Value of magnetic resonance imaging for the diagnosis and follow‐up of haemophilic arthropathy

Abstract

An orthopaedic assessment of the joint status of seven severe haemophiliacs (mean age 12.5 y - range 8.9-15.5) on prophylactic treatment (PT) by magnetic resonance imaging (MRI) and physical examination was carried out. Median duration of PT of these patients was 84 months (range 32-107). A locally designed MRI joint score considering seven parameters (1 - joint effusion, 2 - synovial membrane thickening, 3 - haemosiderin deposits, 4 - joint cartilage injury, 5 - subchondral bone erosion, 6 - subchondral bone cysts, 7 - osteonecrosis) was used (maximum score = 13 points). MRI scans were performed in 17 joints (nine ankles, seven knees and one elbow): mean MRI scores for the affected joints was 5.1. A poor consistency between physical examination and MRI findings or the real extent of joint damage was found (Cohen kappa index 0.320). MRI is a precise non-invasive tool for the assessment of early joint cartilage and synovium pathological changes still undetectable by physical examination or conventional X-rays in the haemophilic setting.

State‐of‐the‐art imaging techniques for the evaluation of haemophilic arthropathy: present and future

“…To measure arthropathic changes in clinical practice and in clinical research trials, tentative haemophilic arthropathy scales based on MRI findings have been developed in the last decade [20][21][22][23][24][25]. In 2005, the International Prophylaxis Study Group (IPSG) presented a preliminary comprehensive scoring scheme [22,26,27] that combined the pioneer Denver [20] and European MRI scores [21].…”

Reliability and construct validity of the compatible MRI scoring system for evaluation of elbows in haemophilic children

“…MRI has exquisite capability for detecting soft tissue changes in arthropathies [4]. In past years, this technique has gained widespread use for evaluation of joints motivating several research groups to design different provisional MRI scoring systems for assessment of haemophilic arthropathy [5][6][7][8][9]. The use of different scoring systems to assess outcomes in clinical trials, has made head-to-head comparisons of prophylactic and therapeutic regimens of different haemophilic centres difficult.…”

MRI demonstrates the extension of juxta-articular venous malformation of the knee and correlates with joint changes

“…Second, joint destruction from inflammation due to recurrent articular haemorrhage. The latter mechanism appears similar to the changes seen in haemophilic arthropathy, with synovial thickening and haemosiderin deposits initiating the inflammatory changes leading to arthropathy [10,11].…”