| Objective:Using magnetic resonance imaging as the reference,to discuss the value of ultrasound in evaluating hemophilic joint disease,and future explore the effect of contrast-enhanced ultrasound in the evaluation of hemophilic joint disease and the correlation between ultrasound examination result and clinical examination indexes,in order to provide reference in clinical diagnosis,follow-up and the selection of treatment.Methods:Ultrasound and MRI examinations were performed respectively on 42 joints of42 hemophilia patients.Using magnetic resonance imaging as reference,to compare the difference betweenultrasound and magnetic resonance imaging in thescore ofjoint diseases.To analysis the consistency of ultrasound and magnetic resonance imaging in the detection and scoreofjoint diseases.And to test the inter-and intra-observer agreement of ultrasound examination.Conventional ultrasound were performed on 75 joints of 75 hemophilia patients and recorded ultrasound examination scores,including joint effusion/hemarthrosis,synovial hypertrophy,hemosiderin deposition,cartilage destruction,bone destruction,color doppler flow imaging semiquantitative score.Contrast-enhanced ultrasound was performed in 45 joints of 45 hemophilic patients and recorded contrast-enhanced ultrasound semiquantitative scores.Start of prevention and treatment and were followed up for 4 months after the patients were recorded during the follow-up period,the number of joint bleeding,according to the follow-up period without joint bleeding were divided into joint bleeding group and non bleeding group joint.The clinical data including age,height,body weight,the lowest coagulation factor level,the age of primary replacement therapy,and the age of primary prevention therapy were recorded.The correlation between the patients with hemophilia joint routine ultrasound score and clinical data;the difference of gray scale ultrasound mode and ultrasound contrast mode measured synovial thickness;comparison of joint bleeding group and no difference in bleeding group joint synovial thickness difference and ultrasound examination scores;to compare the correlation between ultrasound scores and joint bleeding frequency.Results:The diagnostic sensitivity of joint effusion/hemarthrosis,synovial hypertrophy,hemosiderin,cartilage destruction,bone destruction and subchondral cysts were 82.9%?97.0%?97.0%?90.0%?70.9%?14.0%;the specificity were 94.1%?100.0%?100.0%?92.0%?94.7%?100.0%;the false positive rate were 5.9%?0.0%?0.0%?8.0%?10.5%?100.0%;the false negative rate were 17.0%?3.0%?3.0%?10.0%?29.0%?86.0%;the coincidence rate were 88.0%?97.3%?97.3%?90.7%?76.0%?42.7%.The consistency of grey-scaleultrasound and magnetic resonance imaging was excellent in the detection of early soft tissue changes(P<0.001),excellent in the detection of cartilage loss(P<0.001),poorin the detection of bone erosions(P=0.132)and poor in the detection ofsubchondral cysts(P=0.137).The differences between the score of grey-scale ultrasound and magnetic resonance imaging were not significant for early soft tissue changes and cartilage(P>0.05).However,significant difference was detected for the score of bone destruction(P<0.05).The consistency of grey-scale ultrasound and magnetic resonance imaging was good to excellent in the score of early soft tissue changes(P<0.001).In the score of advancedosteochondral changes,the consistency waspoor to good(P<0.001).For early soft tissue changes,the inter-observer agreement was good toexcellent(P<0.001)and moderate to excellent for advanced osteochondral changes(P<0.001).The intra-observer agreement was good toexcellent for early soft tissue changes(P<0.001)and moderate to good for advanced osteochondral changes(k=0.532-0.732,P<0.001).In addition to joint effusion/hemarthrosis,positive correlation was found between age,body mass index,treatment of age and ultrasound scores(r=0.19?0.67,P<0.05);negative correlation was found between the trough coagulation factor level and ultrasound scores(r=-0.304?-0.444,P=0.000).The thickness of synovial membrane measured by contrast enhanced ultrasound(CEUS)was thicker than that of gray scale ultrasound,and the thickness was about 0.53±0.29cm,0.39±0.16cm,respectively.The difference was statistically significant(P =0.012).During the follow-up period,joint synovial thickness hemorrhage were measured in the CEUS mode and the mode of gray scale ultrasound were relatively non bleeding group joint thickness,thickness were about 0.62±0.31cm,0.33± 0.11cm vs 0.44±0.16cm,0.30±0.12cm,the difference was statistically significant(P =0.000;P =0.021).Joint bleeding group ultrasonography were compared with the joint bleeding group,scores were 0.38±0.75cm?6.86±3.49cm vs 0.10±0.42cm?4.42±3.86cm,there was significant difference between two groups(P=0.000?0.029);group by ultrasonography during the project scoring and follow-up joint bleeding times were positively correlated(r=0.17-0.63,P=0.000?0.030),which the correlation of CEUS score was the highest.Conclusions:Ultrasound can accurately assess the early soft tissue lesions and cartilage destruction in the joint of hemophilia,and also has some value in the assessment of bone destruction,but it can not accurately assess the formation of bone cyst.The lower the trough coagulation level,the higher the scores of ultrasound;with age,patients with hemophilia BMI growth and initial replacement therapy and primary prevention treatment delay age age,joint ultrasound score increased.It is suggested that the control of body weight and early treatment,especially the prevention and treatment,can delay the development of joint diseases.The ultrasound scores had a significant effect in forecasting the risk of bleeding in hemophilia patients.Contrast enhanced ultrasound can more clearly and accurately show the proliferation of synovial membrane and evaluate the degree of vascularization of the synovial membrane. |
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