MRI T2 and T1 relaxation in patients at risk for knee osteoarthritis: a systematic review and meta-analysis

BackgroundMagnetic resonance imaging (MRI) T2 and T1 relaxation are increasingly being proposed as imaging biomarkers potentially capable of detecting biochemical changes in articular cartilage before structural changes are evident. We aimed to: 1) summarize MRI methods of published studies investigating T2 and T1 relaxation time in participants at risk for but without radiographic knee OA; and 2) compare T2 and T1 relaxation between participants at-risk for knee OA and healthy controls.MethodsWe conducted a systematic review of studies reporting T2 and T1 relaxation data that included both participants at risk for knee OA and healthy controls. Participant characteristics, MRI methodology, and T1 and T2 relaxation data were extracted. Standardized mean differences (SMDs) were calculated within each study. Pooled effect sizes were then calculated for six commonly segmented knee compartments.Results55 articles met eligibility criteria. There was considerable variability between scanners, coils, software, scanning protocols, pulse sequences, and post-processing. Moderate risk of bias due to lack of blinding was common. Pooled effect sizes indicated participants at risk for knee OA had lengthened T2 relaxation time in all compartments (SMDs from 0.33 to 0.74; p<0.01) and lengthened T1 relaxation time in the femoral compartments (SMD from 0.35 to 0.40; p<0.001).ConclusionsT2 and T1 relaxation distinguish participants at risk for knee OA from healthy controls. Greater standardization of MRI methods is both warranted and required for progress towards biomarker validation.