Three-Dimensional Surface-Based Analysis of Cartilage MRI Data in Knee Osteoarthritis: Validation and Initial Clinical Application

J Magn Reson Imaging. 2020 Oct;52(4):1139-1151. doi: 10.1002/jmri.27193. Epub 2020 May 24.


Background: Traditional quantitative analysis of cartilage with MRI averages measurements (eg, thickness) across regions-of-interest (ROIs) which may reduce responsiveness.

Purpose: To validate and describe clinical application of a semiautomated surface-based method for analyzing cartilage relaxation times ("composition") and morphology on MRI, 3D cartilage surface mapping (3D-CaSM).

Study type: Validation study in cadaveric knees and prospective observational (cohort) study in human participants.

Population: Four cadaveric knees and 14 participants aged 40-60 with mild-moderate knee osteoarthritis (OA) and 6 age-matched healthy volunteers, imaged at baseline, 1, and 6 months.

Field strength/sequence: 3D spoiled gradient echo, T1 rho/T2 magnetization-prepared 3D fast spin echo for mapping of T1 rho/T2 relaxation times and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) using variable flip angle T1 relaxation time mapping at 3T.

Assessment: 3D-CaSM was validated against high-resolution peripheral quantitative computed tomography (HRpQCT) in cadaveric knees, with comparison to expert manual segmentation. The clinical study assessed test-retest repeatability and sensitivity to change over 6 months for cartilage thickness and relaxation times.

Statistical tests: Bland-Altman analysis was performed for the validation study and evaluation of test-retest repeatability. Six-month changes were assessed via calculation of the percentage of each cartilage surface affected by areas of significant change (%SC), defined using thresholds based on area and smallest detectable difference (SDD).

Results: Bias and precision (0.06 ± 0.25 mm) of 3D-CaSM against reference HRpQCT data were comparable to expert manual segmentation (-0.13 ± 0.26 mm). 3D-CaSM demonstrated significant (>SDD) 6-month changes in cartilage thickness and relaxation times in both OA participants and healthy controls. The parameter demonstrating the greatest 6-month change was T2 relaxation time (OA median %SC [IQR] = 8.8% [5.5 to 12.6]).

Data conclusion: This study demonstrates the construct validity and potential clinical utility of 3D-CaSM, which may offer advantages to conventional ROI-based methods.

Level of evidence: 2.

Technical efficacy stage: 2. J. Magn. Reson. Imaging 2020;52:1139-1151.

Keywords: 3D; cartilage composition; cartilage mapping; cartilage thickness; knee osteoarthritis; magnetic resonance imaging.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cartilage, Articular* / diagnostic imaging
  • Gadolinium DTPA
  • Humans
  • Infant
  • Knee Joint
  • Magnetic Resonance Imaging
  • Middle Aged
  • Osteoarthritis, Knee* / diagnostic imaging
  • Reproducibility of Results


  • Gadolinium DTPA