Ultrasound and magnetic resonance imaging for the detection of blood: An ex‐vivo study

Regi, Soumya Susan; Livingstone, Roshan S; Kandagaddala, Madhavi; Poonnoose, Pradeep Mathew; Gibikote, Sridhar; Keshava, Shyamkumar N.; Srivastava, Alok

doi:10.1111/hae.14303

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…As has been recently demonstrated in ex-vivo phantom studies, small quantities of blood can be missed on ultrasonographic examination, more often with 12 MHz probes (as in most POCUS devices) than with the more advanced 18 MHz probes. 18 Furthermore, it should be recognized that traces of blood in the joint can be enough to trigger inflammation, clinical symptoms and subsequent joint damage. 19 It is also a challenge to differentiate traces of fresh blood in an already haemorrhagic joint fluid from previous bleeds as is the case in many joints with chronic haemarthrosis.…”

Section: 11mentioning

confidence: 99%

“…Any radiological technique has its limit of detection and the same is true for ultrasonography. As has been recently demonstrated in ex‐vivo phantom studies, small quantities of blood can be missed on ultrasonographic examination, more often with 12 MHz probes (as in most POCUS devices) than with the more advanced 18 MHz probes 18 . Furthermore, it should be recognized that traces of blood in the joint can be enough to trigger inflammation, clinical symptoms and subsequent joint damage 19 .…”

Section: Diagnosis Of Haemophilia—defining the Disease Burdenmentioning

confidence: 99%

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Defining success in haemophilia care – Are we doing it right?

Srivastava

2024

Haemophilia

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IntroductionTransformational advances have occurred in the management of haemophilia in the last decade leading to much better outcomes. However, a detailed and critical examination of its assessment and reporting show gaps in many aspects. These are discussed in this review.MethodsThe relevant literature related to different aspects of management of haemophilia was reviewed to identify gaps which need to be addressed. These include detection and diagnosis of haemophilia, documentation and reporting of joint bleeding, its management and methods of reporting in clinical trials and practice, aspects of personalizing care as well as access to therapeutic products and the need for and organization of comprehensive care.ResultsCurrent diagnostic approaches have more than doubled the identified number of persons with haemophilia (PWH) over the last 25 years but still constitute only ∼30% of the expected number. Joint bleeding is the primary indicator of disease severity and treatment efficacy, but there is lack of consistency and standardization in the way it is recorded and reported. Its continued use as an efficacy measure of modern treatments which maintain steady state factor levels or equivalence of >5% will lack sensitivity. The treatment of acute haemarthrosis has focussed on haemostasis and pain control, ignoring the role of inflammation in joint damage. Phenotypic heterogeneity of severe haemophilia has recognized clinical and laboratory variations based on haemostasis but not differences in local response to blood in the joint. At the organizational level, IU/capita provides a relevant measure of access to therapeutic products when the detection rate is ∼100% but is fallaciously low when detection rates are very low. With highly effective modern therapies for haemophilia and nearly no bleeding, the concept of comprehensive care team will need modifications.ConclusionAs haemophilia care advances, a deeper dive is needed into the details of various aspects its management to ensure consistency and contemporary relevance.

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Section: 11mentioning

confidence: 99%

Section: Diagnosis Of Haemophilia—defining the Disease Burdenmentioning

confidence: 99%

Defining success in haemophilia care – Are we doing it right?

Srivastava

2024

Haemophilia

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“…Ultrasound is increasingly used in addition to physical examination since it is a non-invasive method that can accurately assess joint effusion and changes in synovial tissue [ 11 , 14 – 16 ], it is widely available, and provides real-time information [ 11 , 14 – 16 ]. Moreover, previous studies have shown that ultrasonography is sensitive to differentiate between simple and complex joint effusion [ 17 , 18 ]. However, limitations of ultrasound are the operator dependency and therefore a substantial inter-observer variation of findings [ 11 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

“…Large haemarthroses may show fluid-fluid levels or thrombi on MRI. However, the accuracy of standard MRI protocols for the detection of early or minor joint bleeding has not been established yet [ 17 , 18 ]. Therefore, an accurate non-invasive reference standard to detect joint bleeding is lacking.…”

