Hemarthrosis versus Acute Synovitis in Patients with Hemophilia: Noninvasive Differentiation by Means of Quantitative Magnetic Resonance Imaging

Purpose or Learning Objective: In the X-linked coagulopathies hemophilia A and B, spontaneous bleeding occurs, particularly in the elbow, knee, and upper ankle joints. This bleeding leads to synovial inflammation and ultimately to premature arthropathy. This study developed the first noninvasive method of differentiating spontaneous hemarthrosis from an acute episode of synovial inflammation.

Methods or Background: A dilution series of whole blood from three different subjects were submitted to T1 and T2 mapping over a period of 2 weeks, and the relaxation times were correlated with the blood concentrations. Subsequently, joint effusions from 30 patients with hemophilia were subjected to T2 mapping and then punctured or operated on, allowing bloody and nonbloody effusions to be distinguished. The relaxometry results were correlated with the findings.

Results or Findings: All mappings of the phantom scan correlated with blood dilution at all measurement times. The T2 mapping was the most sensitive. In the in vivo examination, a cutoff of T2 = 361 ms was determined that distinguishes between a hemarthrosis and a reactive effusion with a sensitivity and specificity of 100%.

Conclusion: We found that T2 mapping on 3-T magnetic resonance imaging can spare people with hemophilia a diagnostic arthrocentesis so that targeted therapy can be initiated without delay.

Publikationsverlauf

Artikel online veröffentlicht:
02. Juni 2025