De waarde van echo en MRI bij de evaluatie van gewrichtsschade bij hemofilie

Repeated provoked or spontaneous bleeding into the joints are the hallmark of haemophilia. From a clinical perspective, it is important to assess early, potentially reversible, joint changes in patients with normal findings on physical examination and X-rays. Consequently there is an increasing interest in the use of Magnetic Resonance Imaging (MRI) and ultrasound. So far, there is no literature available about the diagnostic accuracy of a recently developed, simple and fast, ultrasound protocol. Besides, the clinical relevance of early changes detected by MRI and ultrasound is still unclear. It is not known if subtle alterations such as haemosiderin and synovial hypertrophy seen on MRI are reversible or not, and if they have a predictive value for development of osteochondral changes.
The primary objective of this study is to establish the diagnostic accuracy of ultrasound assessment of the synovium in haemophilic arthropathy compared to MRI. Secondary objectives are to determine whether or not synovial hypertrophy on MRI is able to predict osteochondral changes on MRI five years later and to evaluate if intra-articular haemosiderin can be cleared in five years.

- The diagnostic accuracy of ultrasound assessment regarding the synovium in patients with haemophilia is > 70%.


- Soft tissue changes on initial MRI are associated with osteochondral changes on re-examination after 5 years, independent of bleeding-history in patients with haemophilia.


- Haemosiderin on MRI could be cleared five years later in joints of haemophilic patients without new joint bleeds

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Diagnostic procedures:

* Ultrasound assessment of knees and ankles

* MRI assessment of knees and ankles