Extract

Sir, Thank you for the opportunity to respond to the letter from Crema and colleagues [1] about our recent article [2]. They have commented on the assessment of bone marrow lesions (BMLs) using MRI from a radiological perspective. While this is important, as previously mentioned in a reply [3] to a similar comment from the same group [4], these comments are made in the absence of any data comparing the reliability and sensitivity of T1- and T2-weighted images in detecting the presence of BMLs and their changes in size over time in knee OA patients. Indeed, a review of published studies does not seem to support this view, including publications from this group. The fact that T2-weighted sequences may show bigger BML size is not necessarily better and may be a simplistic view of this particular study and other similar works. Until accurate comparative studies are conducted, the above issue will remain based only on qualitative assessment and impression rather than conclusions from reliable scientific observations.

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