PET/MRI of metabolic activity in osteoarthritis: A feasibility study

Feliks Kogan, Audrey P. Fan, Emily J. McWalter, Edwin H.G. Oei, Andrew Quon, Garry E. Gold

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Purpose: To evaluate positron emission tomography / magnetic resonance imaging (PET/MRI) knee imaging to detect and characterize osseous metabolic abnormalities and correlate PET radiotracer uptake with osseous abnormalities and cartilage degeneration observed on MRI. Materials and Methods: Both knees of 22 subjects with knee pain or injury were scanned at one timepoint, without gadolinium, on a hybrid 3.0T PET-MRI system following injection of 18F-fluoride or 18F-fluorodeoxyglucose (FDG). A musculoskeletal radiologist identified volumes of interest (VOIs) around bone abnormalities on MR images and scored bone marrow lesions (BMLs) and osteophytes using a MOAKS scoring system. Cartilage appearance adjacent to bone abnormalities was graded with MRI-modified Outerbridge classifications. On PET standardized uptake values (SUV) maps, VOIs with SUV greater than 5 times the SUV in normal-appearing bone were identified as high-uptake VOI (VOIHigh). Differences in 18F-fluoride uptake between bone abnormalities, BML, and osteophyte grades and adjacent cartilage grades on MRI were identified using Mann–Whitney U-tests. Results: SUVmax in all subchondral bone lesions (BML, osteophytes, sclerosis) was significantly higher than that of normal-appearing bone on MRI (P < 0.001 for all). Of the 172 high-uptake regions on 18F-fluoride PET, 63 (37%) corresponded to normal-appearing subchondral bone on MRI. Furthermore, many small grade 1 osteophytes (40 of 82 [49%]), often described as the earliest signs of osteoarthritis (OA), did not show high uptake. Lastly, PET SUVmax in subchondral bone adjacent to grade 0 cartilage was significantly lower compared to that of grades 1–2 (P < 0.05) and grades 3–4 cartilage (P < 0.001). Conclusion: PET/MRI can simultaneously assess multiple early metabolic and morphologic markers of knee OA across multiple tissues in the joint. Our findings suggest that PET/MR may detect metabolic abnormalities in subchondral bone, which appear normal on MRI. Level of Evidence: 2. Technical Efficacy: Stage 1. J. MAGN. RESON. IMAGING 2017;45:1736–1745.

Original languageEnglish (US)
Pages (from-to)1736-1745
Number of pages10
JournalJournal of Magnetic Resonance Imaging
Issue number6
StatePublished - Jun 2017
Externally publishedYes


  • bone remodeling
  • osteoarthritis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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