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

Abstract

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.

Inflammatory focal bone destruction in femoral heads with end‐stage haemophilic arthropathy: a study on clinic samples with micro‐CT and histological analyses

“…A high prevalence of systematic osteoporosis or osteopenia in haemophilia patients has been reported . Focal lesion of subchondral bone destruction was observed in CT and MR images of HA affected joints and the correlation between bone loss and severity of haemophilia arthropathy was also confirmed . However, in this study, all of the femoral heads collected from patients with end‐stage HA and RA had severe focal subchondral bone lesions.…”

“…In recent years, bone loss, in haemophiliacs attracted a lot of interests of clinic researchers. In HA patients, in addition to systemic osteoporosis, focal bone destruction presented as cystic change in radiographic imaging has a high prevalence in affected joints . Focal bone destruction in HA affected femoral head presented as cystic change in radiographic imaging, and usually was misdiagnosed as osteonecrosis .…”

Post-operative bracing after ACL reconstruction has no effect on knee joint effusion. A prospective, randomized study

“…Knee joint effusion was determined by computed tomography (CT) which has previously shown high reliability [16]. The knee was examined for joint fluid five centimeters proximal to the joint line, in the injured and healthy leg, one week before as well as three and 12 months after surgery (Fig.…”

“…Computed tomography (CT) has been shown to be a valuable method for determining knee joint effusion [16]. In the present study, we used CT to examine the presence of knee joint effusion in ACL injured patients before ACL reconstructive surgery with ST/G tendon grafts, as well as three and 12 months after.…”

Rationale for a randomized controlled trial comparing two prophylaxis regimens in adults with severe hemophilia A: the Hemophilia Adult Prophylaxis Trial

“…If minimal or no joint ROM change is detected on either study arm, then it may be less useful in assessing prophylaxis differences, but this will be new information, not previously reported. Although MRI is more sensitive to joint change than x-ray [30] and is used in clinical joint scoring assessment [31–33], it is costly (US$1500), and unlikely to detect change in a 52-week trial.…”