The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston-Leeds Osteoarthritis Knee Score)
The reliability of a new scoring system for knee osteoarthritis MRI and the validity of bone marrow lesion assessment: BLOKS (Boston-Leeds Osteoarthritis Knee Score)
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DOI：
10.1136/ard.2006.066183
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发表时间：
2008-02-01
影响因子：
27.4
通讯作者：
Conaghan, P. G.
中科院分区：
文献类型：
--
作者：
Hunter, D. J.;Lo, G. H.;Conaghan, P. G.
目的：MRI 为骨关节炎 (OA) 过程中涉及的所有解剖结构提供无与伦比的可视化。需要可靠的方法来量化这些结构的异常。这项工作的目的是评估用于评估膝关节 OA 的新型 MRI 评分系统的可靠性，并探索该新工具的骨髓病变 (BML) 评分部分的有效性。方法：在审查相关文献后，来自英国和美国中心的风湿病学家和放射科医生组成的合作小组建立了初步的解剖学划分、项目（必然广泛包含）和新型半定量膝关节评分的尺度。进行了一系列迭代可靠性练习以减少初始项目，并检查了所得的波士顿-利兹骨关节炎膝关节评分 (BLOKS) 的可靠性。另一个样本同时进行了 BLOKS 和 WORMS（全器官 MRI 评分）骨髓病变 (BML) 评分，以评估每种评分方法的结构有效性（与膝盖疼痛相关）和纵向有效性（软骨损失预测）。 结果：BLOKS 评分方法评估 9 个关节内区域，包含 8 个项目，包括骨髓病变、软骨、骨赘、滑膜炎、积液和韧带的特征。每个特征的缩放范围为 0-3。最终 BLOKS 项目的读者间可靠性范围从半月板挤压的 0.51 到半月板撕裂的 0.79。其他关键特征的可靠性：BML 等级为 0.72，软骨形态为 0.72，滑膜炎为 0.62。 BLOKS 量表上的最大 BML 大小与视觉模拟量表 (VAS) 疼痛呈正线性关系，但 WORMS 量表则不然。基线 BML 与 BLOKS 和 WORMS 量表上的软骨损失相关。 BLOKS 的这种关联性比 WORMS 更强。结论：我们设计了一种新颖的 MRI OA 膝关节评分系统 BLOKS，该系统表现出良好的可靠性。对这一新工具的其中一个组件的有效性的初步检查支持了 BLOKS BML 评分方法相对于现有工具的有效性。进一步的迭代开发将包括在临床试验和流行病学研究中使用的验证。
Aim: MRI provides unparalleled visualisation of all the anatomical structures involved in the osteoarthritis (OA) process. There is a need for reliable methods of quantifying abnormalities of these structures. The aim of this work was to assess the reliability of a novel MRI scoring system for evaluating OA of the knee and explore the validity of the bone marrow lesion (BML) scoring component of this new tool.Methods: After review of the relevant literature, a collaborative group of rheumatologists and radiologists from centres in the UK and USA established preliminary anatomical divisions, items ( necessarily broadly inclusive) and scaling for a novel semi- quantitative knee score. A series of iterative reliability exercises were performed to reduce the initial items, and the reliability of the resultant Boston-Leeds Osteoarthritis Knee Score ( BLOKS) was examined. A further sample had both the BLOKS and WORMS ( Whole Organ MRI Score) bone marrow lesion ( BML) score performed to assess the construct validity ( relation to knee pain) and longitudinal validity ( prediction of cartilage loss) of each scoring method.Results: The BLOKS scoring method assesses nine intraarticular regions and contains eight items, including features of bone marrow lesions, cartilage, osteophytes, synovitis, effusions and ligaments. The scaling for each feature ranges from 0-3. The inter-reader reliability for the final BLOKS items ranged from 0.51 for meniscal extrusion up to 0.79 for meniscal tear. The reliability for other key features was 0.72 for BML grade, 0.72 for cartilage morphology, and 0.62 for synovitis. Maximal BML size on the BLOKS scale had a positive linear relation with visual analogue scale ( VAS) pain, however the WORMS scale did not. Baseline BML was associated with cartilage loss on both BLOKS and WORMS scale. This association was stronger for BLOKS than WORMS.Conclusion: We have designed a novel scoring system for MRI OA knee, BLOKS, that demonstrates good reliability. Preliminary inspection of the validity of one of the components of this new tool supports the validity of the BLOKS BML scoring method over an existing instrument. Further iterative development will include validation for use in both clinical trials and epidemiological studies.