Open Access Open Badges Research article

Development of a rapid knee cartilage damage quantification method using magnetic resonance images

Ming Zhang1, Jeffrey B Driban1, Lori Lyn Price2, Daniel Harper1, Grace H Lo34, Eric Miller5, Robert J Ward6 and Timothy E McAlindon1*

Author Affiliations

1 Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA 02111, USA

2 The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington Street, Box #63, Boston, MA 02111, USA

3 Medical Care Line and Research Care Line; Houston Health Services Research and Development (HSR&D), Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA

4 Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX. 1 Baylor Plaza, BCM-285, Houston, TX 77030, USA

5 Department of Electrical and Computer Engineering, Tufts University, 216 Halligan Hall, Medford, MA 02155, USA

6 Department of Radiology, Tufts Medical Center, 800 Washington Street, Box #299, Boston, MA 02111, USA

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BMC Musculoskeletal Disorders 2014, 15:264  doi:10.1186/1471-2474-15-264

Published: 6 August 2014



Cartilage morphometry based on magnetic resonance images (MRIs) is an emerging outcome measure for clinical trials among patients with knee osteoarthritis (KOA). However, current methods for cartilage morphometry take many hours per knee and require extensive training on the use of the associated software. In this study we tested the feasibility, reliability, and construct validity of a novel osteoarthritis cartilage damage quantification method (Cartilage Damage Index [CDI]) that utilizes informative locations on knee MRIs.


We selected 102 knee MRIs from the Osteoarthritis Initiative that represented a range of KOA structural severity (Kellgren Lawrence [KL] Grade 0 – 4). We tested the intra- and inter-tester reliability of the CDI and compared the CDI scores against different measures of severity (radiographic joint space narrowing [JSN] grade, KL score, joint space width [JSW]) and static knee alignment, both cross-sectionally and longitudinally.


Determination of the CDI took on average14.4 minutes (s.d. 2.1) per knee pair (baseline and follow-up of one knee). Repeatability was good (intra- and inter-tester reliability: intraclass correlation coefficient >0.86). The mean CDI scores related to all four measures of osteoarthritis severity (JSN grade, KL score, JSW, and knee alignment; all p values < 0.05). Baseline JSN grade and knee alignment also predicted subsequent 24-month longitudinal change in the CDI (p trends <0.05). During 24 months, knees with worsening in JSN or KL grade (i.e. progressors) had greater change in CDI score.


The CDI is a novel knee cartilage quantification method that is rapid, reliable, and has construct validity for assessment of medial tibiofemoral osteoarthritis structural severity and its progression. It has the potential to addresses the barriers inherent to studies requiring assessment of cartilage damage on large numbers of knees, and as a biomarker for knee osteoarthritis progression.

Osteoarthritis; Cartilage; Quantitative measurements; Informative locations; Magnetic resonance imaging