Ma Fei, Zhang Ya-Ru, Luke Koon Hung, Liu Hao, Luo Wan-Xian, Zhang Li, Xiao Li-Ling, Yi Mei, Gao Yang, Wang Wei-Zhen, Qiu Shi-Qiu, Feng Xiao-Qin, Sun Jing, Li Ying-Jia
Department of Medicine Ultrasonics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
Hematology and Lab Medicine Divisions, Children Hospital of Eastern Ontario, Ottawa, K1H 8L1, Canada.
Curr Med Sci. 2022 Apr;42(2):439-446. doi: 10.1007/s11596-022-2520-9. Epub 2022 Mar 15.
Contrast-enhanced ultrasound (CEUS) is advantageous for evaluating microcirculation, and has been applied to assess arthritis in previous studies. However, CEUS examinations have not been studied for hemophilia arthritis. Hemophilia arthritis is different from other arthritis, because it is induced by spontaneous joint bleeding. Hence, CEUS may have special value in evaluating hemophilia arthritis. The present study assessed the value of CEUS in evaluating synovial hypertrophy and predicting recurrent joint bleeding in severe hemophilia A patients.
From August 2016 to January 2017, 81 severe hemophilia A patients, who were referred to our hospital for ultrasound joint assessment with conventional ultrasound, were enrolled. Among these 81 patients, 46 patients consented for CEUS examinations on the same day.
Compared to color Doppler flow imaging (CDFI), four more joints presented with a blood flow signal under CEUS mode. In addition, the synovial hypertrophy measured by CEUS was thicker than that measured by conventional ultrasound. The ultrasound scores (including the total grey-scale ultrasound score, joint effusion/hemarthrosis, synovial hypertrophy, CDFI semi-quantitative score, and CEUS semi-quantitative score) were significantly higher in the joint bleeding group than in the no joint bleeding group (P<0.05). Furthermore, these ultrasound scores were positively correlated with the joint bleeding frequency, and had the highest correlation with the CEUS score (r=0.620, P<0.05).
CEUS can more accurately assess the degree of synovial hypertrophy and vascularization, and diagnose synovitis, when compared to conventional ultrasound. In addition, CEUS appears to be essential for evaluating the possibility of recurrent joint bleeding, and providing more reliable evidence for individualized treatment.
超声造影（CEUS）在评估微循环方面具有优势，且在先前研究中已被用于评估关节炎。然而，尚未有关于血友病性关节炎的CEUS检查研究。血友病性关节炎与其他关节炎不同，因为它是由自发性关节出血引起的。因此，CEUS在评估血友病性关节炎方面可能具有特殊价值。本研究评估了CEUS在评估重度甲型血友病患者滑膜肥厚和预测复发性关节出血中的价值。
2016年8月至2017年1月，纳入81例因常规超声关节评估转诊至我院的重度甲型血友病患者。在这81例患者中，46例患者在同一天同意接受CEUS检查。
与彩色多普勒血流成像（CDFI）相比，CEUS模式下多4个关节出现血流信号。此外，CEUS测量的滑膜肥厚比传统超声测量的更厚。关节出血组的超声评分（包括总灰阶超声评分、关节积液/关节积血、滑膜肥厚、CDFI半定量评分和CEUS半定量评分）显著高于无关节出血组（P<0.05）。此外，这些超声评分与关节出血频率呈正相关，且与CEUS评分的相关性最高（r=0.620，P<0.05）。
与传统超声相比，CEUS能更准确地评估滑膜肥厚程度和血管化情况，并诊断滑膜炎。此外，CEUS对于评估复发性关节出血的可能性似乎至关重要，并为个体化治疗提供更可靠的证据。
