Structural tissue damage and 24-month progression of semi-quantitative MRI biomarkers of knee osteoarthritis in the IMI-APPROACH cohort

Frank W Roemer, Mylène Jansen, Anne C A Marijnissen, Ali Guermazi, Rafael Heiss, Susanne Maschek, Agnes Lalande, Francisco J Blanco, Francis Berenbaum, Lotte A van de Stadt, Margreet Kloppenburg, Ida K Haugen, Christoph H Ladel, Jaume Bacardit, Anna Wisser, Felix Eckstein, Floris P J G Lafeber, Harrie H Weinans, Wolfgang Wirth

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND: The IMI-APPROACH cohort is an exploratory, 5-centre, 2-year prospective follow-up study of knee osteoarthritis (OA). Aim was to describe baseline multi-tissue semiquantitative MRI evaluation of index knees and to describe change for different MRI features based on number of subregion-approaches and change in maximum grades over a 24-month period.

METHODS: MRIs were acquired using 1.5 T or 3 T MRI systems and assessed using the semi-quantitative MRI OA Knee Scoring (MOAKS) system. MRIs were read at baseline and 24-months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. In descriptive fashion, the frequencies of MRI features at baseline and change in these imaging biomarkers over time are presented for the entire sample in a subregional and maximum score approach for most features. Differences between knees without and with structural radiographic (R) OA are analyzed in addition.

RESULTS: Two hundred eighty-nine participants had readable baseline MRI examinations. Mean age was 66.6 ± 7.1 years and participants had a mean BMI of 28.1 ± 5.3 kg/m 2. The majority (55.3%) of included knees had radiographic OA. Any change in total cartilage MOAKS score was observed in 53.1% considering full-grade changes only, and in 73.9% including full-grade and within-grade changes. Any medial cartilage progression was seen in 23.9% and any lateral progression on 22.1%. While for the medial and lateral compartments numbers of subregions with improvement and worsening of BMLs were very similar, for the PFJ more improvement was observed compared to worsening (15.5% vs. 9.0%). Including within grade changes, the number of knees showing BML worsening increased from 42.2% to 55.6%. While for some features 24-months change was rare, frequency of change was much more common in knees with vs. without ROA (e.g. worsening of total MOAKS score cartilage in 68.4% of ROA knees vs. 36.7% of no-ROA knees, and 60.7% vs. 21.8% for an increase in maximum BML score per knee).

CONCLUSIONS: A wide range of MRI-detected structural pathologies was present in the IMI-APPROACH cohort. Baseline prevalence and change of features was substantially more common in the ROA subgroup compared to the knees without ROA.

TRIAL REGISTRATION: identification: NCT03883568.

Original languageEnglish
Article number988
JournalBMC Musculoskeletal Disorders
Issue number1
Publication statusPublished - 17 Nov 2022


  • Aged
  • Biomarkers
  • Cartilage Diseases/pathology
  • Cartilage, Articular/diagnostic imaging
  • Follow-Up Studies
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Osteoarthritis, Knee/diagnostic imaging
  • Prospective Studies
  • Knee
  • MRI
  • Progression; reliability
  • Osteoarthritis


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