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Diagnostic accuracy of haemophilia early arthropathy detection with ultrasound (HEAD-US): a comparative magnetic resonance imaging (MRI) study

Domen Plut

Domen Plut

  • Clinical Radiology Institute, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Plut, Domen
, 
Barbara Faganel Kotnik

Barbara Faganel Kotnik

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Division of Paediatrics, University Medical Centre LjubljanaLjubljana, Slovenia
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Kotnik, Barbara Faganel
, 
Irena Preloznik Zupan

Irena Preloznik Zupan

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Division of Internal Medicine, University Medical Centre LjubljanaLjubljana, Slovenia
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Zupan, Irena Preloznik
, 
Damjana Kljucevsek

Damjana Kljucevsek

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • Division of Paediatrics, University Medical Centre LjubljanaLjubljana, Slovenia
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Kljucevsek, Damjana
, 
Gaj Vidmar

Gaj Vidmar

  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
  • University Rehabilitation Institute Republic of SloveniaLjubljana, Slovenia
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Vidmar, Gaj
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Ziga Snoj

Ziga Snoj

  • Clinical Radiology Institute, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Snoj, Ziga
, 
Carlo Martinoli

Carlo Martinoli

School of Medicine and Pharmacy, University of GenoaGenoa, Italy
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Martinoli, Carlo
 and 
Vladka Salapura

Vladka Salapura

  • Clinical Radiology Institute, University Medical Centre LjubljanaLjubljana, Slovenia
  • Faculty of Medicine, University of LjubljanaLjubljana, Slovenia
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Salapura, Vladka
  
Jun 01, 2019
Diagnostic accuracy of haemophilia early arthropathy detection with ultrasound (HEAD-US): a comparative magnetic resonance imaging (MRI) study's Cover Image
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Article Category: Research Article
Published Online: Jun 01, 2019
Page range: 178 - 186
Received: Feb 21, 2019
Accepted: Apr 25, 2019
DOI: https://doi.org/10.2478/raon-2019-0027
Keywords
© 2019 Domen Plut, Barbara Faganel Kotnik, Irena Preloznik Zupan, Damjana Kljucevsek, Gaj Vidmar, Ziga Snoj, Carlo Martinoli, Vladka Salapura, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Concordance bubble-plot for depicting agreement between HEAD-US and MRI score for all three joints. The circles are centered at the observed combinations of the HEAD-US and MRI scores; their size is proportional to the number of the patients with a given combination. Dashed line represents a perfect agreement.
Concordance bubble-plot for depicting agreement between HEAD-US and MRI score for all three joints. The circles are centered at the observed combinations of the HEAD-US and MRI scores; their size is proportional to the number of the patients with a given combination. Dashed line represents a perfect agreement.

Figure 2

An example of a good concordance between HEAD-US and MRI. US images of the femoral trochlea in the transverse plane (A) and the medial femorotibial space in the coronal plane (B) are shown. T2* weighted MR images in the sagittal (1) and coronal (2) planes and a PD weighted MR image in the transverse plane (3) of the same knee are shown for comparison of the corresponding structures. The smooth surface, normal thickness and homogenous structure of the trochlear joint cartilage are shown in the US image (A) (white arrow); the corresponding intact cartilage is shown on MR image (1). The intact cortical bone of the medial femoral condyle (hollow arrow) is shown by US in the images (A) and (B); the corresponding cortical bone is depicted by MRI in the image (3). No signs of synovium hypertrophy are shown by US in the medial femorotibial recess (white star) in the image B; the corresponding recess confirming no synovium hypertrophy is shown by MRI in the image (2). On MRI, there were also no arthropathic changes in the parts of the joint not visualized by US. The images show a perfect concordance between US and MRI findings in this knee with no signs of haemophilic arthropathy.
An example of a good concordance between HEAD-US and MRI. US images of the femoral trochlea in the transverse plane (A) and the medial femorotibial space in the coronal plane (B) are shown. T2* weighted MR images in the sagittal (1) and coronal (2) planes and a PD weighted MR image in the transverse plane (3) of the same knee are shown for comparison of the corresponding structures. The smooth surface, normal thickness and homogenous structure of the trochlear joint cartilage are shown in the US image (A) (white arrow); the corresponding intact cartilage is shown on MR image (1). The intact cortical bone of the medial femoral condyle (hollow arrow) is shown by US in the images (A) and (B); the corresponding cortical bone is depicted by MRI in the image (3). No signs of synovium hypertrophy are shown by US in the medial femorotibial recess (white star) in the image B; the corresponding recess confirming no synovium hypertrophy is shown by MRI in the image (2). On MRI, there were also no arthropathic changes in the parts of the joint not visualized by US. The images show a perfect concordance between US and MRI findings in this knee with no signs of haemophilic arthropathy.

Figure 3

An example of a discordance between US and MRI. An US image of the tibiotalar joint in the sagittal plane is shown on the left, a PD weighted MR image of the same ankle in the sagittal plane is shown on the right for comparison of the corresponding structures. In both images, the smooth surface of the tibial cortical bone is marked by the horizontal hollow arrow and the smooth surface of the talar cortical bone is marked by the vertical hollow arrow. MRI demonstrates an osteochondral defect at the tibial side of the talocrural joint (white arrow), which is outside of the visualization area of US.
An example of a discordance between US and MRI. An US image of the tibiotalar joint in the sagittal plane is shown on the left, a PD weighted MR image of the same ankle in the sagittal plane is shown on the right for comparison of the corresponding structures. In both images, the smooth surface of the tibial cortical bone is marked by the horizontal hollow arrow and the smooth surface of the talar cortical bone is marked by the vertical hollow arrow. MRI demonstrates an osteochondral defect at the tibial side of the talocrural joint (white arrow), which is outside of the visualization area of US.

Correlation between the HEAD-US and IPSG MRI scores

ElbowsKneesAnklesAll joints
Overall score (r)0.9490.9410.8380.921
Detailed scores:
Synovial hypertrophy (r)0.8400.7100.561
Cartilage degradation (r)0.7340.8120.537
Bone changes (r)0.8830.7410.725

Baseline characteristics of the study population

Age: median; range (years)33; 16–49
Age of start of prophylaxis: mean (years)17.4
age group: 0–9 (patient count)7
age group: 10–19 (patient count)14
age group: 20+ (patient count)9
Duration of prophylaxis: mean (years)15.4
AnklesKneesElbows
RightLeftRightLeftRightLeft
No. of joints302925282828
No. of lifetime joint bleeds:5512151413
0–5 (joint count)121171042
6–20 (joint count)
> 20 (joint count)131253912
Unknown (joint count)011011
HJHS 2.1 score: mean; max*3.3; 122.6; 111.4; 71.2; 81.9; 91.9; 8
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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