, Eckstein F. Quantitative assessment of cartilage status in osteoarthritis by quantitative magnetic resonance imaging: technical validation for use in analysis of cartilage volume and further morphologic parameters. Arthritis Rheum 2004;50:811–816. Crossref, MedlineGoogle Scholar
  • 45 Gandy SJ, Dieppe PA, Keen MC, Maciewicz RA, Watt I, Waterton JC. No loss of cartilage volume over 3 years in patients with knee osteoarthritis as assessed by magnetic resonance imaging. Osteoarthritis Cartilage 2002;10:929–937. Crossref, MedlineGoogle Scholar
  • 46 Cicuttini FM, Wluka AE, Forbes A, Wolfe R. Comparison of tibial cartilage volume and radiologic grade of the tibiofemoral joint. Arthritis Rheum 2003;48:682–688. Crossref, MedlineGoogle Scholar
  • 47 Cicuttini FM, Wang YY, Forbes A, Wluka AE, Glisson M. Comparison between patella cartilage volume and radiological assessment of the patellofemoral joint. Clin Exp Rheumatol 2003;21:321–326. MedlineGoogle Scholar
  • 48 Jones G, Ding C, Scott F, Glisson M, Cicuttini F. Early radiographic osteoarthritis is associated with substantial changes in cartilage volume and tibial bone surface area in both males and females. Osteoarthritis Cartilage 2004;12:169–174. Crossref, MedlineGoogle Scholar
  • 49 Raynauld JP, Martel-Pelletier J, Berthiaume MJ, et al. Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over 2 years and correlation with clinical symptoms and radiologic changes. Arthritis Rheum 2004;50:476–487. Crossref, MedlineGoogle Scholar
  • 50 Wluka AE, Wolfe R, Stuckey S, Cicuttini FM. How does tibial cartilage volume relate to symptoms in subjects with knee osteoarthritis? Ann Rheum Dis 2004;63:264–268. Crossref, MedlineGoogle Scholar
  • 51 Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD. The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 2001;286:188–195. Crossref, MedlineGoogle Scholar
  • 52 Adams JG, McAlindon T, Dimasi M, Carey J, Eustace S. Contribution of meniscal extrusion and cartilage loss to joint space narrowing in osteoarthritis. Clin Radiol 1999;54:502–506. Crossref, MedlineGoogle Scholar
  • 53 Gale DR, Chaisson CE, Totterman SM, Schwartz RK, Gale ME, Felson D. Meniscal subluxation: association with osteoarthritis and joint space narrowing. Osteoarthritis Cartilage 1999;7:526–532. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2005