Abstract
BackgroundRepeated bleeding in hemophilic arthropathy (HA) may result in severe degenerative changes and joint destruction. The gradient-recalled echo (GRE) sequence MR is proved to be the best method to detect hemosiderin deposition. However, MR is not widely available in developing countries, including Indonesia. Some studies have proposed ultrasonography (US) as an alternative tool in evaluating hemophilic joint. However, there is still some disagreement on the ability of US to detect hemosiderin deposition.ObjectiveTo evaluate the association between US and GRE-sequence MR imaging in detecting hemosiderin deposition in hemophilic ankle joint.Material and methodsA total of 102 sites from 17 ankle joints of 11 boys with severe hemophilia A underwent US examination using a high-frequency linear array transducer. GRE-sequence MR examination was performed in sagittal view consistent with the sites scanned by US. Both examinations were performed on the same day, but MR interpretation was performed blindly at different times. The association between US and GRE-sequences in detecting hemosiderin deposition was analyzed using McNemar’s test.ResultsStatistical analysis showed a significant association (p value < 0.001) between US and GRE MR in detecting hemosiderin deposition, but the association is weak (R = 0.26). Sensitivity and specificity of US for detecting hemosiderin deposition were 46.84% (95%CI: 35.51–58.40) and 95.65% (95%CI: 78.05–99.89), respectively, with positive predictive value 97.37% (95%CI: 84.29–99.61), negative predictive value 34.38% (95%CI: 29.50–39.60) and accuracy 57.84% (95%CI: 47.66–67.56).ConclusionThere was a weak association between US and GRE-sequences in detecting hemosiderin deposition of hemophilic ankle joint.
Highlights
IntroductionRecurrent bleeding causes synovial hypertrophy, hemosiderin deposition, cartilage destruction, and changes in the structure of subchondral bone
Hemophilic arthropathy (HA) is the most common clinical manifestation of hemophilia
There was a weak association between US and gradient-recalled echo (GRE)-sequences in detecting hemosiderin deposition of hemophilic ankle joint
Summary
Recurrent bleeding causes synovial hypertrophy, hemosiderin deposition, cartilage destruction, and changes in the structure of subchondral bone. Hemosiderin deposition can stimulate further synovial hypertrophy and inflammation. Magnetic Resonance (MR) imaging is superior to other imaging modality in detecting soft tissue changes, such as synovial hypertrophy, hemarthrosis, joint effusion, cartilage defect, and changes in bone structure [5,6,7]. The gradient-recalled echo (GRE) MR imaging sequence is regarded as a sensitive method in evaluating hemosiderin deposition [8]. Repeated bleeding in hemophilic arthropathy (HA) may result in severe degenerative changes and joint destruction. The gradient-recalled echo (GRE) sequence MR is proved to be the best method to detect hemosiderin deposition. There is still some disagreement on the ability of US to detect hemosiderin deposition
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