Application Value Of Ultrasonic SMI And SWE Technique In Hemophilia Arthropathy

Objectives As a reference of Haemophilic early srthropathy detection with ultrasound in China（HEAD-US-c）,Superb microvasclar imaging（SMI）and Shear wave elastography（SWE）were applied to observe the joint lesions and the changes with the preventive treatment of knee,ankle and elbow joints in hemophiliac patients.To investigate the characteristics of SMI and SWE in Hemophilia arthropathy（HA）.Methods A total of 37 hemophilia patients treated in our hospital from October 2020 to January 2022 were selected.The general data of 37 hemophilia patients were collected at the time of enrollment,including the patient’s age,weight,age of first bleeding,treatment plan and other information.Aplio I800 ultrasonic diagnostic instrument was used for examination.The both knees,ankles and elbows of the hemophilia patients were examined with conventional ultrasound,Power doppler flow imaging（PDFI）examination,SMI examination and SWE examination.Record the HEAD-US-c score,Adler semi-quantitative grading results of PDFI and SMI,Vascularization inde（VI）based on SMI check results,and hemophiliacs on prophylactic treatment are examined every two months.The measurement data of the normal distribution is represented by x±s,the measurement data of the skewness distribution and grade data are represented by M(P₂₅,P₇₅).Friedman test was used to compare the results of four examinations in 30 patients with hemophilia.Chi-square test and rank sum test were used to compare the detection rate and grading results of PDFI and SMI.Spearman correlation test was used to compare the correlation among parameters.According to whether PDFI detected synovial blood flow,variance analysis was used to compare the difference of synovial Emean and ROC analysis was performed on the synovial Emean to calculate the elastic boundary value of synovial membrane during inflammation.The difference was statistically significant（P<0.05）.Results 1 The total score of HEAD-US-c,joint effusion score,synovial thickness score,synovial blood flow score,PDFI grading,SMI grading and VI were all decreased for 30hemophiliac patients（all P<0.05）,while cartilage and bone had no obvious changes.Among them,the change time（T2）of total ultrasound score,joint effusion score,synovial thickness score and VI was earlier than that of synovial blood flow score,PDFI grading and SMI grading（T3）.2 PDFI detection rate（54.5%）was lower than SMI detection rate（65.1%）（χ²=207.042,P<0.05）.The SMI grading of 4 observation sites was higher than PDFI grading（all P<0.05）.HEAD-US-c score was strongly positively correlated with PDFI,SMI and VI（r=0.75,0.79,0.79,all P<0.05）.3 Emean,Cmean and HEAD-US-c score had weak negative correlation（r=0.39,0.32,all P<0.05）.Emean were negatively correlated with PDFI,SMI and VI（r=0.55,0.59,0.53,all P<0.05）.Cmean was negatively and weakly correlated with PDFI,SMI and VI（r=0.45,0.49,0.39,all P<0.05）.The Emean and Cmean of synovial membrane had no obvious correlation with the thickness of synovial membrane.4 The thickened synovium was examined by PDFI,The Emean of the group with synovium blood flow signal detected was lower than that of the group without synovium blood flow signal（F=7.165,P<0.05）.but there was no significant difference in the Emean of synovium with different PDFI grades.The Emean cut-off value was27.25kpa.The sensitivity,specificity and accuracy were 73%,86%and 86%.Conclusions 1 SMI and VI was more sensitive to the changes of synovial blood flow in hemophiliac arthropathy,SMI grade and VI were positively correlated with HEAD-US-c score,SMI and VI can provide a clinical indication of the degree of joint lesions and the risk of bleeding.2 Emean was negatively correlated with HEAD-US-c score.When the Emean of synovium of joint was less than 27.25kpa,it indicated that the joint might be in the inflammatory stage.There is a high risk of joint bleeding.Figure 4;Table 13;Reference 118...