Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Haemophilia. 2018 Nov;24(6):971-979. doi: 10.1111/hae.13524. Epub 2018 May 23.
Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging (MRI) is associated with an increased risk of future joint bleeding.
The aim of this study was to investigate whether point-of-care ultrasound (POC-US) is an accurate alternative for MRI for the detection of early joint changes.
In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X-rays were scanned using POC-US and 3 Tesla MRI. POC-US was performed by 1 medical doctor, blinded for MRI, according to the "Haemophilia Early Arthropathy Detection with Ultrasound" (HEAD-US) protocol. MRIs were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals (CI).
Knees and ankles of 24 haemophilia patients (96 joints), aged 18-34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC-US for synovial tissue was correct (overall accuracy) in 97% (CI: 91-99) with a positive predictive value of 94% (CI: 73-100) and a negative predictive value of 97% (CI: 91-100). The overall accuracy of POC-US for cartilage abnormalities was 91% (CI: 83-96) and for bone surface irregularities 97% (CI: 91-99).
POC-US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC-US is an accurate and available alternative for MRI, it can be used for routine evaluation of early joint changes.
反复关节出血是血友病的特征。磁共振成像（MRI）观察到的滑膜增生与未来关节出血的风险增加有关。
本研究旨在探讨即时超声（POC-US）是否是 MRI 检测早期关节变化的准确替代方法。
在这项单中心诊断准确性研究中，对 X 射线无或最小关节炎的血友病患者的双侧膝关节和踝关节进行 POC-US 和 3 特斯拉 MRI 扫描。POC-US 由 1 名医生根据“超声检测血友病早期关节炎（HEAD-US）”协议进行，对 MRI 结果不知情。MRI 由 2 名放射科医生独立评分，对临床数据和超声结果不知情。使用 95%置信区间（CI）计算诊断准确性参数。
研究了 24 名年龄在 18-34 岁的血友病患者的膝关节和踝关节（96 个关节）。MRI 观察到 20%的关节存在滑膜增生。POC-US 检测滑膜组织的总体准确性为 97%（CI：91-99），阳性预测值为 94%（CI：73-100），阴性预测值为 97%（CI：91-100）。POC-US 检测软骨异常的总体准确性为 91%（CI：83-96），检测骨表面不规则的总体准确性为 97%（CI：91-99）。
POC-US 可准确评估有限关节疾病的血友病患者的滑膜增生、骨表面不规则和软骨异常。由于 POC-US 是 MRI 的准确且可行的替代方法，因此可用于常规评估早期关节变化。
