Application Of Quantitative MSCT And MRI Enhanced Scans In Imaging Diagnosis And Prognosis Evaluation Of Hemophilic Arthropathy

Part ? The value of quantitative multislice spiral CT imaging in evaluating hemophilic arthropathy Objective:To explore quantitative MSCT in the diagnostic and prophylactic value of hemophilic arthropathy(HA).Materials and Methods:This study was a retrospective study,in which 38 patients diagnosed with HA in the *** hemophilia treatment and management center from January 2016 to May2018 were selected,with 73 diseased joints.Among them,there are 42 knee joints,19 ankle joints,5 elbow joints and 7 hip joints.All 73 joints were examined by X-ray,CT and MRI within two days.According to the X-ray Pettersson score,73 joints were divided into mild,moderate and severe groups.MRI scoring was performed for each joint according to IPSG scoring criteria.In CT quantitative scoring,joint effusion/hemorrhage,synovial hyperplasia,hemosiderin deposition,bone erosion,and bone cyst change were performed with reference to the MRI IPSG score.The quantitative scoring of cartilage injury was determined according to the degree of joint space narrowing in Pettersson scoring.Wilcoxon signed-rank test was used to compare the differences of CT and MRI quantification scores among mild,moderateand severe groups.The correlations between the CT score of joint space narrowing and MRI score of cartilage injury and the total CT and MRI scores were analyzed by Spearman rank correlation.Results:MRI score was superior to CT in small amount of joint effusion/hemarthrosis,synovial hypertrophy and hemosiderin deposition in mild groups(p=0.000,0.025,0.014).There was no significant difference between CT and MRI in scores of the moderate to large amounts of joint effusion/hemarthrosis,moderate and severe groups of synovial hypertrophy and hemosiderin deposition,bone erosion and bone cystic change(p>0.05),indicating the same diagnostic efficacy.There was a high positive correlation between the Pettersson score of CT joint space narrowing and the IPSG score of MRI cartilage injury(r =0.905,p=0.000),and the degree of CT joint space stenosis could indirectly reflect the damage of articular cartilage.There was a high positive correlation between the total IPSG scores of CT and MRI.Conclusion:Quantitative multislice spiral CT has a strong positive correlation with IPSG MRI scores,except for mild synovitis,and in the case of low doses,the scope of application is wider and the scanning speed is faster,it can be used as an alternative to MRI to image and evaluate hemophilic arthropathy.Part ?: Preliminary study of the effect of enhanced magnetic resonance imaging on synovial IPSG score in hemophilic arthropathyPurpose:To investigate the diagnostic value of magnetic resonance(MRI)enhanced scan for synovial hyperplasia in patients with hemophilic joint disease(HA)and its effect on IPSG score.Materials and Methods:This study was a retrospective study,in which 46 patients diagnosed with HA in the treatment and management center of hemophilia in *** from August 2016 to September 2017 were selected as research objects,with a total of 54 diseased joints.3.0T MRI plain scan and enhanced scan were performed simultaneously in 54 joints.Among them,there are 31 knee joints,17 ankle joints,4 elbow joints and 2 hip joints.Synovial hyperplasia before and after the enhancement of each joint was scored according to the IPSG scoring standard,and the total IPSG scoring of the joint was conducted at the same time.The signal intensity of hyperplastic synovial membrane and muscle at the same layer before and after enhancement was measured by post-processing workstation,and the enhancement rate of synovium and muscle at the same level was calculated.The paired rank sum test was used to compare the difference of MRI plain scan and enhanced scan on synovial hyperplasia IPSG score and total joint IPSG score.Spearman rank correlation analysis was used to analyze the correlation between the total IPSG score of the enhanced joint,the IPSG score of the enhanced synovial membrane,the enhancement rate of synovial membrane and the total bleeding times,disease course and HJHS score of the joint.Results:There were statistically significant differences in IPSG score of synovial hyperplasia and total IPSG score of joint between plain and enhanced MRI scans,enhanced MRI scans could show the thickened synovium more clearly and comprehensively(p=0.025),and enhanced MRI scans could make the total IPSG score of joint more accurate(p=0.025).In MRI enhanced scanning,the proliferative synovium of 54 joints had different degrees of enhancement,and the overall enhancement amplitude of synovium was higher than that of the same layer of muscle.There was no clinical correlation between synovial enhancement rate and total bleeding times,course of disease and HJHS score(p>0.05),and no clinical correlation between enhanced synovial IPSG score and HJHS score(p>0.05).After enhancement,the total IPSG score of joint was highly positively correlated with the total number of joint bleeding and the course of disease(r=0.957?0.835,p=0.000),and moderately positively correlated with the HJHS score(r=0.578,p=0.000).The enhanced synovial IPSG score was lowly positively correlated with the total number of joint bleeding and the course of disease(r=0.369,0.357,p=0.006,0.008).Conclusion:Compared with plain MRI scan,enhanced MRI scan can show the proliferated synovium more clearly and comprehensively,and make the total IPSG score of joint more accurate.The type of synovial hyperplasia can be predicted by the magnitude of synovial enhancement in enhanced MRI scan.MRI-enhanced scanning can provide precise visualization of synovial hyperplasia in HA patients.