Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score) D.J. Hunter, A. Guermazi, G.H. Lo, A.J. Grainger,

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Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score) D.J. Hunter, A. Guermazi, G.H. Lo, A.J. Grainger, P.G. Conaghan, R.M. Boudreau, F.W. Roemer Osteoarthritis and Cartilage Volume 19, Issue 8, Pages 990-1002 (August 2011) DOI: 10.1016/j.joca.2011.05.004 Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Subregional division of the patella in the axial plane. Axial T2w image shows the medial (M) and lateral (L) portions of the patella as divided in MOAKS. Note that the patellar apex is part of the medial subregion (arrow). Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Anatomical delineation of femur into trochlea (T), central (C) and posterior (P) regions on sagittal projection. Sagittal projection depicts delineation of the tibia into anterior, central and posterior sub-regions, which is divided into equal thirds. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Coronal IW image shows anatomical delineation of the tibia into medial, subspinous (SS) and lateral sub-regions. The femur is divided into the medial and lateral femoral condyle. The intercondylar notch is considered to be part of the medial femur. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 BML grading. Grade 0=none, grade 1 <33% of subregional volume, grade 2=33–66% of subregional volume and grade 3 >66% of subregional volume. A. Coronal T2 w image shows small grade 1 BML in central subregion of medial tibia. B. A grade 2 BML is depicted in central subregion of medial femur. C. Grade 3 BMLs in the central sub-regions of the medial femur (arrows) and central medial tibia (arrowheads). D. Coronal image shows BML consisting of non-cystic/ill-defined portion (arrowheads) and cystic (arrow) part. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Grade for size of any cartilage loss as a % of surface area as related to the size of each individual region. Grade 0=none, grade 1 <10% of region of cartilage surface area, grade 2=10–75% of region of cartilage surface area and grade 3 >75% of region of cartilage surface area. (Drawing courtesy of Daichi Hayashi, MD). Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Locations for osteophytes scoring. A. Coronal plane. Osteophytes are scored at the marginal locations of the medial and lateral femur and tibia, respectively (arrowheads). B. Sagittal plane. Osteophytes are scored at the superior and inferior patellar pole (arrowheads). C. Axial plane. Osteophytes are scored at the medial and lateral patella poles (arrowheads), at the anterior medial and lateral femur (black arrows) and the posterior femur medial and lateral (white arrows). Note that there are two locations medially and laterally for osteophytes scoring at the posterior femur, the central and peripheral location. Only the larger osteophyte for either the central or peripheral location will be scored. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 7 Scoring of osteophytes. Grade 0=none, grade 1=small, grade 2=medium and grade 3=large. A. Grade 1 osteophyte medial femur. B. Grade 2 osteophyte lateral femur. C. Grade 3 osteophyte lateral femur. Size of osteophyte should reflect protuberance (how far the osteophyte extends from the joint) rather than total volume of osteophyte. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 8 Hoffa-synovitis. Sagittal T2w image shows grade 2 hyperintense signal changes in Hoffa’s fat pad consistent with Hoffa-synovitis. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions

Fig. 9 Effusion-synovitis. Hyperintensity within the articular cavity represents a composite of effusion and synovial thickening that cannot be distinguished from each other in the absence of contrast. Grade 0=none, grade 1=small, grade 2=medium and grade 3=large. A. Grade 0 effusion-synovitis. Normal intra-articular hyperintensity is depicted. B. Grade 1 effusion-synovitis. C. Grade 2 effusion-synovitis. D. Grade 3 effusion-synovitis. Osteoarthritis and Cartilage 2011 19, 990-1002DOI: (10.1016/j.joca.2011.05.004) Copyright © 2011 Osteoarthritis Research Society International Terms and Conditions