A systematic review of MR imaging as a tool for evaluating haemophilic arthropathy in children

Abstract

Summary Our purposes were to determine: (i) whether there is direct evidence that currently available MRI techniques are accurate for early diagnosis of pathological findings in haemophilic arthropathy; (ii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy; (iii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy. Articles were screened using MEDLINE (n = 566), EMBASE (n = 201), and the Cochrane Library (n = 1). Two independent reviewers assessed articles for inclusion under the overarching purposes of the review by using the Standards for Reporting of Diagnostic Accuracy (STARD) tool, and the quality of the studies were graded using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2) tool. The electronic literature search retrieved 777 references (after duplicates were removed). A total of 32 studies were chosen for inclusion from the results of the search and review of bibliographical references. Using the STARD tool, seven studies were of excellent quality of reporting, and using the QUADAS‐2 tool, 10 studies were judged to be of adequate quality. There is ‘fair’ evidence to recommend MRI as an accurate test for detecting evidence of haemophilic arthropathy and the use of second or third generation MRI scales for assessing haemophilic arthropathy. However, there is no evidence that screening of early intra‐articular soft tissue bleed with MRI improves the functional status of joints over time.

Imaging of haemophilic arthropathy in growing joints: pitfalls in ultrasound and MRI

“…In the last 15 years, several MR‐based scoring systems have been proposed . MRI can depict both soft tissue and osteochondral changes in reproducible and measurable ways that allow proper follow‐up, and is considered the reference standard imaging technique for assessment of haemophilic arthropathy . First‐generation scores include the Denver and the European score.…”

“…Previous investigation has shown that the use of gadolinium contrast agent is not useful for evaluating chronic haemophilic arthropathy due to the obscuration of synovial enhancement by adjacent haemosiderin deposition in cases of massive haemosiderin impregnation within the synovium . In unenhanced MR studies, the low‐to‐intermediate T1 signal hypertrophied synovium cannot be separately discriminated from low T1 signal joint effusion or low T1, T2 or GRE signal intra‐articular haemosiderin . This usually results in underestimation of the degree of synovial hypertrophy on MRI.…”

Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

“…Magnetic Resonance Imaging (MRI) is the most sensitive imaging modality to demonstrate early intra-articular joint changes. 8 As MRI is relatively expensive and time consuming, routine assessment of multiple joints of haemophilia patients is not feasible. As ultrasound showed to be highly accurate in assessing synovial hypertrophy, it may provide an alternative for MRI.…”

Nacionalna priporočila za obravnavo bolnikov s hemofilijo

“…Haemophilia Early Arthropathy Detection with UltraSound), ali z MR slikanjem po protokolu IPSG (angl. International Prophylaxis Study Group) (90,91).…”