Magnetic resonance imaging and ultrasound evaluation of "healthy" joints in young subjects with severe haemophilia A

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 19; no. 3; pp. e167 - e173
• Main Authors: Di Minno, M. N. D., Iervolino, S., Soscia, E., Tosetto, A., Coppola, A., Schiavulli, M., Marrone, E., Ruosi, C., Salvatore, M., Di Minno, G.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.05.2013
• Subjects: Adult; Ankle - diagnostic imaging; Arthrography; arthropathy; Bleeding; early lesions; Elbow - diagnostic imaging; haemophilia; Hemophilia A - pathology; Humans; Joints - diagnostic imaging; Knee - diagnostic imaging; Magnetic Resonance Imaging; Male; Severity of Illness Index; Ultrasonography; ultrasound; Young Adult
• ISSN: 1351-8216; 1365-2516; 1365-2516
• DOI: 10.1111/hae.12107

Summary Magnetic resonance imaging (MRI) and ultrasonography (US) are increasingly used in haemophilia A (HA) to detect early joint changes. A total of 40 clinically asymptomatic joints, never involved by bleeding events [“healthy joints” (HJ)], were evaluated by MRI and, in parallel, by US in 20 young subjects with severe HA (22.45 ± 2.72 years old; no history of arthritides, of viral infections or of inhibitors against factor VIII). The same joints were evaluated in 20 matched non‐haemophilic (no‐HA) subjects (mean age 23.90 ± 2.31 years, P = 0.078 vs. HA subjects). US images were obtained with specific probe positions according to validated procedures. A validated US score and progressive (P‐MRI) and additive (A‐MRI) MRI scores were employed for data collection and analysis. The US score was higher in HA than in no‐HA subjects (3.40 ± 1.72 vs. 0.80 ± 1.10, P < 0.001). Taking into account only moderate/severe alterations, joint effusion was found in 55% of HA and in 5% of no‐HA joints (P < 0.001); synovial hypertrophy was found in 20% of HA and in none of the no‐HA joints; cartilage erosion was found in 30% of HA and in none of no‐HA joints. MRI examinations confirmed these findings and the US score correlated with the A‐MRI (r = 0.732, P < 0.001) and with the P‐MRI (r = 0.598, P < 0.001) scores. MRI and US data significantly correlated as to effusion (r = 0.819, P = 0.002), synovial hypertrophy (r = 0.633, P = 0.036) and cartilage erosion (r = 0.734, P = 0.010). Despite inherent limitations, joint US examination identified subclinical abnormalities of HJ in young subjects with severe HA.