Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA 02118, USA.
Osteoarthritis Cartilage. 2010 Nov;18(11):1402-7. doi: 10.1016/j.joca.2010.06.016. Epub 2010 Sep 17.
There are two widely used scoring systems for knee magnetic resonance imaging (MRI) in osteoarthritis (OA) and the strengths and weaknesses of each system in terms of ease of use and association with known risk factors and outcomes are unknown.
To compare Whole Organ Magnetic Resonance Imaging Score (WORMS) and Boston Leeds Osteoarthritis Knee Score (BLOKS) scales using longitudinal MRI and X-ray data.
In the Osteoarthritis Initiative (OAI), knee radiographs, long limb films for alignment and MRI's were acquired in the interval from 0 to 24 months follow-up. OAI MRI's from baseline and 24 months were read separately using BLOKS and WORMS scales. X-rays were scored semiquantitatively for joint space loss and long limb films were measured for alignment angle. We evaluated which of the WORMS or BLOKS cartilage loss scores best correlated with joint space loss on the X-ray and which was best predicted by varus malalignment on long limb film. To examine the validity of bone marrow lesion (BML) and meniscal scales, we tested which of WORMS or BLOKS baseline scores for BML or meniscus best predicted cartilage loss from baseline to 24 months. We critically evaluated strengths and weaknesses of each scoring system also.
Of 113 knees read longitudinally, 33 showed any cartilage loss using BLOKS and 30 using WORMS with high agreement between the scales. In the medial compartment, both BLOKS and WORMS picked up only 42% of the knees with X-ray joint space loss with similar specificity (88 vs 86%). Varus knees were more likely to be a risk factor for medial cartilage loss in BLOKS [adj odds ratio (OR) 5.9 (95% confidence intervals (CIs) 1.5, 24.0)] than in WORMS [adj OR 2.1 (95% CI 0.7, 6.3)]. WORMS BML scores predicted cartilage loss more strongly than any BLOKS BML variables and some BLOKS BML measures did not affect risk of cartilage loss at all. However, across the range of scores, meniscal tear scores in BLOKS predicted cartilage loss better for each abnormality than did WORMS meniscal tear scores and the meniscal signal abnormality scored in BLOKS but not in WORMS, predicted cartilage loss. BLOKS took longer and was more difficult to score longitudinally especially for BML scores.
In a comparison of instruments limited by small numbers of knees compared, BLOKS meniscal score was preferable to WORMS meniscal scale in predicting cartilage loss most likely because it includes potentially important pathology missed by WORMS. On the other hand, BML scoring in WORMS was preferable in that it better predicted later cartilage loss, was easier to score and did not include potentially extraneous measures. Neither method was definitively better for cartilage scoring.
在骨关节炎（OA）中，有两种广泛使用的膝关节磁共振成像（MRI）评分系统，每个系统在易用性以及与已知风险因素和结果的相关性方面的优缺点尚不清楚。
通过纵向 MRI 和 X 射线数据比较全器官磁共振成像评分（WORMS）和波士顿利兹骨关节炎膝关节评分（BLOKS）量表。
在骨关节炎倡议（OAI）中，在 0 至 24 个月的随访期间获取膝关节 X 射线、长肢线片以评估对线情况和 MRI。使用 BLOKS 和 WORMS 量表分别对基线和 24 个月的 OAI MRI 进行阅读。X 射线的关节间隙损失进行半定量评分，长肢线片用于测量对线角度。我们评估了 WORMS 或 BLOKS 软骨损失评分中哪一个与 X 射线的关节间隙损失相关性最好，以及哪一个与长肢线片上的内翻对线不良相关性最好。为了检查骨髓病变（BML）和半月板评分的有效性，我们测试了 WORMS 或 BLOKS 基线 BML 或半月板评分中哪一个最能预测从基线到 24 个月的软骨损失。我们还批判性地评估了每个评分系统的优缺点。
在 113 个进行纵向评估的膝关节中，33 个使用 BLOKS 显示有任何软骨损失，30 个使用 WORMS 显示有软骨损失，两个评分系统之间具有高度一致性。在内侧间室，BLOKS 和 WORMS 均仅检测到 42%的 X 射线关节间隙损失的膝关节，特异性相似（88%与 86%）。内翻的膝关节更有可能成为 BLOKS 中内侧软骨损失的危险因素[调整后的优势比（OR）5.9（95%置信区间（CI）1.5，24.0）]，而不是 WORMS [调整后的 OR 2.1（95%CI 0.7，6.3）]。WORMS 的 BML 评分比任何 BLOKS BML 变量更能强烈预测软骨损失，并且一些 BLOKS BML 测量根本不影响软骨损失的风险。然而，在评分范围内，BLOKS 的半月板撕裂评分比 WORMS 的半月板撕裂评分更能预测每个异常的软骨损失，并且 BLOKS 但不是 WORMS 评分的半月板信号异常预测了软骨损失。BLOKS 评分耗时更长，尤其是 BML 评分，更难以进行纵向评估。
在对比较小数量的膝关节的仪器进行比较时，BLOKS 的半月板评分在预测软骨损失方面优于 WORMS 半月板评分，这很可能是因为它包括了 WORMS 遗漏的潜在重要病理变化。另一方面，WORMS 中的 BML 评分更有优势，因为它更好地预测了后期的软骨损失，更易于评分，并且不包括潜在的无关措施。这两种方法都不能明确地确定用于软骨评分。
