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__NOTOC__
__NOTOC__
{{Hemophilia}}
{{Hemophilia}}
{{CMG}} {{AE}} {{Sab}}
{{CMG}} {{AE}} {{Sab}}; {{Rohan}}


==Overview==
==Overview==
MRI may be helpful in the diagnosis of hemophilia. Findings on MRI suggestive of hemophilic arthropathy include effusion, synovial hyperplasia, erosion, subchondral cyst, cartilage loss, osteonecrosis, fibrocartilage tear, ligament tear, loose body.
[[Magnetic resonance imaging|MRI]] may be helpful in the [[diagnosis]] of hemophilia. Findings on [[Magnetic resonance imaging|MRI]] suggestive of [[Hemophilia|hemophilic]] [[arthropathy]] include effusion, [[synovial]] [[Hypertrophy (medical)|hypertrophy]], [[Erosion (dental)|erosion]], subchondral [[cyst]], [[cartilage]] loss, osteonecrosis, [[fibrocartilage]] [[Tears|tear]], [[ligament]] [[Tears|tear]], loose body.
 
==MRI==
==MRI==
===Additive European MRI scoring system===
'''The additive European MRI scoring system'''<ref name="pmid15230954">{{cite journal |vauthors=Lundin B, Pettersson H, Ljung R |title=A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy |journal=Haemophilia |volume=10 |issue=4 |pages=383–9 |date=July 2004 |pmid=15230954 |doi=10.1111/j.1365-2516.2004.00902.x |url=}}</ref>
'''The additive European MRI scoring system'''<ref name="pmid15230954">{{cite journal |vauthors=Lundin B, Pettersson H, Ljung R |title=A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy |journal=Haemophilia |volume=10 |issue=4 |pages=383–9 |date=July 2004 |pmid=15230954 |doi=10.1111/j.1365-2516.2004.00902.x |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:670px"
{| style="border: 0px; font-size: 90%; margin: 3px; width:680px"
| valign="top" |
| valign="top" |
|+
|+
! style="background: #4479BA; width: 620px;" | {{fontcolor|#FFF|Type of change}}
! style="background: #4479BA; width: 560px;" | {{fontcolor|#FFF|Type of change}}
! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Score}}
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Score}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold " |
Subchondral cysts
Subchondral [[Cyst|cysts]]
*Present in at least one bone
*Present in at least one [[bone]]
*Present in at least two bones
*Present in at least two [[Bone|bones]]
*More than three cysts in at least one bone
*More than three [[Cyst|cysts]] in at least one [[bone]]
*More than three cysts in at least two bones
*More than three [[Cyst|cysts]] in at least two [[Bone|bones]]
*Largest size > 4 mm in at least one bone
*Largest size > 4 mm in at least one [[bone]]
*Largest size > 4 mm in at least two bones
*Largest size > 4 mm in at least two [[Bone|bones]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
<br>
<br>
Line 30: Line 32:
*1
*1
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold |
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold " |
Irregularity/erosion of subchondral cortex
Irregularity/erosion of subchondral [[cortex]]
*Present in at least one bone
*Present in at least one [[bone]]
*Present in at least two bones
*Present in at least two [[Bone|bones]]
*Involves more than half of joint surface in at least one bone
*Involves more than half of [[joint]] surface in at least one [[bone]]
*Involves more than half of joint surface in at least two bones
*Involves more than half of [[joint]] surface in at least two [[Bone|bones]]
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<br>
<br>
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|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold " |
Chondral destruction
Chondral destruction
*Present in at least one bone
*Present in at least one [[bone]]
*Present in at least two bones
*Present in at least two [[Bone|bones]]
*Full-thickness defect in at least one bone
*Full-thickness [[defect]] in at least one [[bone]]
*Full-thickness defect in at least two bones
*Full-thickness [[defect]] in at least two [[Bone|bones]]
*Full-thickness defect involves more than one-third of joint surface in at least one bone
*Full-thickness [[defect]] involves more than one-third of [[joint]] surface in at least one [[bone]]
*Full-thickness defect involves more than one-third of joint surface in at least two bones
*Full-thickness [[defect]] involves more than one-third of [[joint]] surface in at least two [[Bone|bones]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
<br>
<br>
Line 63: Line 65:
*1
*1
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Narrowing of [[joint]] space
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold " |Effusion/[[hemarthrosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent    = 0
*Equivocal = 1
*Small    = 2
*Moderate  = 3
*Large    = 4
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold " |[[Synovial]] [[Hypertrophy (medical)|hypertrophy]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent    =  0
*Equivocal =  1
*Small    =  2
*Moderate  =  3
*Large    =  4
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold " |[[Hemosiderin]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent    =  0
*Equivocal =  1
*Small    =  2
*Moderate  =  3
*Large    =  4
 
