University of Oulu

Guermazi A, Roemer FW, Crema MD, Jarraya M, Mobasheri A, Hayashi D. Strategic application of imaging in DMOAD clinical trials: focus on eligibility, drug delivery, and semiquantitative assessment of structural progression. Therapeutic Advances in Musculoskeletal Disease. 2023;15. doi:10.1177/1759720X231165558

Strategic application of imaging in DMOAD clinical trials : focus on eligibility, drug delivery, and semiquantitative assessment of structural progression

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Author: Guermazi, Ali1,2; Roemer, Frank W.1,2; Crema, Michel D.3,4;
Organizations: 1Department of Radiology, School of Medicine, Boston University, Boston, MA 02132, USA
2VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA, USA
3Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
4Department of Radiology, School of Medicine, Boston University, Boston, MA, USA
5Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
6Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
7Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
8Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
9World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
10Department of Radiology, Tufts Medical Center, Tufts Medicine, Boston, MA, USA
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.9 MB)
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Language: English
Published: SAGE Publications, 2023
Publish Date: 2023-09-28


Despite decades of research efforts and multiple clinical trials aimed at discovering efficacious disease-modifying osteoarthritis (OA) drugs (DMOAD), we still do not have a drug that shows convincing scientific evidence to be approved as an effective DMOAD. It has been suggested these DMOAD clinical trials were in part unsuccessful since eligibility criteria and imaging-based outcome evaluation were solely based on conventional radiography. The OA research community has been aware of the limitations of conventional radiography being used as a primary imaging modality for eligibility and efficacy assessment in DMOAD trials. An imaging modality for DMOAD trials should be able to depict soft tissue and osseous pathologies that are relevant to OA disease progression and clinical manifestations of OA. Magnetic resonance imaging (MRI) fulfills these criteria and advances in technology and increasing knowledge regarding imaging outcomes likely should play a more prominent role in DMOAD clinical trials. In this perspective article, we will describe MRI-based tools and analytic methods that can be applied to DMOAD clinical trials with a particular emphasis on knee OA. MRI should be the modality of choice for eligibility screening and outcome assessment. Optimal MRI pulse sequences must be chosen to visualize specific features of OA.

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Series: Therapeutic advances in musculoskeletal disease
ISSN: 1759-720X
ISSN-E: 1759-7218
ISSN-L: 1759-720X
Volume: 15
Article number: 1759720X231165558
DOI: 10.1177/1759720X231165558
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © The Author(s), 2023. Article reuse guidelines: Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (