Research progress on semi-quantitative MRI assessment of knee osteoarthritis

doi:10.3877/cma.j.issn.1674-134X.2024.04.015

Abstract

Abstract:

Semi-quantitative magnetic resonance imaging (MRI) assessment forms a key part of MRI imaging evaluation of knee osteoarthritis (KOA). Several generalized knee scoring systems have been developed, including the Whole Organ Magnetic Resonance Imaging Score (WORMS) and the MRI Osteoarthritis Knee Score (MOAKS), and systems for synovitis or specific conditions. Observational studies and clinical trials have shown that semi-quantitative MRI assessment contributes to the understanding of the natural history of disease and plays an increasing role in early diagnosis, efficacy assessment, eligibility screening and safety evaluation. Artificial intelligence can further improve its performance in the fields of image processing, phenotypic categorization, and risk prediction.

Key words: Osteoarthritis, knee, Magnetic resonance imaging, Patient outcome assessment

Ruoyu Zhuang, Minghui Hang, Wenhua Li, Ting Zhang, Wei Hou. Research progress on semi-quantitative MRI assessment of knee osteoarthritis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(04): 545-552.

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References 62

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评分系统	评分项及其分级
评分系统	软骨损伤	骨髓病变	软骨下囊肿	半月板撕裂	骨赘	积液与滑膜	关节周围特征	游离体	韧带/肌腱	半月板突出	关节面损伤
WORMS	0~6大小与深度	0~3面积占比	0~3	0~4	0~7	0~3	0~3关节周围囊肿	0~3	0~1前/后十字韧带、内/外侧副韧带	/	0~3
KOSS	0~3大小、深度	0~3大小	0~3	0~3	0~3	0~3积液 0~1滑膜增厚	0~3腘窝囊肿	/	/	0~3	/
BLOKS	0~3缺损面积占比（任意程度、全层）、具体位点损伤程度	0~3大小、面积占比、非囊肿病变占比		0~1半月板形态（半月板信号、撕裂、浸渍、半月板囊肿，各项独立评分）	0~3	0~3积液、脂肪垫滑膜炎 0~1其他区域滑膜炎	0~1关节周围囊肿、滑囊，独立评分	0~1	0~1前/后十字韧带、髌腱	0~3	/
MOAKS	0~3缺损面积占比（任意程度、全层）	0~3体积占比、非囊肿病变占比		0~1半月板形态（半月板信号、撕裂、浸渍、半月板囊肿、半月板肥大，各项独立评分）	0~3	0~3积液滑膜炎、脂肪垫滑膜炎	0~1关节周围囊肿、滑囊，独立评分	0~1	0~1前/后十字韧带、髌腱	0~3	/
ACLOAS	0~6深度与面积占比	0~3体积占比（区分外伤性与退化性）		0~8半月板形态（半月板信号、撕裂、半月板修补、浸渍）	0~7	0~3积液滑膜炎、脂肪垫滑膜炎	/	/	0~3前/后十字韧带、内/外侧副韧带、移植物	0~2	0~4
CROAKS	全关节评分同MOAKS
KIMRISS	/	0~1切片扇区		/	/	0~4积液深度	/	/	/	/	/
ROAMES	0~3大小与深度	0~3体积占比、非囊肿病变占比		0~4（半月板信号、撕裂、浸渍）	0~3	0~3积液滑膜炎、脂肪垫滑膜炎	/	/	/	0~2	/

评分系统	评分项及其分级
评分系统	软骨损伤	骨髓病变	软骨下囊肿	半月板撕裂	骨赘	积液与滑膜	关节周围特征	游离体	韧带/肌腱	半月板突出	关节面损伤
WORMS	0~6大小与深度	0~3面积占比	0~3	0~4	0~7	0~3	0~3关节周围囊肿	0~3	0~1前/后十字韧带、内/外侧副韧带	/	0~3
KOSS	0~3大小、深度	0~3大小	0~3	0~3	0~3	0~3积液 0~1滑膜增厚	0~3腘窝囊肿	/	/	0~3	/
BLOKS	0~3缺损面积占比（任意程度、全层）、具体位点损伤程度	0~3大小、面积占比、非囊肿病变占比		0~1半月板形态（半月板信号、撕裂、浸渍、半月板囊肿，各项独立评分）	0~3	0~3积液、脂肪垫滑膜炎 0~1其他区域滑膜炎	0~1关节周围囊肿、滑囊，独立评分	0~1	0~1前/后十字韧带、髌腱	0~3	/
MOAKS	0~3缺损面积占比（任意程度、全层）	0~3体积占比、非囊肿病变占比		0~1半月板形态（半月板信号、撕裂、浸渍、半月板囊肿、半月板肥大，各项独立评分）	0~3	0~3积液滑膜炎、脂肪垫滑膜炎	0~1关节周围囊肿、滑囊，独立评分	0~1	0~1前/后十字韧带、髌腱	0~3	/
ACLOAS	0~6深度与面积占比	0~3体积占比（区分外伤性与退化性）		0~8半月板形态（半月板信号、撕裂、半月板修补、浸渍）	0~7	0~3积液滑膜炎、脂肪垫滑膜炎	/	/	0~3前/后十字韧带、内/外侧副韧带、移植物	0~2	0~4
CROAKS	全关节评分同MOAKS
KIMRISS	/	0~1切片扇区		/	/	0~4积液深度	/	/	/	/	/
ROAMES	0~3大小与深度	0~3体积占比、非囊肿病变占比		0~4（半月板信号、撕裂、浸渍）	0~3	0~3积液滑膜炎、脂肪垫滑膜炎	/	/	/	0~2	/

