Hemosiderin deposition evaluation in hemophilic ankle joints: association between US finding and gradient-recalled echo MR imaging sequence

Abstract

Background Repeated bleeding in hemophilic arthropathy (HA) may result in severe degenerative changes and joint destruction. The gradient-recalled echo (GRE) sequence MR is proved to be the best method to detect hemosiderin deposition. However, MR is not widely available in developing countries, including Indonesia. Some studies have proposed ultrasonography (US) as an alternative tool in evaluating hemophilic joint. However, there is still some disagreement on the ability of US to detect hemosiderin deposition. Objective To evaluate the association between US and GRE-sequence MR imaging in detecting hemosiderin deposition in hemophilic ankle joint. Material and methods A total of 102 sites from 17 ankle joints of 11 boys with severe hemophilia A underwent US examination using a high-frequency linear array transducer. GRE-sequence MR examination was performed in sagittal view consistent with the sites scanned by US. Both examinations were performed on the same day, but MR interpretation was performed blindly at different times. The association between US and GRE-sequences in detecting hemosiderin deposition was analyzed using McNemar’s test. Results Statistical analysis showed a significant association (p value < 0.001) between US and GRE MR in detecting hemosiderin deposition, but the association is weak (R = 0.26). Sensitivity and specificity of US for detecting hemosiderin deposition were 46.84% (95%CI: 35.51–58.40) and 95.65% (95%CI: 78.05–99.89), respectively, with positive predictive value 97.37% (95%CI: 84.29–99.61), negative predictive value 34.38% (95%CI: 29.50–39.60) and accuracy 57.84% (95%CI: 47.66–67.56). Conclusion There was a weak association between US and GRE-sequences in detecting hemosiderin deposition of hemophilic ankle joint. ​​

Hemophilic Arthropathy: Barriers to Early Diagnosis and Management

“…Such hemosiderin deposits can stimulate further synovial hypertrophy and swelling. 7 Several in vitro and in vivo animal studies have shown how blood has a direct effect on cartilage due to the combination of mononuclear cells and red blood cells present in the blood. 8 The development of hemarthrosis induces chondrocyte apoptosis, which alters the cartilage matrix renewal.…”

Foam roller-based self-induced myofascial therapy in patients with hemophilic knee arthropathy: a multicenter, single-blind, randomized clinical study

“…Such hemosiderin deposition can stimulate further synovial hypertrophy and inflammation. 4 The development of hemarthrosis induces chondrocyte apoptosis, 5 which alters cartilage matrix regeneration. Initially expressed by hypertrophic synovium, hypervascularization occurs on the synovial tissue, increasing the risk of further bleeding, and the onset of inflammatory changes.…”

Reliability of haemophilia early arthropathy detection with ultrasound (HEAD-US) in children: a comparative magnetic resonance imaging (MRI) study

“…18 In another study that evaluated ankles in 11 boys with haemophilia, Prasetyo et al evaluated only the ability of US to detect hemosiderin deposits within the joint and determined that the association between the US and MRI for detection of hemosiderin deposits was weak. 19 Additional two studies included children as a part of their study group. Sierra Aisa et al included patients with HA between the age of 4-82 years and reported sensitivity, specificity, positive predictive value, and negative predictive value for diagnosing HA within the same interval as presented in our study.…”