Gadolinium contrast agent is of limited value for magnetic resonance imaging assessment of synovial hypertrophy in hemophiliacs

Lundin, Björn; Berntorp, Erik; Pettersson, Holger; Wirestam, Ronnie; Jonsson, Kjell; Ståhlberg, Freddy; Ljung, Rolf

doi:10.1080/02841850701280775

Cited by 24 publications

(19 citation statements)

References 35 publications

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“…In keeping with these observations, Pettersson radiographic scores which indicate advanced bony changes correlated significantly with synovial thickness on both imaging studies in adults but not in children which has also been reported by Lundin et al. on MRI [20]. Nuss et al.…”

Section: Discussionsupporting

confidence: 77%

“…MRI studies were acquired with a 3.0T GE (General electric, Milwaukee, WI, USA) scanner using a single‐channel linear extremity coil. Gadopentetate dimeglumine (Gd‐DTPA) (Magnevist ® ; Berelx Laboratories, Wayne, NJ, USA) was used as a paramagnetic contrast agent at a concentration of 0.1 m m kg −1 as previously described [20]. Dynamic contrast enhanced (DCE) perfusion studies were acquired using a 3D FAME (Fast Acquisition with Multiphase Enhanced) gradient echo sequence as previously described [21].…”

Section: Methodsmentioning

confidence: 99%

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Power Doppler sonography in the diagnosis of hemophilic synovitis – a promising tool

Acharya

Schloss

Dyke

et al. 2008

Journal of Thrombosis and Haemostasis

106

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Summary. Background: Recurrent hemarthroses in hemophilia results in synovitis and joint arthropathy. Primary prophylaxis when universally instituted at current doses can prevent joint deterioration but is expensive. Alternatively, the selective implementation of prophylaxis would require a more sensitive tool for detecting synovitis than possible with clinical surveillance or plain radiographs. Magnetic resonance imaging (MRI) is such a tool and is utilized for the evaluation of hemophilic joint disease (HJD). However, it is expensive, and requires sedation in younger children precluding its utility for monitoring of synovitis. Ultrasonography (USG) with power Doppler (USG-PDS) has been utilized to detect and quantitate synovial vascularity in other arthritides and could provide an equally effective but less costly tool for HJD, particularly in children who would not require sedation. Objectives: To determine whether USG-PDS is comparable to MRI in the evaluation of hemophilic synovitis. Patients: A prospective cohort of 31 subjects including 33 joints (knees, elbows, ankles) underwent dynamic contrast enhanced (DCE)-MRI and USG-PDS. Results: USG-PDS measurements of synovial thickness(r = 0.70, P < 0.0001) and synovial vascularity (r = 0.73, P < 0.0001) correlated strongly with those obtained with DCE-MRI. A cutoff of PDS intensity of 1.3 decibels (dB) per mm 2 was found to yield a sensitivity of 100% and a specificity of 94.1% in 17 joints with/without a history of hemarthroses. Pettersson radiographic scores correlated significantly with synovial thickness in adults but not children. Conclusions: Our data suggest that USG-PDS may be an inexpensive and easily implemented imaging tool for detecting hemophilic synovitis and could be useful in tailoring effective prophylaxis.

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Section: Discussionsupporting

confidence: 77%

Section: Methodsmentioning

confidence: 99%

Power Doppler sonography in the diagnosis of hemophilic synovitis – a promising tool

Acharya

Schloss

Dyke

et al. 2008

Journal of Thrombosis and Haemostasis

106

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“…Consequently, the sensitivity and positive predictive value of POC‐US in the evaluation of synovial hypertrophy may have been overestimated in our study. However, this is unlikely as synovial hypertrophy according to the IPSG MRI score is evaluated using robust surface measurements in a single MRI slice only . Therefore, MRI with contrast is not expected to change the classification of synovial hypertrophy according to the haemophilia specific MRI score.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…However, Lundin et al. [14] showed that routine enhanced MR imaging did not improve the evaluation of synovial hypertrophy. The need for improved quantitative assessment methods should be taken into account when developing new imaging techniques and software.…”

Section: Discussionmentioning

confidence: 99%

“…This is qualitative not quantitative evaluation, but it is still very helpful for monitoring synovial changes during treatment. We did not evaluate quantitatively the hypertrophied synovium changes even on the enhanced MR imaging, although other authors have evaluated the synovial changes [10,14], with a semiquantitative assessment. However, Lundin et al [14] showed that routine enhanced MR imaging did not improve the evaluation of synovial hypertrophy.…”

Section: Discussionmentioning

confidence: 99%

Comparison of radiography, CT and MR imaging in detection of arthropathies in patients with haemophilia

Lin

Guermazi

et al. 2009

Haemophilia

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To compare magnetic resonance (MR) imaging, computed tomography (CT) and radiography for the detection of arthropathies in patients with haemophilia. Forty-one symptomatic joints in 14 men with haemophilia, ages 11-24 years (mean age 17.5 +/- 3.9 years) were examined with radiography, CT and MR. Images of each joint were acquired on the same day. The precontrast MR examination obtained coronal spin-echo T1 images and gradient echo with rephasing T2* images, as well as sagittal, axial gradient echo with rephasing T2* images using a low-field-strength 0.3-T MR imager. For the postcontrast MR examination, coronal, sagittal and axial images were acquired using the same precontrast T1 sequence. Thirteen joints were also examined on enhanced MR. The severity of damage was classified using conventional radiographical staging. Severely affected haemophilic arthropathy (HA) patients (stage 5) were excluded. Findings of soft tissue swelling, osteoporosis, epiphyseal overgrowth, joint erosion, cysts, joint space narrowing, bone marrow oedema, joint effusion, haemorrhage, synovial hypertrophy and widened intercondylar notches as well as anterior and posterior cruciate ligaments (for the knee) were used in all imaging comparisons. The joints were classified by radiographical criteria into stage 0 (n = 5), stage 1 (n = 7), stage 2 (n = 6), stage 3 (n = 8) and stage 4 (n = 15). Soft tissue swelling or joint effusion was observed in 33 joints on radiographs, in 34 on both CT and MR; joint erosions were observed in 34 joints on MR, 33 on CT and 20 on radiographs. Joint cysts appeared in 21 joints on MR, 18 on CT and 9 on radiographs. Significant differences in detection of erosion and cysts were found between radiography and CT (P < 0.05) and radiography and MR imaging (P < 0.05), not between CT and MR (P > 0.05). MR was better for detecting foci of both erosion and cysts than CT and radiography, and CT was better than radiography. MR imaging, CT and radiography were equally effective in showing the changes of epiphyseal overgrowth in 26 joints, joint space narrowing in 14 joints and widened intercondylar notches in 20 knee joints. However, only MR imaging detected tears in 17 anterior and 13 posterior cruciate ligaments in the 20 knee joints with widened intercondylar notches. Bone marrow oedema in 14 joints, haemorrhage in 34 joints and synovial hypertrophy in 27 joints were seen on MR images, but not on CT or radiography. MR imaging is superior to CT and conventional radiography for detecting abnormal changes and should be considered the first choice among imaging modalities in evaluating HAs.

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Gadolinium contrast agent is of limited value for magnetic resonance imaging assessment of synovial hypertrophy in hemophiliacs

Cited by 24 publications

References 35 publications

Power Doppler sonography in the diagnosis of hemophilic synovitis – a promising tool

Power Doppler sonography in the diagnosis of hemophilic synovitis – a promising tool

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

Comparison of radiography, CT and MR imaging in detection of arthropathies in patients with haemophilia

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