A systematic review of ultrasound imaging as a tool for evaluating haemophilic arthropathy in children and adults

Abstract

The purpose of this study was to semi-quantitatively assess the evidence on the value of ultrasound (US) for assessment of haemophilic arthropathy (HA) in children and adults based on the following questions: (1) Does early diagnosis of pathological findings, using available US techniques, impact the functional status of the joint? (2) Do current available US techniques have the ability to accurately detect pathological changes in target joints in haemophilic patients? (3) Does treatment (prophylaxis) improve US evidence of haemophilic arthropathy in children and adults? (4) Is there any association between various US scoring systems and other clinical/radiological constructs? Of the 6880 citations identified searching databases such as MEDLINE, Embase, CENTRAL and Web of Science, 20 articles investigating either the diagnostic accuracy of US and/or US scanning protocols and scoring systems for assessment of HA met the inclusion criteria for the study. Of these, 14 articles evaluating the diagnostic accuracy of US were assessed by two independent reviewers for reporting quality using the Standards for Reporting of Diagnostic Accuracy (STARD) tool and for methodological quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Using STARD, 1/14 studies (7%) was scored as of high reporting quality and 8/14 (57%), of moderate quality. Assessment with QUADAS-2 reported 2/14 (14%) studies as having high methodological quality and 6/14 (43%) as having moderate quality. There is fair evidence (Grade B) to recommend US as an accurate technique for early diagnosis of HA, to demonstrate that US scores correlate with clinical/US constructs and to prove an association between US findings and functional status of the joint. However, there is insufficient evidence (Grade I) to conclude that US-detectable findings in HA are sensitive to changes in therapy.

Comparison of the efficacy and safety of 12‐month low‐dose factor VIII tertiary prophylaxis vs on‐demand treatment in severe haemophilia A children

“…The HJHS results in our study showed higher scores compared to Magnetic resonance imaging (MRI) is the standard modality in the evaluation of haemophilic arthropathy, but it is expensive, may require sedation in children and is not widely available. 25 Ultrasound is an alternative to MRI, which is less expensive, fast and does not require sedation in paediatric patients. [25][26][27][28] The HEAD-US scoring system is different than others due to the additional score for synovial hypertrophy with emphasis on quantitative scoring of cartilage and bone changes.…”

“…25 Ultrasound is an alternative to MRI, which is less expensive, fast and does not require sedation in paediatric patients. [25][26][27][28] The HEAD-US scoring system is different than others due to the additional score for synovial hypertrophy with emphasis on quantitative scoring of cartilage and bone changes. It is fast to perform and capable of screening six joints (elbows, knees and ankles) at a time.…”

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

“…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 . Various clinicians perform ultrasound examinations themselves for specific indications, known as point‐of‐care ultrasound (POC‐US) .…”

Physiotherapist inter‐rater reliability of the Haemophilia Early Arthropathy Detection with Ultrasound protocol

“…Recently, there has been increasing interest in using ultrasound (US) imaging to evaluate soft tissue, such as synovial hypertrophy and peripheral cartilage in people with haemophilia . Compared to MRI, ultrasound imaging is more readily available and a quarter the cost (Health England NHS Tariff).…”

“…Recently, there has been increasing interest in using ultrasound (US) imaging to evaluate soft tissue, such as synovial hypertrophy and peripheral cartilage in people with haemophilia. [6][7][8][9][10][11][12][13][14] Compared to MRI, ultrasound imaging is more readily available and a quarter the cost (Health England NHS Tariff). Ultrasound examinations proposed by Doria et al 13 and Melchiorre et al 15 have demonstrated good reliability when performed by imaging specialists.…”