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

Abstract

Introduction Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging (MRI) is associated with an increased risk of future joint bleeding. Aim The aim of this study was to investigate whether point‐of‐care ultrasound (POC‐US) is an accurate alternative for MRI for the detection of early joint changes. Methods In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X‐rays were scanned using POC‐US and 3 Tesla MRI. POC‐US was performed by 1 medical doctor, blinded for MRI, according to the “Haemophilia Early Arthropathy Detection with Ultrasound” (HEAD‐US) protocol. MRIs were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals (CI). Results Knees and ankles of 24 haemophilia patients (96 joints), aged 18‐34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC‐US for synovial tissue was correct (overall accuracy) in 97% (CI: 91‐99) with a positive predictive value of 94% (CI: 73‐100) and a negative predictive value of 97% (CI: 91‐100). The overall accuracy of POC‐US for cartilage abnormalities was 91% (CI: 83‐96) and for bone surface irregularities 97% (CI: 91‐99). Conclusion POC‐US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC‐US is an accurate and available alternative for MRI, it can be used for routine evaluation of early joint changes.

Joint status in Spanish haemophilia B patients assessed using the Haemophilia Early Arthropathy Detection with Ultrasound (HEAD‐US) score

“…The HEAD‐US scoring system was designed to provide a means to follow‐up the joint status longitudinally, in order to assess the results of treatment and to measure outcomes. It is intended to be used as a point‐of‐care tool by non‐imaging experts, and can greatly minimize operator‐dependency since it is based on a straightforward protocol which has been developed to allow joint assessment by non‐radiologists…”

“…[12][13][14][15][16][17][18][19] Its use in the diagnosis and evaluation of the early stages of haemophilic arthropathy was described for the first time in 1992 by Merchan et al 20 and since then MSK-US has shown excellent results in depicting disease-specific findings, including haemarthrosis episodes and their evolution, 16,17,21,22 persistence of changes beyond apparent healing, 23 chronic synovial proliferation and articular cartilage and subchondral bone damage. 17,24,25 The HEAD-US scoring system 15 was designed to provide a means to follow-up the joint status longitudinally, in order to assess the results of treatment and to measure outcomes.…”

“…It is intended to be used as a point-of-care tool by non-imaging experts, 25 and can greatly minimize operator-dependency since it is based on a straightforward protocol which has been developed to allow joint assessment by non-radiologists. 15 The aim of this study was twofold: (a) to screen the elbows, knees and ankles in the HB population of Spain using MSK-US; and (b) to explore the relationship of joint status with disease type and treatment strategy.…”

“…Nonetheless, in a recent publication,19 MSK-US was shown to be more sensitive in detecting low concentrations of intra-articular blood than MRI in vitro and in vivo, demonstrating that MSK-US may be a suitable technique for rapid bleed detection in clinical practice. In addition, a recent diagnostic accuracy study25 has demonstrated that ultrasound, according to the HEAD-US protocol, could accurately evaluate the presence of synovial hypertrophy in joints of haemophilia patients. Thus, MSK-US may represent a fast, easily accessible and affordable alternative for MRI for the evaluation of early joint changes and it may also help determine the need for an MRI scan, 15 thereby promoting better assessment of arthropathy in routine patient care while contributing to a rational use of medical resources.Our study represents a novel approach to the epidemiology of haemophilic arthropathy in HB patients, with a considerable sample size given the low prevalence of this condition and provides new insight on the joint status of HB patients and the effect of treatment decisions.…”

Merging into the mainstream: the evolution of the role of point-of-care musculoskeletal ultrasound in hemophilia

“…The diagnostic accuracy of the HEAD-US, POC-MSKUS protocol for the detection of HA biomarkers, compared with joint MRI, was recently evaluated by Foppen et al . 84 . HEAD-US was found to be able to accurately assess the presence/absence of synovial hypertrophy in joints of PwH with a positive predictive value of 94% (confidence interval (CI) 73–100%) and a negative predictive value of 97% (CI 91–100%).…”