Magnetic Resonance Imaging Changes and Clinical Response in Chinese Haemophilic Joints Treated with Yttrium 90 Radiosynoviorthesis

Abstract

Objectives: Radiosynoviorthesis has been shown to be effective in decreasing bleeding frequency, reducing pain, and improving quality of life in haemophilic patients. The aim of this study was to evaluate the clinical response and magnetic resonance imaging (MRI) changes in Chinese haemophilic joints after Yttrium 90 (Y-90) radiosynoviorthesis. Methods: We retrospectively reviewed Chinese haemophilic patients treated by Y-90 radiosynoviorthesis between 2004 and 2011. A total of nine joints in six patients (all males; mean age, 17 years; age range, 5-27 years) with recurrent joint bleeding were studied. The joints consisted of three knees, three elbows, two ankles, and one hip. The frequency of bleeding episodes, pain, and MRI features of pre-synovectomy (within 1 month before the procedure) and post-synovectomy (12-18 months after the procedure) were compared. Presence of effusion / haemarthrosis, synovial hypertrophy, haemosiderin, subchondral cysts / erosion and cartilage loss on MRI were evaluated. The Denver MRI scales before and after synovectomy were also compared. Results: Clinically, all joints showed improvement in frequency of bleeding episodes (p < 0.001) and pain. The majority (89%, 8/9 joints) of the joints showed a decrease in effusions / haemarthrosis and synovial thickening / enhancement while more than half (56%, 5/9 joints) of the joints yielded a decrease in the extent of haemosiderin deposits. Only one joint (11%) showed progression of subchondral cyst / erosion and cartilage loss while the rest (89%, 8/9 joints) of the joints had no worsening of degenerative changes. The difference in Denver MRI scores showed no statistically significant changes in scores before and after synovectomy (median pre-score: 9 vs. postscore: 10; p = 0.347). Conclusion: Clinical together with MRI improvements in terms of effusions / haemarthrosis, synovial hypertrophy, and haemosiderin were found in majority of haemophilic joints treated by Y-90 radiosynoviorthesis. Majority of joints also showed no further worsening of joint degeneration (including subchondral cysts / erosions and cartilage loss) though none of above-mentioned changes were considered reversible or important for ultimate joint function.