评分系统（发布年份）	特点	局限
通用：
WORMS（2004）	全关节通用，最早全器官评分系统，较简便，具有关节面损伤评分	无半月板形态、半月板突出评分
KOSS（2005）	全关节通用，较简便，相较WORMS加入半月板突出评分，简化骨赘分级	无半月板形态、游离体、韧带评分
BLOKS（2008）	全关节通用，较全面，吸纳WORMS和KOSS内容，软骨损伤、半月板形态评分详细	软骨损伤、骨髓病变计算复杂
MOAKS（2011）	全关节通用，较全面，基于BLOKS精简，加入半月板肥大评分	软骨损伤、骨髓病变计算复杂
CROAKS（2014）	全关节通用，全面，等于MOAKS合并MOCART，兼顾评价手术疗效功能	涉及两种评分系统，使用繁琐
专用：
Rhodes等（2005）； Baker等（2010）； Guermazi等（2011）	滑膜炎专用，多区域评分，数量分别为4（Rhodes）、8（Baker）、11（Guermazi）	仅限于滑膜炎
MOCART（2006，2021）^*	手术疗效评价专用，较全面，针对软骨损伤修复	不适用非软骨修复手术
ACLOAS（2014）	前交叉韧带损伤评价专用，区分外伤性与退化性骨髓损伤，韧带、关节面损伤评分详细	无关节周围特征、游离体评分
KIMRISS（2017，2023）^*	骨髓病变、滑膜炎积液专用，相较MOAKS易用	基于网页开发，需要注册联网使用
ROAMES（2021）	临床筛查排除专用，相较MOAKS简化软骨损伤、骨髓病变、半月板形态评分，可供表型分类	无关节周围特征、游离体、韧带评分

评分系统（发布年份）	特点	局限
通用：
WORMS（2004）	全关节通用，最早全器官评分系统，较简便，具有关节面损伤评分	无半月板形态、半月板突出评分
KOSS（2005）	全关节通用，较简便，相较WORMS加入半月板突出评分，简化骨赘分级	无半月板形态、游离体、韧带评分
BLOKS（2008）	全关节通用，较全面，吸纳WORMS和KOSS内容，软骨损伤、半月板形态评分详细	软骨损伤、骨髓病变计算复杂
MOAKS（2011）	全关节通用，较全面，基于BLOKS精简，加入半月板肥大评分	软骨损伤、骨髓病变计算复杂
CROAKS（2014）	全关节通用，全面，等于MOAKS合并MOCART，兼顾评价手术疗效功能	涉及两种评分系统，使用繁琐
专用：
Rhodes等（2005）； Baker等（2010）； Guermazi等（2011）	滑膜炎专用，多区域评分，数量分别为4（Rhodes）、8（Baker）、11（Guermazi）	仅限于滑膜炎
MOCART（2006，2021）^*	手术疗效评价专用，较全面，针对软骨损伤修复	不适用非软骨修复手术
ACLOAS（2014）	前交叉韧带损伤评价专用，区分外伤性与退化性骨髓损伤，韧带、关节面损伤评分详细	无关节周围特征、游离体评分
KIMRISS（2017，2023）^*	骨髓病变、滑膜炎积液专用，相较MOAKS易用	基于网页开发，需要注册联网使用
ROAMES（2021）	临床筛查排除专用，相较MOAKS简化软骨损伤、骨髓病变、半月板形态评分，可供表型分类	无关节周围特征、游离体、韧带评分

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