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Type: Journal article
Title: Bone marrow lesions detected by specific combination of MRI sequences are associated with severity of osteochondral degeneration
Author: Muratovic, D.
Cicuttini, F.
Wluka, A.
Findlay, D.
Wang, Y.
Otto, S.
Taylor, D.
Humphries, J.
Lee, Y.
Labrinidis, A.
Williams, R.
Kuliwaba, J.
Citation: Arthritis Research and Therapy, 2016; 18(1):54-1-54-11
Publisher: BioMed Central
Issue Date: 2016
ISSN: 1478-6354
Statement of
Dzenita Muratovic, Flavia Cicuttini, Anita Wluka, David Findlay, Yuanyuan Wang, Sophia Otto, David Taylor, Julia Humphries, Yearin Lee, Agatha Labrinidis, Ruth Williams and Julia Kuliwaba
Abstract: Background: Bone marrow lesions (BMLs) are useful diagnostic and prognostic markers in knee osteoarthritis (OA), but what they represent at the tissue level remains unclear. The aim of this study was to provide comprehensive tissue characterization of BMLs detected using two specific MRI sequences. Methods: Tibial plateaus were obtained from 60 patients (29 females, 31 males), undergoing knee arthroplasty for OA. To identify BMLs, MRI was performed ex vivo using T1 and PDFS-weighted sequences. Multi-modal tissue level analyses of the osteochondral unit (OCU) were performed, including cartilage volume measurement, OARSI grading, micro-CT analysis of bone microstructure, routine histopathological assessment and quantitation of bone turnover indices.Results: BMLs were detected in 74 % of tibial plateaus, the remainder comprising a No BML group. Of all BMLs, 59 % were designated BML 1 (detected only by PDFS) and 41 % were designated BML 2 (detected by both PDFS + T1). The presence of a BML was related to degeneration of the OCU, particularly within BML 2. When compared to No BML, BML 2 showed reduced cartilage volume (p = 0.008), higher OARSI scores (p = 0.004), thicker subchondral plate (p = 0.002), increased trabecular bone volume and plate-like structure (p = 0.0004), increased osteoid volume (p = 0.002) and thickness (p = 0.003), more bone marrow oedema (p = 0.03), fibrosis (p = 0.002), necrosis (p = 0.01) and fibrovascular cysts (p = 0.04). For most measures, BML 1 was intermediate between No BML and BML 2. Conclusions: BMLs detected by specific MRI sequences identify different degrees of degeneration in the OCU. This suggests that MRI characteristics of BMLs may enable identification of different BML phenotypes and help target novel approaches to treatment and prevention of OA.
Keywords: Knee osteoarthritis; bone marrow lesion; MRI; osteochondral unit; subchondral bone; cartilage
Rights: © 2016 Muratovic et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI: 10.1186/s13075-016-0953-x
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