Previous studies evaluated the US findings of haemophilic joints

Previous studies evaluated the US findings of haemophilic joints [32,35] and described a systematic protocol for data acquisition of US findings in haemophilic joints [30,36]. Nevertheless, the value of this technique for the assessment of haemophilic arthropathy in comparison with MRI and physical examination has not been fully evaluated so far. As a result, this technique has been underemployed in clinical practice. Another challenge of US relates to the interpretation of images and comparison with other diagnostic tests. Further studies comparing US and MRI are needed to quantitate the diagnostic sensitivity loss of US (for central aspects

of the joint which are deeper in nature) with special regard to the interpretation of subchondral abnormalities

and cartilage loss. Haemophilic pseudotumours are chronic, NVP-LDE225 datasheet encapsulated and hemorrhagic fluid collections that contain coagulated blood and are surrounded by a thick wall. They usually destroy adjacent bone and may become quite large. Both MRI and contrast-enhanced computed tomography (CT) are useful in determining the thickness of the wall and the extent of the lesion [4,37]. In the acute stage, the centre of the pseudotumour appears hypodense on CT, but the periphery is isodense and indistinguishable from surrounding muscle [32]. CT shows the thick wall of pseudotumours more consistently than US does. Multiple irregular echoes on US may represent solid material that cannot be documented on CT. Differential diagnosis from abscesses may be difficult. Radiosynoviorthesis MCE is effective in limiting the frequency of joint haemorrhage, decreasing pain and improving the

function in haemophiliacs [38]. Blood-pool indices can be used to evaluate the efficacy of radioisotopic synoviorthesis (90Y and 186Re radiosynovectomy) in patients with haemophilic synovitis, and therefore can be an objective means for monitoring therapy response in these patients. An in vivo method for erythrocyte labelling with Technetium-99 m generates a dynamic perfusion sequence, which is obtained using a scintillation camera positioned over the area to be examined [39]. This demonstrates the vascularity of the tissue. Subsequently, equilibrium blood-pool images of the area are obtained and analysed with a densitometer to assess relative regional blood volume. In patients who are not bleeding but have chronic arthropathy, vascularity is not increased, and the blood volume of comparable joints may be similar. By contrast, marked increases in vascularity and image density are typically observed in studies of acute bleeding joints. Chronic hemarthroses are typically associated with persistent, but less marked increases in joint perfusion. Transient increases in joint vascularity are demonstrated after insertion of prostheses. In a patient with a thigh haematoma, the dimensions of the haemorrhage can be clearly delineated.

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