Reply to Roemer and Guermazi: Early biochemical changes on MRI can predict risk of symptomatic progression

We thank Roemer and Guermazi for their Letter, “Biochemical cartilage changes based on MRI-defined T2 relaxation times do not equal OA detection” (1). In their comments on our paper (2), the authors (1) raise questions about osteoarthritis (OA) incidence, visual signs of disease on the images, MRI-based scoring systems, and radiomics which we address below. In ref. 2, we propose a fully automated machine learning technique for discovery of imaging biomarkers in the cartilage of asymptomatic individuals for prediction of future symptomatic OA. We overcome a long-standing limitation of machine learning regarding explainability, by enabling visual recognition of classification biomarkers. First, regarding OA incidence, the American College of Rheumatology publication (3) cited by the authors (1) recommends diagnosis based on … [↵][1]1To whom correspondence may be addressed. Email: skundu2{at}jhmi.edu. [1]: #xref-corresp-1-1