Research Article|Articles in Press

MRI underestimates presence and size of knee osteophytes using CT as a reference standard

  • F.W. Roemer
    Address correspondence and reprint requests to: F.W. Roemer, Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA 02118, USA. Tel: 1-617-414-4954; Fax: 1-617-638-6616.
    Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 4th Floor, Boston, MA 02118, USA

    Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054 Erlangen, Germany
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  • K. Engelke
    Department of Rheumatology & Immunology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Ulmenweg 19, 91054 Erlangen, Germany

    Institute of Medical Physics, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Henkestr. 91, 91052 Erlangen, Germany
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  • L. Li
    Pfizer, Inc., New York, NY, USA
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  • Author Footnotes
    a Shared last authorship.
    J.-D. Laredo
    a Shared last authorship.
    Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière & B3OA, UMR CNRS 7052, Inserm U1271 Université de Paris, Paris, France
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  • Author Footnotes
    a Shared last authorship.
    A. Guermazi
    a Shared last authorship.
    Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 4th Floor, Boston, MA 02118, USA

    Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132, USA
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  • Author Footnotes
    a Shared last authorship.
Published:February 14, 2023DOI:



      To explore the diagnostic performance of routine magnetic resonance imaging (MRI) for the cross-sectional assessment of osteophytes (OPs) in all three knee compartments using computed tomography (CT) as a reference standard.


      The Strontium Ranelate Efficacy in Knee Osteoarthritis (SEKOIA) trial explored the effect of 3 years of treatment with strontium ranelate in patients with primary knee OA. OPs were scored for the baseline visit only using a modified MRI Osteoarthritis Knee Score (MOAKS) scoring system in the patellofemoral (PFJ), the medial tibiofemoral (TFJ) and the lateral TFJ. Size was assessed from 0 to 3 in 18 locations. Descriptive statistics were used to describe differences in ordinal grading between CT and MRI. In addition, weighted-kappa statistics were employed to assess agreement between scoring using the two methods. Sensitivity, specificity, positive predictive value and negative predictive value as well as area under the curve (AUC) measures of diagnostic performance were employed using CT as the reference standard.


      Included were 74 patients with available MRI and CT data. Mean age was 62.9 ± 7.5 years. Altogether 1,332 locations were evaluated. For the PFJ, MRI detected 141 (72%) of 197 CT-defined OPs with a w-kappa of 0.58 (95% CI [0.52–0.65]). In the medial TFJ, MRI detected 178 (81%) of 219 CT-OPs with a w-kappa of 0.58 (95% CI [0.51–0.64]). For the lateral compartment these numbers were 84 (70%) of 120 CT-OPs with a w-kappa of 0.58 (95% CI [0.50–0.66]).


      MRI underestimates presence of osteophytes in all three knee compartments. CT may be helpful particularly regarding assessment of small osteophytes particularly in early disease.


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