Objective: To synthesize up-to-date evidence on the value of magnetic resonance imaging (MRI) for early detection of knee osteoarthritis (OA) and cartilage damage before radiographic changes and irreversible structural loss occur.
Methods: A targeted search (2000–2025) was conducted in PubMed, Embase and Scopus using the keywords “osteoarthritis”, “MRI”, “cartilage”, “compositional MRI”, “T1rho”, “T2 mapping”, “dGEMRIC”, “bone marrow lesion”, “MOAKS/WORMS”. Priority was given to human studies and major reviews on early-stage disease and cartilage lesions; case reports and studies not using MRI were excluded.
Results: Compared with radiography, MRI enables whole-joint assessment in early OA, including alterations of the cartilage matrix, meniscal tear/hernation, subchondral bone lesions (BMLs), and synovitis/effusion. Semi-quantitative scoring systems such as WORMS and MOAKS allow reproducible whole-joint evaluation and prognostication. Compositional MRI techniques (T1rho, T2/T2* and dGEMRIC) detect biochemical changes in proteoglycan and collagen networks before morphological cartilage loss, with a certain degree of correlation between techniques [4,5]. BMLs and synovitis are associated with pain and predict structural progression, representing potential therapeutic targets; 3.0-T MRI shows higher sensitivity for detecting cartilage lesions than 1.5-T systems.
Conclusion: MRI provides sensitive and comprehensive assessment in early OA and cartilage damage, supports identification of high-risk patients and monitoring of structural change. Combining whole-joint semi-quantitative scoring with quantitative compositional measurements on optimized 3.0-T MRI constitutes an appropriate framework for early diagnosis, risk stratification and follow-up in clinical practice and clinical trials.