MRI assessment of haemophilic arthropathy

Research output: ThesisDoctoral Thesis (compilation)

Abstract

Haemophilia is a recessive genetic bleeding disorder in which coagulation time is prolonged due to the absence or malfunction of either of the serum proteins Factor VIII or IX. Joint destruction following repeated haemarthroses is the main cause of morbidity in haemophiliacs, and such arthropathy can be prevented or postponed by implementing prophylactic therapy with factor concentrate at an early age. Prophylaxis is the recommended treatment for severe haemophilia, but there is no consensus as to the optimal or the most cost effective prophylactic regimen. New sensitive methods are needed to monitor and evaluate haemophilia care.

Magnetic resonance imaging (MRI) is a modality with superior capacity to visualize joint pathology. We designed a new additive MRI scoring method for haemophilic arthropathy (the European MRI score) that can monitor reversible and irreversible components of the joint disease separately. We compared this approach with a previously presented progressive method (the Denver MRI score), and then analysed the correlation between the results obtained with those two methods and clinical data on joint bleeds and physical joint examinations. Based on the findings, we developed a combined scoring scheme (the compatible MRI scales). Moreover, we investigated the intra- and interobserver agreement of the MRI scores, and the value of gadolinium contrast agent for MRI scoring of haemophilic arthropathy.

The European MRI scoring method is useful for sensitive assessments of the progression of haemophilic arthropathy, and it is more efficient than the Denver method in differentiating the arthropatic changes. Nonetheless, the European and Denver scores are highly correlated with each other, and they show the same degree of correlation with data on number of joint bleeds and physical joint examination. The compatible MRI scales can be applied to achieve practical assessment of early arthropathy and for assessment of the progression of the disease over time. Reliable MRI scoring is feasible, provided uniform imaging protocols are utilized and the evaluation is conducted by specially trained radiologists. Gadolinium contrast agent is not routinely indicated for MRI scoring of haemophilic arthropathy
Original languageEnglish
QualificationDoctor
Awarding Institution
  • Diagnostic Radiology, (Lund)
Supervisors/Advisors
  • Ljung, Rolf, Supervisor
Award date2007 Feb 14
Publisher
ISBN (Print)978-91-85559-00-8
Publication statusPublished - 2007

Bibliographical note

Defence details

Date: 2007-02-14
Time: 13:00
Place: Föreläsningssal 3, Centralblocket, Universitetssjukhuset i Lund, Lund, Sweden

External reviewer(s)

Name: Aspelin, Peter
Title: Professor
Affiliation: Institutionen för Klinisk Vetenskap, Intervention, och Teknik. Enheten för Radiologi. Karolinska Ins

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<div class="article_info">B Lundin, H Pettersson and R Ljung. <span class="article_issue_date">2004</span>. <span class="article_title">A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy.</span> <span class="journal_series_title">Haemophilia</span>, <span class="journal_volume">vol 10</span> <span class="journal_pages">pp 383-389</span>.</div>
<div class="article_info">B Lundin, R Ljung and H Pettersson. <span class="article_issue_date">2005</span>. <span class="article_title">MRI scores of ankle joints in children with haemophilia—comparison with clinical data.</span> <span class="journal_series_title">Haemophilia</span>, <span class="journal_volume">vol 11</span> <span class="journal_pages">pp 116-122</span>.</div>
<div class="article_info">B Lundin, P Babyn, A S Doria, R Kilcoyne, R Ljung, S Miller, R Nuss, G Rivard and H Pettersson. <span class="article_issue_date">2005</span>. <span class="article_title">Compatible scales for progressive and additive MRI assessments of haemophilic arthropathy.</span> <span class="journal_series_title">Haemophilia</span>, <span class="journal_volume">vol 11</span> <span class="journal_pages">pp 109-115</span>.</div>
<div class="article_info">. <span class="article_issue_date"></span>. <span class="article_title">Gadolinium contrast agent is of limited value for MRI assessment of synovial hypertrophy in hemophiliacs.</span> (submitted)</div>
<div class="article_info">B Lundin, E Berntorp, H Pettersson, R Wirestam, K Jonsson, F Ståhlberg and R Ljung. <span class="article_issue_date"></span>. <span class="article_title">Gadolinium contrast agent is of limited value for MRI assessment of synovial hypertrophy in hemophiliacs.</span> <span class="journal_series_title">ACTA Radiologica</span>, (submitted)</div>
<div class="article_info">A S Doria, P Babyn, B Lundin, R F Kilcoyne, S Miller, G E Rivard, R Moineddin and H Pettersson. <span class="article_issue_date">2006</span>. <span class="article_title">Reliability and construct validity of the compatible MRI scoring system for evaluation of haemophilic knees and ankles of haemophilic arthropathy. Expert MRI working group of the international prophylaxis study group.</span> <span class="journal_series_title">Haemophilia</span>, <span class="journal_volume">vol 12</span> <span class="journal_pages">pp 503-513</span>.</div>

Subject classification (UKÄ)

  • Radiology, Nuclear Medicine and Medical Imaging

Keywords

  • radiologi
  • tomografi
  • medicinsk instrumentering
  • medical instrumentation
  • tomography
  • radiology
  • Clinical physics
  • Medicin (människa och djur)
  • Medicine (human and vertebrates)
  • Arthropathy
  • Factor VIII
  • Factor IX
  • MRI
  • Haemophilia
  • Klinisk fysiologi

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