OSTEOARTHRITIS: Edited by Mukundan AtturAdvances in osteoarthritis imagingChalian, Majida; Roemer, Frank W.b,c; Guermazi, Alic,d Author Information aDepartment of Radiology, University of Washington, Seattle, Washington, USA bDepartment of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany cQuantitative Imaging Center, Department of Radiology, Boston University School of Medicine dDepartment of Radiology, VA Boston Healthcare System, Boston, Massachusetts, USA Correspondence to Ali Guermazi, MD, PhD, 1400 VFW Parkway, Suite 1B105, West Roxbury, MA 02132, USA. E-mail: [email protected] Current Opinion in Rheumatology 35(1):p 44-54, January 2023. | DOI: 10.1097/BOR.0000000000000917 Buy Metrics Abstract Purpose of review Imaging plays a pivotal role for diagnosis, follow-up and stratification of osteoarthritis patients in clinical trials and research. We aim to present an overview of currently available and emerging imaging techniques for osteoarthritis assessment and provide insight into relevant benefits and pitfalls of the different modalities. Recent findings Although radiography is considered sufficient for a structural diagnosis of osteoarthritis and is commonly used to define eligibility of patients for participation in clinical trials, it has inherent limitations based on the projectional nature of the technique and inherent challenges regarding reproducibility in longitudinal assessment. MRI has changed our understanding of the disease from ‘wear and tear’ of cartilage to a whole organ disorder. MRI assessment of structural changes of osteoarthritis includes semi-quantitative, quantitative and compositional evaluation. Ultrasound is helpful in evaluating the degree of synovitis and has value in the assessment particularly of the patella-femoral joint. Recent development of computed tomography technology including weight-bearing systems has led to broader application of this technology in a research context. Summary Advances in MRI technology have resulted in a significant improvement in understanding osteoarthritis as a multitissue disease Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.