Annette von Drygalski1,2, Randy E Moore3, Sonha Nguyen1, Richard F W Barnes1, Lena M Volland1, Tudor H Hughes4, Jiang Du4, Eric Y Chang5. 1. Department of Medicine, Division of Hematology/Oncology, University of California San Diego, San Diego, California, USA. 2. Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, California, USA. 3. General Musculoskeletal Imaging, Inc, Cincinnati, Ohio, USA. 4. Department of Radiology, University of California San Diego, San Diego, California, USA. 5. Radiology Service, VA San Diego Healthcare System, San Diego, California, USA.
Abstract
OBJECTIVES: Point-of-care musculoskeletal ultrasound (US) is increasingly used by hemophilia providers to guide management; however, pathologic tissue differentiation with US is uncertain. We sought to determine the extent to which point-of-care musculoskeletal US can identify and discriminate pathologic soft tissue changes in hemophilic arthropathy. METHODS: Thirty-six adult patients with hemophilia A/B were prospectively enrolled. Point-of-care musculoskeletal US examinations were performed on arthropathic joints (16 knees, 10 ankles, and 10 elbows) using standard views by a musculoskeletal US-trained and certified hematologist, who recorded abnormal intra-articular soft tissue accumulation. Within 3 days, magnetic resonance imaging was performed using conventional and multiecho ultrashort echo time sequences. Soft tissue identification (synovial proliferation with or without hemosiderin, fat, and/or blood products) was performed by a musculoskeletal radiologist. Findings obtained with both imaging modalities were compared and correlated in a blinded fashion. RESULTS: There was perfect agreement between the modalities on the presence of abnormal soft tissue (34 of 36 cases). However, musculoskeletal US was unable to discriminate between coagulated blood, synovium, intrasynovial or extrasynovial fat tissue, or hemosiderin deposits because of wide variations in echogenicity. CONCLUSIONS: Musculoskeletal US is valuable for point-of-care imaging to determine the presence of soft tissue accumulation in discrete areas. However, because of limitations of musculoskeletal US in discriminating the nature of pathologic soft tissues and detecting hemosiderin, magnetic resonance imaging will be required if such discrimination is clinically important.
OBJECTIVES: Point-of-care musculoskeletal ultrasound (US) is increasingly used by hemophilia providers to guide management; however, pathologic tissue differentiation with US is uncertain. We sought to determine the extent to which point-of-care musculoskeletal US can identify and discriminate pathologic soft tissue changes in hemophilic arthropathy. METHODS: Thirty-six adult patients with hemophilia A/B were prospectively enrolled. Point-of-care musculoskeletal US examinations were performed on arthropathic joints (16 knees, 10 ankles, and 10 elbows) using standard views by a musculoskeletal US-trained and certified hematologist, who recorded abnormal intra-articular soft tissue accumulation. Within 3 days, magnetic resonance imaging was performed using conventional and multiecho ultrashort echo time sequences. Soft tissue identification (synovial proliferation with or without hemosiderin, fat, and/or blood products) was performed by a musculoskeletal radiologist. Findings obtained with both imaging modalities were compared and correlated in a blinded fashion. RESULTS: There was perfect agreement between the modalities on the presence of abnormal soft tissue (34 of 36 cases). However, musculoskeletal US was unable to discriminate between coagulated blood, synovium, intrasynovial or extrasynovial fat tissue, or hemosiderin deposits because of wide variations in echogenicity. CONCLUSIONS: Musculoskeletal US is valuable for point-of-care imaging to determine the presence of soft tissue accumulation in discrete areas. However, because of limitations of musculoskeletal US in discriminating the nature of pathologic soft tissues and detecting hemosiderin, magnetic resonance imaging will be required if such discrimination is clinically important.
Authors: James V Luck; Mauricio Silva; E Carlos Rodriguez-Merchan; Navid Ghalambor; Christopher A Zahiri; Richard S Finn Journal: J Am Acad Orthop Surg Date: 2004 Jul-Aug Impact factor: 3.020
Authors: Akram Mesleh Shayeb; Richard F W Barnes; Cris Hanacek; Peter Aguero; Bruno Steiner; Cindy Bailey; Doris Quon; Rebecca Kruse-Jarres; Annette von Drygalski Journal: Haemophilia Date: 2021-06-25 Impact factor: 4.263
Authors: Nihal Bakeer; Saunya Dover; Paul Babyn; Brian M Feldman; Annette von Drygalski; Andrea S Doria; Danial M Ignas; Audrey Abad; Cindy Bailey; Ian Beggs; Eric Y Chang; Amy Dunn; Sharon Funk; Sridhar Gibikote; Nicholas Goddard; Pamela Hilliard; Shyamkumar N Keshava; Rebecca Kruse-Jarres; Yingjia Li; Sébastien Lobet; Marilyn Manco-Johnson; Carlo Martinoli; James S O'Donnell; Olympia Papakonstantinou; Helen Pergantou; Pradeep Poonnoose; Felipe Querol; Alok Srivastava; Bruno Steiner; Karen Strike; Merel Timmer; Pascal N Tyrrell; Logi Vidarsson; Victor S Blanchette Journal: Res Pract Thromb Haemost Date: 2021-07-10