Funk M B, Schmidt H, Becker S, Escuriola C, Klarmann D, Klingebiel T, Kreuz W
Department of Paediatrics III, J. W. Goethe University, Frankfurt, Germany.
Haemophilia. 2002 Mar;8(2):98-103. doi: 10.1046/j.1365-2516.2002.00585.x.
Twenty-four joints (10 knees and 14 ankles), with at least one manifestation of bleeding (proven by sonographic assessment), of 15 patients with haemophilia were investigated prospectively. For magnetic resonance imaging (MRI) evaluation, the MRI scale of Nuss et al. was modified to a MRI score (max. 13 points/joint) to allow a comparison with the physical examination score (max. 12 points) and the radiological score (Pettersson score; max. 13 points). The number of joint bleeds correlated well with the degree of arthropathy P < 0.01). In all 16 joints with a maximum of two bleeds, no alterations were found by physical examination, or radiological and MRI assessment. Joints with three bleeds had physical examination scores between 0 and 2, Pettersson scores from 0 to 3 and MRI scores of 2. Joints with four or more bleeds had physical examination scores ranging between 3 and 7, radiological scores between 7 and 12 and MRI scores between 3 and 8. The MRI score describes initial joint alterations more precisely and earlier than other assessments, allowing a discerning estimation of the degree of arthropathy, as well as a follow-up of haemophilic arthropathy and an improvement after change of treatment. In addition, the modified MRI score seems to differentiate better between early and advanced signs of arthropathy than the MRI scale of Nuss et al.
对15例血友病患者的24个关节（10个膝关节和14个踝关节）进行了前瞻性研究，这些关节至少有一处出血表现（经超声评估证实）。为了进行磁共振成像（MRI）评估，将Nuss等人的MRI量表修改为MRI评分（每个关节最高13分），以便与体格检查评分（最高12分）和放射学评分（Pettersson评分；最高13分）进行比较。关节出血的次数与关节病的程度密切相关（P<0.01）。在所有最多有两次出血的16个关节中，体格检查、放射学和MRI评估均未发现异常。有三次出血的关节，体格检查评分为0至2分，Pettersson评分为0至3分，MRI评分为2分。有四次或更多次出血的关节，体格检查评分在3至7分之间，放射学评分在7至12分之间，MRI评分在3至8分之间。MRI评分比其他评估更精确、更早地描述了关节的初始改变，能够对关节病的程度进行有鉴别力的评估，以及对血友病性关节病进行随访和观察治疗改变后的改善情况。此外，修改后的MRI评分似乎比Nuss等人的MRI量表能更好地区分关节病的早期和晚期体征。
