Altahawi Faysal, Lartey Richard, Obuchowski Nancy, Li Xiaojuan, Winalski Carl S
Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio, USA.
Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Osteoarthr Imaging. 2025 Jun 7. doi: 10.1016/j.ostima.2025.100272.
We propose a supplement to MOAKS (MRI Osteoarthritis Knee Score) for capturing >50% partial thickness cartilage loss on knee MRI and measure reader agreement.
MOAKS scores 2 severity levels of cartilage damage (any loss, full-thickness loss) within knee subregions with lesional area graded 0-3. We propose supplemented MOAKS (sMOAKS) by adding a similarly graded third level assessment for deep cartilage loss (DCL), >50% thickness, in addition to traditional MOAKS for improved granularity of partial thickness cartilage loss. Using sMOAKS, two radiologists independently graded cartilage subscores for 40 knees and rescored 20 knees. Consolidated inter-reader and intra-reader agreement was calculated with kappa values for the DCL level supplement. To measure agreement for one example of a more granular combined sMOAKS outcome, coverage probability reader agreement was calculated for a scaled cartilage damage score (CDS), a summed normalized score (0-100) with equal weighting to articular surfaces combining subregion scores.
DCL represented 27.8% (63/227) of partial but not full-thickness cartilage loss subregion interpretations. Pooled subregion DCL involving >10% surface area demonstrated 97.7% (ĸ=0.71) inter-reader agreement and 98.8% (ĸ=0.78) intra-reader agreement. For greatest subregion DCL size, weighted ĸ agreement was 0.73/0.82 (inter-reader/intra-reader) for articular surfaces and 0.75/0.83 for joint compartments. At 90% CDS intra-reader agreement coverage, inter-reader CDS agreement values were 83%, 82%, and 78% for surfaces, compartments, and whole joints, respectively.
There is substantial agreement for deep cartilage loss detection using sMOAKS across varied analysis methods. Further assessment will determine when the added granularity of sMOAKS is beneficial.
我们提出一种对MOAKS（MRI膝关节骨关节炎评分）的补充方法，用于在膝关节MRI上捕捉超过50%的部分厚度软骨损伤，并测量阅片者间的一致性。
MOAKS对膝关节亚区域内2个软骨损伤严重程度级别（任何损伤、全层损伤）进行评分，损伤面积分为0 - 3级。我们提出补充MOAKS（sMOAKS），除了传统的MOAKS外，增加一个对深度软骨损伤（DCL，厚度>50%）进行类似分级的第三级评估，以提高部分厚度软骨损伤分级的精细度。使用sMOAKS，两名放射科医生对40个膝关节的软骨子评分进行独立分级，并对20个膝关节重新评分。计算DCL水平补充的阅片者间和阅片者内的合并一致性，用kappa值表示。为测量一个更精细的合并sMOAKS结果示例的一致性，计算了一个缩放后的软骨损伤评分（CDS）的覆盖概率阅片者间一致性，CDS是一个总和标准化评分（0 - 100），对关节表面的子区域评分进行同等加权合并。
DCL占部分厚度而非全层厚度软骨损伤亚区域解读的27.8%（63/227）。合并的涉及>10%表面积的亚区域DCL显示阅片者间一致性为97.7%（κ = 0.71），阅片者内一致性为98.8%（κ = 0.78）。对于最大的亚区域DCL大小，关节表面的加权κ一致性为0.73/0.82（阅片者间/阅片者内），关节腔为0.75/0.83。在90%的CDS阅片者内一致性覆盖下，阅片者间CDS一致性值在关节表面、关节腔和整个关节分别为83%、82%和78%。
使用sMOAKS在各种分析方法中对深度软骨损伤检测有很高的一致性。进一步评估将确定sMOAKS增加的精细度何时有益。
