Which imaging modalities are used in the workup of hemophilia?

Updated: Sep 27, 2019
  • Author: Lars J Grimm, MD, MHS; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Imaging tests such as plain radiography or magnetic resonance imaging (MRI) are helpful in defining the degree of joint destruction.  MRI and US have been shown to provide information that is complementary to clinical evaluation, especially in patients with normal radiographs. [20, 21] The stages of altered anatomy are defined by classification systems that have been developed for plain radiographs and MRI. [19, 22, 23] Plain radiographic classification systems for describing the clinical progression of arthropathy were developed in the 1970s. However, radiographs may lead to the underestimation of soft-tissue changes that precede bone destruction. Treatment of patients with hemophilia at an early age may prevent progression to the later, destructive changes seen on radiographs.

MRI has played a major role in defining such destructive soft-tissue changes and has led to early, aggressive treatment of affected patients. [22] Overall, the best imaging modality is MRI, because this technique combines excellent spatial resolution with the ability to detect soft-tissue bleeding at an early stage. In a given case, all of the other mentioned imaging modalities may play a role, but the first choice is MRI.

Early arthropathic changes may be identified by T2 mapping MRI of cartilage before clinical symptoms become apparent. Cross-sectional imaging modalities such as CT, ultrasonography, and MRI may be useful in assessing bleeding-related musculoskeletal complications, such as pseudotumors. [24]

Ultrasonography offers an appealing alternative for assessing the joint fluid and synovial proliferation. This technique has been used more extensively in Canada and Europe than in the United States. [31, 9]


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