| Objective: To explore the application value of musculoskeletal ultrasound(MSKUS)in hemophilic arthropathy(HA)by using MRI as a reference.Moreover,MSKUS examination combined with HEAD-US scoring system was used to explore the degree and distribution characteristics of joint lesions in patients with hemophilia at different ages,so as to guide the clinic to formulate different joint protection measures according to the age of hemophilia patients.Methods: The study is divided into two parts.The first part: collect16 knee joints with clinical bleeding records from 13 patients with moderate and severe hemophilia who meet the standard.MSKUS examination and MRI examination were performed in 16 knee joints at the same time to evaluate the diagnostic efficacy of MSKUS examination for HA joint effusion(blood),synovial hyperplasia,hemosiderin deposition,cartilage damage and bone destruction.And to evaluate the consistency of the two imaging methods in the detection of joint effusion(blood),synovial hyperplasia,hemosiderin deposition,cartilage damage and bone destruction.Moreover,the difference and consistency of HA ultrasound scoring system(HEAD-US scoring system)and magnetic resonance scoring system(IPSG MRI scoring system)on the imaging indexes(synovial hyperplasia,cartilage damage and bone destruction)were compared.The second part: 135 patients with moderate and severe hemophilia who met the standard were collected.According to the age,the 135 patients were divided into two groups,including 76 patients in the children group(0～9 years old)and 59 patients in the adolescent group(10～19 years old).MSKUS examination combined with HEAD-US scoring system was used to compare the differences of HA prone joints and the degree of joint lesions between the children and adolescent group.Results: The first part of the study showed that: all the 13 hemophilia patients were male,aged from 7 to 19 years old,with an average age of(14.13±3.98)years.All the 16 included knee joints were diagnosed as HA,and MSKUS sonographic features included joint effusion(blood),synovial hyperplasia,hemosiderin deposition,cartilage damage or bone destruction.MSKUS examination had high diagnostic efficiency for joint effusion(blood),synovial hyperplasia,and cartilage damage(sensitivity was 100%,93.3%and 90% respectively,specificity was 100%,100% and 83.3% respectively),and had good consistency with gold standard MRI examination(kappa=1.000,0.636,0.733,P=0.000,0.006,0.003).However,the diagnostic efficiency of MSKUS for hemosiderin deposition and bone destruction was poor(sensitivity was 37.5% and 54.5% respectively,specificity was 75% and 60% respectively),and it was inconsistent with MRI examination(kappa=0.125 respectively,P=0.590 respectively).The score of synovial hyperplasia by HEAD-US scoring system was significantly lower than that by IPSG MRI scoring system(P<0.05).There was no significant difference in the scores of cartilage damage and bone destruction between HEAD-US scoring system and IPSG MRI scoring system(P>0.05).There was moderate consistency between HEAD-US scoring system and IPSG MRI scoring system in the score of cartilage damage(kappa=0.563,P=0.000),but there was no consistency in the score of synovial hyperplasia and bone destruction(Kappa=0.162,0.07,P=0.194,0.68).The second part of the study showed that: 135 patients with moderate and severe hemophilia were all male.The average age of patients in the children group was 5.88±2.49 years old,and that in the adolescent group was13.68±2.82 years old.The average level of coagulation factor activity in the children group was 1.46 ±0.84(IU/dl),and that in the adolescent group was 1.59±0.96(IU/dl).There was no significant difference in the activity of coagulation factors in circulation between the two age groups(t=0.83,P=0.408).A total of 347 joints in the two age groups were diagnosed as HA,the most common sites of HA were ankle,knee and elbow joint.The most common site of HA in the children group was ankle joint(44.75%),while that of HA in the adolescent group was knee joint(36.04%)and ankle joint(36.04%).The lesion rates of ankle,knee and elbow joint in the adolescent group were higher than those in the children group,especially in knee joint.The HEAD-US scores of ankle,knee and elbow joint in the adolescent group were significantly higher than those in the children group(z=3.720,7.437,3.105,P=0.000,0.000,0.002).Synovial hyperplasia was the main pathological change of joint lesions in children and the adolescent group(70.27%,56.36%),and the incidence of cartilage damage and bone destruction in the adolescent group was higher than that in the children group.In the children group,91.61% HA was mild joint disease,and in the adolescent group,70.56% HA was mild joint disease.The positive rates of moderate and severe joint diseases in the adolescent group were higher than those in the children group.Conclusion: MSKUS examination can objectively and effectively diagnose and evaluate HA,especially in the diagnosis and evaluate of joint effusion(blood),synovial hyperplasia and cartilage damage.However,the diagnostic efficiency of hemosiderin deposition and bone destruction in HA is low.The HEAD-US scoring system and IPSG MRI scoring system showed moderate consistency in the score of cartilage damage,but inconsistent in the score of synovial hyperplasia and bone destruction.MSKUS examination combined with HEAD-US scoring system can objectively indicate that the predilection site,joint condition and severity of joint lesions are different in patients with hemophilia at different ages.In conclusion,MSKUS examination can effectively evaluate the condition of HA joint and dynamically monitor the progress of joint.MSKUS examination combined with HEAD-US scoring system can evaluate the severity of joint lesions.MSKUS examination can guide the clinical development of different joint protection strategies for hemophilia patients of different ages.In conclusion,MSKUS can be used as the first choice for early joint condition assessment and disease dynamic monitoring of HA. |
