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A call for screening MRI as a tool for osteoarthritis clinical trials

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Abstract

Conventional radiography is the most commonly used imaging modality for the evaluation of osteoarthritis (OA) in clinical trials of disease-modifying OA drugs (DMOADs). Unfortunately, radiography has many shortcomings as an imaging technique to meaningfully assess the pathological features of OA. In this perspective paper, we will describe the reasons why radiography is not an ideal tool for structural OA assessment and why magnetic resonance imaging (MRI) should be preferred for such purposes. These shortcomings include a lack of reproducibility of radiographic joint space measurements (if conducted without using a standardized positioning frame), a lack of sensitivity and specificity, an insufficient definition of disease severity, a weak association of radiographic structural damage and pain, a lack of ability to depict many faces of OA, and incapability to depict diagnoses of exclusion. MRI offers solutions to these limitations of radiography. Several different phenotypes of OA have been recognized and it is important to recruit appropriate patients for specific therapeutic approaches in DMOAD trials. Radiography does not allow such phenotypical stratification. We will explain known hurdles for widespread deployment of MRI at eligibility screening and how they can be overcome by technological advances and the use of simplified image assessment.

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Authors and Affiliations

  1. Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    Ali Guermazi, Frank W. Roemer & Daichi Hayashi

  2. VA Boston Healthcare System, West Roxbury, MA, USA

    Ali Guermazi

  3. Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany

    Frank W. Roemer

  4. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Mohamed Jarraya

  5. Department of Radiology, Tufts Medical Center, Tufts Medicine, Floating 4, 800 Washington Street, Boston, MA, USA

    Daichi Hayashi

  6. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Daichi Hayashi

Authors
  1. Ali Guermazi
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  2. Frank W. Roemer
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  4. Daichi Hayashi
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Corresponding author

Correspondence to Daichi Hayashi.

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Conflict of interest

AG: received consultancy fees from Pfizer, Novartis, MerckSerono, TissueGene, AstraZeneca, and Regeneron. He is a shareholder, president, and director of Musculoskeletal Imaging of Boston Imaging Core Lab., LLC.

FWR: consultant to Calibr and Grünenthal. He is a shareholder, Chief Medical Officer, Director of Research, and Director of Artificial Intelligence of Boston Imaging Core Lab., LLC.

MJ: nothing to disclose.

DH: received publication royalties from Wolters Kluwer.

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Guermazi, A., Roemer, F.W., Jarraya, M. et al. A call for screening MRI as a tool for osteoarthritis clinical trials. Skeletal Radiol 52, 2011–2019 (2023). https://doi.org/10.1007/s00256-023-04354-z

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  • DOI: https://doi.org/10.1007/s00256-023-04354-z

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