Role of Imaging in Management of Hemophilic Patients

Ng, Wee Khoon; Chu, Winnie C.W.; Shing, Ming Kong; Lam, Wynnie W. M.; Chik, Ki Wai; Li, C. K.; Li, C. K.; Ling, Stephen

doi:10.2214/ajr.184.5.01841619

Cited by 59 publications

(35 citation statements)

References 17 publications

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“…Two different score systems were used for this purpose: the Pettersson score (normal joints are scored as 0 and the highest score possible for a joint is 13) [29] and the Arnold-Hilgartner classification system (normal joint score is 0 and the highest is 5) [30] (Tables II and III). …”

Section: Methodsmentioning

confidence: 99%

Is there any association between leptin levels and bone mineral density in haemophiliac men?

Anagnostis¹,

Vakalopoulou²,

Charizopoulou³

et al. 2013

aoms

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IntroductionConflicting data exist regarding the role of leptin in bone metabolism. The purpose of the present study was to investigate serum leptin concentrations in male patients with haemophilia A and B, a disease known to be associated with low bone mass.Material and methodsEighty-one male patients, aged 45.4 ±15 years, were screened. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) in lumbar spine (LS), femoral neck (FN) and total hip (TH).ResultsLow bone mass was diagnosed in 20 patients (24.7%). Serum leptin concentrations were strongly associated with body weight (r s = 0.457, p = 0.0001) and body mass index (BMI) (r s = 0.491, p = 0.0001). In unadjusted analysis leptin was inversely associated with BMD in LS (r s = –0.255, p = 0.023), but not in FN and TH (r s = –0.205, p = 0.068 and r s = –0.191, p = 0.090, respectively). However, after adjusting for BMI and body weight, leptin was inversely associated with BMD in FN (F 1,76 = 7.727, p = 0.007, β = –0.371, ΔR 2 = 0.089) and TH (F 1,76 = 4.533, p = 0.036, β = –0.290, ΔR 2 = 0.054), but not in LS (F 1,75 = 2.076, p = 0.154, β = –0.202, ΔR 2 = 0.026). No association was found between age, presence of HBV, HCV or HIV infection or alkaline phosphatase and leptin levels.ConclusionsOur study showed a negative association between circulating leptin levels and bone mass in males, independently of body weight and BMI.

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Section: Methodsmentioning

confidence: 99%

Is there any association between leptin levels and bone mineral density in haemophiliac men?

Anagnostis¹,

Vakalopoulou²,

Charizopoulou³

et al. 2013

aoms

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“…Elbows have been considered as target joints in haemophilia [12], along with knees and ankles [8,13,14]. Nevertheless, the high frequency of haemophilia-related growth disturbances and the challenges in positioning this joint for MRI scanning make the elbow a part of the skeletal system that requires unique evaluation, both with regard to imaging acquisition and interpretation.…”

mentioning

confidence: 99%

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

Doria¹,

Lundin²,

Miller³

et al. 2007

Haemophilia

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We assessed the reliability and construct validity of the Compatible MRI scale for evaluation of elbows, and compared the diagnostic performance of MRI and radiographs for assessment of these joints. Twenty-nine MR examinations of elbows from 27 boys with haemophilia A and B [age range, 5-17 years (mean, 11.5)] were independently read by four blinded radiologists on two occasions. Three centres participated in the study: (Toronto, n = 24 examinations; Atlanta, n = 3; Cuiaba, n = 2). The number of previous joint bleeds and severity of haemophilia were reference standard measures. The inter-reader reliability of MRI scores was substantial (ICC = 0.73) for the additive (A)-scale and excellent (ICC = 0.83) for the progressive (P)-scale. The intrareader reliability was excellent for both P-scores (ICC = 0.91) and A-scores (ICC = 0.93). The total P- and A-scores correlated poorly (r = 0.36) or moderately (r = 0.54), but positively, with clinical-laboratory measurements. The total MRI scores demonstrated high accuracy for discrimination of presence or absence of arthropathy [P-scale, area-under-the-curve (AUC) = 0.94 +/- 0.05; A-scale, AUC = 0.89 +/- 0.06], as did the soft tissue scores of both scales (P-scale, AUC = 0.90 +/- 0.06; A-scale, AUC = 0.86 +/- 0.06). Areas-under-the-curve used to discriminate severe disease demonstrated high accuracy for both P-MRI scores (AUC = 0.83 +/- 0.09) and A-MRI scores (AUC = 0.87 +/- 0.09), but non-diagnostic ability to discriminate mild disease. Similar results were noted for radiographic scales. In conclusion, both MRI scales demonstrated substantial to excellent reliability and accuracy for discrimination of presence/absence of arthropathy, and severe/non-severe disease, but poor to moderate convergent validity for total scores and non-diagnostic discriminant validity for mild/non-mild disease. Compared with radiographic scores, MRI scales did not perform better for discrimination of severity of arthropathy.

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“…An additional six articles were identified from bibliographical references. Thus, a total of 32 studies were included in our systematic review (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of MR imaging as a tool for evaluating haemophilic arthropathy in children

et al. 2013

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Summary Our purposes were to determine: (i) whether there is direct evidence that currently available MRI techniques are accurate for early diagnosis of pathological findings in haemophilic arthropathy; (ii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy; (iii) whether there is an MRI scoring system that best correlates with clinical/radiological constructs for evaluation of haemophilic arthropathy. Articles were screened using MEDLINE (n = 566), EMBASE (n = 201), and the Cochrane Library (n = 1). Two independent reviewers assessed articles for inclusion under the overarching purposes of the review by using the Standards for Reporting of Diagnostic Accuracy (STARD) tool, and the quality of the studies were graded using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS‐2) tool. The electronic literature search retrieved 777 references (after duplicates were removed). A total of 32 studies were chosen for inclusion from the results of the search and review of bibliographical references. Using the STARD tool, seven studies were of excellent quality of reporting, and using the QUADAS‐2 tool, 10 studies were judged to be of adequate quality. There is ‘fair’ evidence to recommend MRI as an accurate test for detecting evidence of haemophilic arthropathy and the use of second or third generation MRI scales for assessing haemophilic arthropathy. However, there is no evidence that screening of early intra‐articular soft tissue bleed with MRI improves the functional status of joints over time.

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Role of Imaging in Management of Hemophilic Patients

Abstract: In hemophilic patients, the presence of symptomatology in the knee and ankle joints is associated with synovial hypertrophy, and scoring of the conventional radiographs using Arnold-Hilgartner staging is useful for the prediction of synovial hypertrophy.

Cited by 59 publications

References 17 publications

Is there any association between leptin levels and bone mineral density in haemophiliac men?

Is there any association between leptin levels and bone mineral density in haemophiliac men?

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

A systematic review of MR imaging as a tool for evaluating haemophilic arthropathy in children

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