Zukotynski K, Jarrin J, Babyn P S, Carcao M, Pazmino-Canizares J, Stain A M, Doria A S
Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Haemophilia. 2007 May;13(3):293-304. doi: 10.1111/j.1365-2516.2006.01414.x.
Radiological imaging of joints in children with haemophilia is important to detect abnormalities, grade their severity and monitor the effects of treatment. Scoring systems for staging haemophilic arthropathy have been developed based on plain film or magnetic resonance imaging (MRI) findings. Radiographs alone may be inadequate for evaluating joint disease in children with haemophilia on prophylaxis while MRI may be difficult to access and require the child to be sedated. Sonography can be a useful complementary modality in the evaluation of haemophilic arthropathy that is readily available and does not require the child to be sedated. In this paper, we briefly review the current imaging scales available for the assessment of haemophilic arthropathy and present a systematic protocol for sonographic assessment of the knee and ankle in haemophilic children along with examples of findings in joint effusion/hemarthrosis, synovial hypertrophy and cartilage loss. Also, we correlate the ultrasound findings with the corresponding MRI images demonstrating the anatomic planes used for imaging acquisition. Sonography is a promising technique for the assessment of soft tissue changes which are the earliest findings in haemophilic arthropathy. Further investigation is required for evaluation of osteochondral changes given limitations of sonography in this regard and in minimizing operator dependency, especially if applied in multicentric clinical trials.
对血友病患儿的关节进行放射学成像对于检测异常情况、评估其严重程度以及监测治疗效果至关重要。基于X线平片或磁共振成像（MRI）结果，已开发出血友病性关节病的分期评分系统。对于接受预防治疗的血友病患儿，仅靠X线片可能不足以评估关节疾病，而MRI可能难以获得，且需要患儿镇静。超声检查在评估血友病性关节病时可作为一种有用的辅助手段，它易于获得，且不需要患儿镇静。在本文中，我们简要回顾了目前可用于评估血友病性关节病的成像量表，并提出了一个对血友病患儿膝关节和踝关节进行超声评估的系统方案，同时展示了关节积液/关节积血、滑膜增生和软骨损伤的检查结果示例。此外，我们将超声检查结果与相应的MRI图像相关联，展示了用于成像采集的解剖平面。超声检查是评估软组织变化的一种有前景的技术，而软组织变化是血友病性关节病最早出现的表现。鉴于超声检查在这方面的局限性以及尽量减少操作者依赖性的需求，尤其是在多中心临床试验中应用时，对于评估骨软骨变化还需要进一步研究。
