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


  • Awarded among the three best poster presentations at the 5th Annual Congress of the European Association for Hemophilia and Allied Disorders (EAHAD) Rome, Italy from February 22nd to 24th 2012 and published as abstract in Haemophilia 2012 vol 18 (suppl. 1); abstract 52

Correspondence: Matteo Nicola Dario Di Minno, MD, Dept of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, “Federico II” University, Via S. Pansini 5, 80131, Naples.

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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, = 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, < 0.001). Taking into account only moderate/severe alterations, joint effusion was found in 55% of HA and in 5% of no-HA joints (< 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, < 0.001) and with the P-MRI (r = 0.598, < 0.001) scores. MRI and US data significantly correlated as to effusion (r = 0.819, = 0.002), synovial hypertrophy (r = 0.633, = 0.036) and cartilage erosion (r = 0.734, = 0.010). Despite inherent limitations, joint US examination identified subclinical abnormalities of HJ in young subjects with severe HA.