Section: Introductionmentioning

confidence: 99%

Detecting low blood concentrations in joints using T1 and T2 mapping at 1.5, 3, and 7 T: an in vitro study

et al. 2021

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Background Intra-articular blood causes irreversible joint damage, whilst clinical differentiation between haemorrhagic joint effusion and other effusions can be challenging. An accurate non-invasive method for the detection of joint bleeds is lacking. The aims of this phantom study were to investigate whether magnetic resonance imaging (MRI) T1 and T2 mapping allows for differentiation between simple and haemorrhagic joint effusion and to determine the lowest blood concentration that can be detected. Methods Solutions of synovial fluid with blood concentrations ranging from 0 to 100% were scanned at 1.5, 3, and 7 T. T1 maps were generated with an inversion recovery technique and T2 maps from multi spin-echo sequences. In both cases, the scan acquisition times were below 5 min. Regions of interest were manually drawn by two observers in the obtained T1 and T2 maps for each sample. The lowest detectable blood concentration was determined for all field strengths. Results At all field strengths, T1 and T2 relaxation times decreased with higher blood concentrations. The lowest detectable blood concentrations using T1 mapping were 10% at 1.5 T, 25% at 3 T, and 50% at 7 T. For T2 mapping, the detection limits were 50%, 5%, and 25%, respectively. Conclusions T1 and T2 mapping can detect different blood concentrations in synovial fluid in vitro at clinical field strengths. Especially, T2 measurements at 3 T showed to be highly sensitive. Short acquisition times would make these methods suitable for clinical use and therefore might be promising tools for accurate discrimination between simple and haemorrhagic joint effusion in vivo.

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“…Ultrasound can accurately assess the synovium, joint effusion, cartilage and joint bleeds. [11][12][13][14][15] In addition, ultrasound can detect synovial hypertrophy in joints without clinical symptoms. 16 Ultrasound is therefore recommended as an additional tool for diagnosing early joint bleeds and monitoring synovitis.…”

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confidence: 99%

Monitoring recovery of joints after bleeding: Physical examination and ultrasound are complementary

et al. 2023

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Aim: Traditionally, recovery after a joint bleed in people with bleeding disorders is evaluated by clinical symptoms. Following a bleed, however, asymptomatic joints may still show synovial hypertrophy and effusion on ultrasound. We evaluated the duration of full recovery from a joint bleed. Additionally, we determined how recovery differed when assessed by physical examination and ultrasound. Methods:In this retrospective cohort study, we investigated joint bleeds in elbows, knees and ankles of people with haemophilia or Von Willebrand disease who attended the Van Creveldkliniek between 2016 and 2021. Physical examination (warmth, swelling, range of motion and gait) and ultrasound (effusion and synovial hypertrophy) were performed within 7 days after the onset of the bleed, 1 week after the first examination and monthly thereafter until patients had recovered fully. Joint bleeds were treated in line with the current international treatment guidelines. Results:We evaluated 30 joint bleeds in 26 patients. The median recovery time was 1 month (range 0.3-5 months). In 47% of the joint bleeds, the recovery took longer than 1 month. The moment of recovery based on physical examination and ultrasound differed in 27% of bleeds. Both persistent abnormalities at physical examination in joints with normalized ultrasounds and persistent ultrasound findings in clinically recovered joints occurred. Conclusion:Joint bleed recovery can take long and recovery times differed per bleed.Recovery differed when assessed by physical examination or ultrasound. Therefore, both should be used to closely monitor recovery of joint bleeds and offer personalized care.

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Ultrasound and magnetic resonance imaging for the detection of blood: An ex‐vivo study

Cited by 6 publications

References 25 publications

Defining success in haemophilia care – Are we doing it right?

Defining success in haemophilia care – Are we doing it right?

Detecting low blood concentrations in joints using T1 and T2 mapping at 1.5, 3, and 7 T: an in vitro study

Monitoring recovery of joints after bleeding: Physical examination and ultrasound are complementary

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