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Different thresholds for detecting osteophytes and joint space narrowing exist between the site investigators and the centralized reader in a multicenter knee osteoarthritis study—data from the Osteoarthritis Initiative

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Abstract

Objective

To evaluate how the reading of knee radiographs by site investigators differs from that by an expert musculoskeletal radiologist who trained and validated them in a multicenter knee osteoarthritis (OA) study.

Materials and methods

A subset of participants from the Osteoarthritis Initiative progression cohort was studied. Osteophytes and joint space narrowing (JSN) were evaluated using Kellgren-Lawrence (KL) and Osteoarthritis Research Society International (OARSI) grading. Radiographs were read by site investigators, who received training and validation of their competence by an expert musculoskeletal radiologist. Radiographs were re-read by this radiologist, who acted as a central reader. For KL and OARSI grading of osteophytes, discrepancies between two readings were adjudicated by another expert reader.

Results

Radiographs from 96 subjects (49 women) and 192 knees (138 KL grade ≥ 2) were included. The site reading showed moderate agreement for KL grading overall (kappa = 0.52) and for KL ≥ 2 (i.e., radiographic diagnosis of “definite OA”; kappa = 0.41). For OARSI grading, the site reading showed substantial agreement for lateral and medial JSN (kappa = 0.65 and 0.71), but only fair agreement for osteophytes (kappa = 0.37). For KL grading, the adjudicator’s reading showed substantial agreement with the centralized reading (kappa = 0.62), but only slight agreement with the site reading (kappa = 0.10).

Conclusion

Site investigators over-graded osteophytes compared to the central reader and the adjudicator. Different thresholds for scoring of JSN exist even between experts. Our results suggest that research studies using radiographic grading of OA should use a centralized reader for all grading.

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Abbreviations

OA:

Osteoarthritis

OAI:

Osteoarthritis Initiative

KL:

Kellgren-Lawrence

OARSI:

Osteoarthritis Research Society International

JSN:

Joint space narrowing

MRI:

Magnetic resonance imaging

FDA:

Food and Drug Administration

EMEA:

European Medicines Agency

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Funding sources

The Osteoarthritis Initiative (OAI) is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health (NIH), a branch of the Department of Health and Human Services, and conducted by the OAI study investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners. The central radiographic readings and adjudications (i.e., data collection) were funded by Eli Lilly & Company. The sponsors did not have any role in study design, analysis, and interpretation of data; writing of the manuscript; or the decision to submit the manuscript for publication.

Competing interests

Ali Guermazi received grants from General Electric Healthcare and National Institute of Health. He is the President of Boston Imaging Core Lab, LLC; consultant to MerckSerono, Facet Solutions, Novartis, Genzyme, and Stryker. Felix Eckstein is CEO of Chondrometrics, GmbH, and provides consulting services to MerckSerono and Novartis. Olivier Benichou has a full time employment with Lilly & Co, IN. Other authors declared nothing to disclose.

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Authors and Affiliations

  1. Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA

    Ali Guermazi & Daichi Hayashi

  2. Division of Research, New England Baptist Hospital, 125 Parker Hill Avenue, Boston, MA, 02120, USA

    David J. Hunter & Ling Li

  3. Northern Clinical School, University of Sydney, Sydney, Australia

    David J. Hunter

  4. Eli Lilly & Co, Indianapolis, IN, 46285, USA

    Olivier Benichou

  5. Paracelsus Medical University, Salzburg, Austria

    Felix Eckstein

  6. Chondrometrics GmbH, Ainring, Germany

    Felix Eckstein

  7. Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, S700 Biomedical Science Tower, 3500 Terrace Street, Pittsburgh, PA, 15261, USA

    C. Kent Kwoh

  8. Department of Epidemiology and Biostatistics, University of California, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA, 94107, USA

    Michael Nevitt

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  1. Ali Guermazi
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Correspondence to Daichi Hayashi.

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Guermazi, A., Hunter, D.J., Li, L. et al. Different thresholds for detecting osteophytes and joint space narrowing exist between the site investigators and the centralized reader in a multicenter knee osteoarthritis study—data from the Osteoarthritis Initiative. Skeletal Radiol 41, 179–186 (2012). https://doi.org/10.1007/s00256-011-1142-2

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  • DOI: https://doi.org/10.1007/s00256-011-1142-2

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