title: Magnetic resonance imaging and ultrasound evaluation of "healthy" joints in young subjects with severe haemophilia A.
abstract: 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.
authors.affiliation: Regional Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy. dario.diminno@hotmail.it
authors.forename: M N D
authors.initials: MN
authors.lastname: Di Minno
authors.forename: S
authors.initials: S
authors.lastname: Iervolino
authors.forename: E
authors.initials: E
authors.lastname: Soscia
authors.forename: A
authors.initials: A
authors.lastname: Tosetto
authors.forename: A
authors.initials: A
authors.lastname: Coppola
authors.forename: M
authors.initials: M
authors.lastname: Schiavulli
authors.forename: E
authors.initials: E
authors.lastname: Marrone
authors.forename: C
authors.initials: C
authors.lastname: Ruosi
authors.forename: M
authors.initials: M
authors.lastname: Salvatore
authors.forename: G
authors.initials: G
authors.lastname: Di Minno
mesh_terms: D000328:Adult; D000842:Ankle / Q000000981:diagnostic imaging; D001175:Arthrography; D004550:Elbow / Q000000981:diagnostic imaging; D006467:Hemophilia A / Q000473:pathology*; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D007717:Knee / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D012720:Severity of Illness Index; D014463:Ultrasonography; D055815:Young Adult