|-
|}
 
===Progressive Denver MRI scoring system===
'''The progressive Denver MRI scoring system'''<ref name="pmid10792474">{{cite journal |vauthors=Nuss R, Kilcoyne RF, Geraghty S, Shroyer AL, Rosky JW, Mawhinney S, Wiedel J, Manco-Johnson M |title=MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage |journal=Haemophilia |volume=6 |issue=3 |pages=162–9 |date=May 2000 |pmid=10792474 |doi= |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:380px"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Type of change}}
! style="background: #4479BA; width: 180px;" | {{fontcolor|#FFF|Findings and Score}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Effusion
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Absent = 0
*Joint space > 1 mm = 1
*Small = 1
*Joint space < 1 mm = 2
*Moderate = 2
*Large = 3
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Subchondral [[Cyst|cysts]] formation
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |[[Hemarthrosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Absent = 0
*1 cyst = 1
*Small = 1
*>1 cyst = 2
*Moderate = 2
*Large = 3
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Synovial]] [[hyperplasia]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Small = 4
*Moderate = 5
*Large = 6
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Hemosiderin]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Small = 4
*Moderate = 5
*Large = 6
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Erosion
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Partial-surface erosion = 7
*Full-surface erosion = 8
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Subchondral [[cyst]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*1 cyst = 7
*>1 cyst = 8
 
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Cartilage]] loss
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*>50% loss = 9
*≥ 50% loss = 10
|-
|}
{| align="right"
|
[[File:MRI Hemophilia.gif|300px|thumb|MRI of the right Knee showing hemophilic arthropathy with moderate joint effusion, decreased joint space, subchondral erosions and cystic changes, cartilage loss, the synovium is thickened with multifocal low signal intensity and the intercondylar notch is widened with erosive changes. The intercondylar notch is irregular and wide. .[https://radiopaedia.org/cases/haemophilic-arthropathy-2?lang=us#googDisableSync Source: Case courtesy of Dr Abdallah Al Khateeb , Radiopaedia.org, rID: 45521]]]
|}
'''Ancillary findings of Denver MRI scale'''<ref name="pmid10792474">{{cite journal |vauthors=Nuss R, Kilcoyne RF, Geraghty S, Shroyer AL, Rosky JW, Mawhinney S, Wiedel J, Manco-Johnson M |title=MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage |journal=Haemophilia |volume=6 |issue=3 |pages=162–9 |date=May 2000 |pmid=10792474 |doi= |url=}}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width:250px"
| valign="top" |
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Type of change}}
! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Finding}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Effusion
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent
*Present
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" align="center" |Osteonecrosis
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent
*Present
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Erosion of [[joint]] margins
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Fibrocartilage]] [[Tears|tear]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Absent  
*Present = 1
*Present
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Gross incongruence of articulating [[bone]] ends
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Ligament]] [[Tears|tear]]
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Absent
*Slight = 1
*Present
*Pronounced = 2
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |[[Joint]] deformity (angulation and/or displacement)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" |Loose body
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Absent = 0
*Absent  
*Slight = 1
*Present
*Pronounced = 2
|-
|-
|}
|}

Latest revision as of 17:50, 31 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[3]

Overview

MRI may be helpful in the diagnosis of hemophilia. Findings on MRI suggestive of hemophilic arthropathy include effusion, synovial hypertrophy, erosion, subchondral cyst, cartilage loss, osteonecrosis, fibrocartilage tear, ligament tear, loose body.

