Magnetic resonance imaging in teenagers and young adults with limited haemophilic arthropathy: baseline results from a prospective study

Abstract

The clinical relevance of subtle changes on magnetic resonance imaging (MRI) for evaluating haemophilia treatment is unknown. To determine the relationship of findings on MRI with joint function and bleeding in joints with apparently very mild arthropathy, a prospective study was performed. Knees and ankles of 26 patients, 13-26 years, were scanned. Two blinded radiologists scored the MRI (IPSG consensus score) and the radiography [Pettersson score (PS)]. Clinical function (HJHS) was scored by one physiotherapist. Life-time number of bleeds was collected from patient files. Of 104 joints scanned, three were excluded because of previous arthrodesis or trauma. Remaining 101 MRI scores correlated weakly with clinical function (r = 0.27, P = 0.01) and less with lifetime number of bleeds (r = 0.16, P = 0.14). MRI scores were 0 in 58 joints, including 27 with major bleeds. In three joints of patients playing intensive sports MRI showed minor changes (MRI score = 1) in the absence of bleeds. Agreement was reasonable between PS and MRI score (r = 0.41, P < 0.01). In 30% of joints, MRI detected abnormalities in soft-tissue and cartilage, while PS was 0 points. No evidence of occult haemorrhages was found. Instead, we found no abnormalities on MRI in 43 joints with a history of repeated joint bleeding. Haemosiderin seemed associated with the time between assessment and last bleed; joints that had suffered a bleed long before MRI had hardly haemosiderin, while those with a recent bleed showed haemosiderin, suggesting joint damage may be reversible. Abnormalities detected by MRI, but not by PS were minor and their clinical implications are not yet clear.

Early prophylaxis in children with severe haemophilia A: clinical and ultrasound imaging outcomes

“…Lundin et al . found MRI scores correlated with the orthopaedic joint scores in ankles of boys aged 4 to 17 years and Den Uijl, found a weak correlation between MRI and HJHS in ankles and knees of patients aged 13 to 26 years with minor joint damage . The differences in the age of patients and the joint status could influence the discrepancy in the results between studies.…”

Choosing outcome assessment tools in haemophilia care and research: a multidisciplinary perspective

“…Studies on MRI in healthy young males playing sports , healthy children , and children with haemophilia have recently been published. In addition, following reports of MRI changes in joints without any reported bleeds there is a growing interest in the association of bleeding history with MRI changes . However, MRI has practical disadvantages such as difficulties in standardizing MRI‐scanner settings according to different MRI manufacturers, long scanning time required, high cost, limited availability, and the need for sedation in young children.…”

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

“…For clinical interpretation, the positive and negative predictive values are the most valuable diagnostic accuracy parameters. Based on preliminary data, the prevalence of synovial hypertrophy in the imaging cohort was estimated at 23% . Based on recent data on a different ultrasound protocol, a sensitivity of 90% and a specificity of 95% were expected with POC‐US.…”

“…Repeated traumatic or spontaneous joint bleeds result in synovial hypertrophy and progressive osteochondral changes due to mechanical and metabolic processes . Synovial hypertrophy on MRI is not observed in all joints with a history of bleeding and may be responsive to treatment . As synovial hypertrophy is associated with an increased risk of bleeding, early detection may be relevant in order to guide treatment changes.…”