Towards novel osteoarthritis biomarkers: Multi-criteria evaluation of 46,996 segmented knee MRI data from the Osteoarthritis Initiative

PLoS One. 2021 Oct 21;16(10):e0258855. doi: 10.1371/journal.pone.0258855. eCollection 2021.

Abstract

Convolutional neural networks (CNNs) are the state-of-the-art for automated assessment of knee osteoarthritis (KOA) from medical image data. However, these methods lack interpretability, mainly focus on image texture, and cannot completely grasp the analyzed anatomies' shapes. In this study we assess the informative value of quantitative features derived from segmentations in order to assess their potential as an alternative or extension to CNN-based approaches regarding multiple aspects of KOA. Six anatomical structures around the knee (femoral and tibial bones, femoral and tibial cartilages, and both menisci) are segmented in 46,996 MRI scans. Based on these segmentations, quantitative features are computed, i.e., measurements such as cartilage volume, meniscal extrusion and tibial coverage, as well as geometric features based on a statistical shape encoding of the anatomies. The feature quality is assessed by investigating their association to the Kellgren-Lawrence grade (KLG), joint space narrowing (JSN), incident KOA, and total knee replacement (TKR). Using gold standard labels from the Osteoarthritis Initiative database the balanced accuracy (BA), the area under the Receiver Operating Characteristic curve (AUC), and weighted kappa statistics are evaluated. Features based on shape encodings of femur, tibia, and menisci plus the performed measurements showed most potential as KOA biomarkers. Differentiation between non-arthritic and severely arthritic knees yielded BAs of up to 99%, 84% were achieved for diagnosis of early KOA. Weighted kappa values of 0.73, 0.72, and 0.78 were achieved for classification of the grade of medial JSN, lateral JSN, and KLG, respectively. The AUC was 0.61 and 0.76 for prediction of incident KOA and TKR within one year, respectively. Quantitative features from automated segmentations provide novel biomarkers for KLG and JSN classification and show potential for incident KOA and TKR prediction. The validity of these features should be further evaluated, especially as extensions of CNN-based approaches. To foster such developments we make all segmentations publicly available together with this publication.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cartilage, Articular / diagnostic imaging*
  • Databases, Factual
  • Female
  • Femur / diagnostic imaging
  • Fibula / diagnostic imaging
  • Humans
  • Incidence
  • Knee Joint / diagnostic imaging*
  • Magnetic Resonance Imaging
  • Male
  • Menisci, Tibial / diagnostic imaging
  • Osteoarthritis, Knee / diagnostic imaging*
  • Osteoarthritis, Knee / epidemiology
  • Tibia / diagnostic imaging

Grants and funding

The German Federal Ministry of Education and Research (BMBF) (https://www.bmbf.de/) research network on musculoskeletal diseases supported AT (grant no. 01EC1408B, Overload/PrevOP) and FA (grant no. 01EC1406E, TOKMIS). AT was further supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) (https://www.dfg.de/) research campus MODAL (grant no. 3FO18501) and DFG research project ZA 592/4-1. FA was further supported by the DFG under Germany’s Excellence Strategy - The Berlin Mathematics Research Center MATH+ (EXC-2046/1, project ID: 390685689). SZ reports funding by the DFG cluster of excellence Cluster of Excellence "Matters of Activity. Image Space Material" under Germany’s Excellence Strategy – EXC 2025 – 390648296. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.