MRI

Additive European MRI scoring system

The additive European MRI scoring system[1]

Type of change Score

Subchondral cysts

  • Present in at least one bone
  • Present in at least two bones
  • More than three cysts in at least one bone
  • More than three cysts in at least two bones
  • Largest size > 4 mm in at least one bone
  • Largest size > 4 mm in at least two bones


  • 1
  • 1
  • 1
  • 1
  • 1
  • 1

Irregularity/erosion of subchondral cortex

  • Present in at least one bone
  • Present in at least two bones
  • Involves more than half of joint surface in at least one bone
  • Involves more than half of joint surface in at least two bones


  • 1
  • 1
  • 1
  • 1

Chondral destruction

  • Present in at least one bone
  • Present in at least two bones
  • Full-thickness defect in at least one bone
  • Full-thickness defect in at least two bones
  • Full-thickness defect involves more than one-third of joint surface in at least one bone
  • Full-thickness defect involves more than one-third of joint surface in at least two bones


  • 1
  • 1
  • 1
  • 1
  • 1
  • 1
Effusion/hemarthrosis
  • Absent = 0
  • Equivocal = 1
  • Small = 2
  • Moderate = 3
  • Large = 4
Synovial hypertrophy
  • Absent = 0
  • Equivocal = 1
  • Small = 2
  • Moderate = 3
  • Large = 4
Hemosiderin
  • Absent = 0
  • Equivocal = 1
  • Small = 2
  • Moderate = 3
  • Large = 4

Progressive Denver MRI scoring system

The progressive Denver MRI scoring system[2]

Type of change Findings and Score
Effusion
  • Absent = 0
  • Small = 1
  • Moderate = 2
  • Large = 3
Hemarthrosis
  • Absent = 0
  • Small = 1
  • Moderate = 2
  • Large = 3
Synovial hyperplasia
  • Absent = 0
  • Small = 4
  • Moderate = 5
  • Large = 6
Hemosiderin
  • Absent = 0
  • Small = 4
  • Moderate = 5
  • Large = 6
Erosion
  • Absent = 0
  • Partial-surface erosion = 7
  • Full-surface erosion = 8
Subchondral cyst
  • Absent = 0
  • 1 cyst = 7
  • >1 cyst = 8
Cartilage loss
  • Absent = 0
  • >50% loss = 9
  • ≥ 50% loss = 10
MRI of the right Knee showing hemophilic arthropathy with moderate joint effusion, decreased joint space, subchondral erosions and cystic changes, cartilage loss, the synovium is thickened with multifocal low signal intensity and the intercondylar notch is widened with erosive changes. The intercondylar notch is irregular and wide. .Source: Case courtesy of Dr Abdallah Al Khateeb , Radiopaedia.org, rID: 45521

Ancillary findings of Denver MRI scale[2]

Type of change Finding
Effusion
  • Absent
  • Present
Osteonecrosis
  • Absent
  • Present
Fibrocartilage tear
  • Absent
  • Present
Ligament tear
  • Absent
  • Present
Loose body
  • Absent
  • Present

References

  1. ↑ Lundin B, Pettersson H, Ljung R (July 2004). "A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy". Haemophilia. 10 (4): 383–9. doi:10.1111/j.1365-2516.2004.00902.x. PMID 15230954.
  2. ↑ 2.0 2.1 Nuss R, Kilcoyne RF, Geraghty S, Shroyer AL, Rosky JW, Mawhinney S, Wiedel J, Manco-Johnson M (May 2000). "MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage". Haemophilia. 6 (3): 162–9. PMID 10792474.

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