Reliability assessment and multicenter clinical application of magnetic resonance methods for knee cartilage quantification
Background: This study evaluated interreader agreement and longitudinal performance of MRI methods for knee cartilage volume, thickness, and defect-area quantification. Methods: AI-presegmented masks from 1,189 phase III examinations underwent independent correction by two readers and adjudication. Cartilage volume, three-dimensional ray-tracing thickness (3D-RT), and ray-based defect area (3D-RBA), defined by a 1.5-mm thickness threshold, were calculated. Agreement was assessed using segmentation metrics, intraclass correlation coefficients (ICCs), repeated-measures Bland-Altman analysis, and minimal detectable change at 95% confidence (MDC95). The 3D-RBA framework was evaluated in 120 digital-phantom experiments from 40 participants. Longitudinal analyses included 374 participants, alternative-method comparisons included 65, and retrospective phase II analysis included 24 participants with four visits. Results: Overall AI-to-adjudicated-mask Dice was 0.964 +/- 0.029. Interreader ICCs for volume, thickness, and defect area were 0.956, 0.904, and 0.932; corresponding MDC95 values were 1,596.9 mm^3, 0.227 mm, and 147.4 mm^2. Geometric mean absolute percentage error for defect area was 5.62%, with spatial Dice of 0.961. In 374 participants, volume changes correlated positively with thickness changes (rho=0.431) and negatively with defect-area changes (rho=-0.221). Within-participant phase II correlations followed the same directions in both groups. Conclusions: The workflow demonstrated good interreader agreement. Controlled geometric results and longitudinal associations supported the feasibility of threshold-based defect-area estimation. Volume, thickness, and defect area provide complementary measures of cartilage structure.