| Background and ObjectiveHemophilia is a rare,hereditary,bloody disease caused by coagulation factor deficiency or dysfunction,and joint damage is a hallmark of the disease.Haemophilic arthropathy?HA?is a form of joint disease that develops secondary to joint bleeding and presents with synovial hypertrophy,cartilage and bony destruction.HA is the main cause of disability in hemophiliacs?knee about 45%?.Articular cartilage injury is a key stage of HA.Imaging examination is the main part of HA clinical assessment,so the application of sensitive imaging technology is very important for the early diagnosis of articular cartilage injury in hemophilia patients.Magnetic resonance imaging?MRI?is a gold standard method for the noninvasive assessment of articular cartilage,and quantitative MRI techniques are often used as non-invasive biomarkers to detect early articular cartilage degeneration prior to the loss of cartilage morphology.This study intends to explore the value of new MRI techniques in detecting early cartilage injury in patients with haemophilic arthropathy,and to provide useful information for patients with hemophilia for choosing the correct preventive treatment mode,and so as to assess efficacy of therapy,and to further reduce the rate of disability in patients.Materials and MethodsThe study was reviewed and approved by the Ethics Committee of our institute.All subjects were given informed consent.From January 1,2016 to December 31,2017,patients diagnosed with hemophilia arthropathy in Henan Provincial Hemophilia diagnosis and treatment Center and healthy volunteers of the same period were selected prospectively.Routine sequence MRI and new sequence T2 mapping,DWI?diffusion weighted imaging?,SWI?susceptibility weighted imaging?,and3D-DESS?three-dimensional double-echo steady state?sequence of knees of all study subjects were performed in 3.0T MRI.The healthy volunteers were set up as the control group and the patients as the experimental group.The experimental group were further devided according to the degree of the ICRS?International Cartilage Repair Society?cartilage injury to subgroups?group A,B,and C?.According to the division of articular cartilage area:patella,lateral femoral condyle,lateral tibial condyle,medial femoral condyle,medial tibial condyle,the T2 value and ADC?apparent diffusion coefficient?value of each area articular cartilage were measured in the control group,the experimental group A and B.The IPSG?international prophylaxis study group?scores of the hemosiderin deposition of synovium in the experimental groups of the conventional and SWI sequences were performed and devided into 1 to 3 score:a small amount of hemosiderin deposition is score 1,medium amount is score 2,and a large number is score 3.The matching age of the control group and the experimental group was analyzed by two independent samples t test,and joint number distribution using chi-square test.The T2 value and ADC value of cartilage in each group were analyzed by ANOVA?analysis of variance?.Multiple comparisons between groups were performed using the LSD-t test.The T2 and ADC were analyzed by receiver operating characteristic curve.The joint count data of IPSG scores were statistically described using the composition ratio,and the rank sum test was used for the difference analysis.Set the test level to 0.05,P<0.05 the difference is statistically significant.Results1.Finally,20 cases of control group and 55 cases of experimental group were included in the study.There were 34 joints in control group,40 knees in group A,33knees in group B and 14 knees in group C.Routine MR examination of knee joints of the control group and the experimental group A showed no significant abnormalities in articular cartilage.Routine MR examinations of knee joints of patients in experimental group B and experimental group C showed image manifestations of haemophilic arthropathy.2.The color scale signal of T2 mapping image of articular cartilage was uniform with that of DWI in the control group,and the color scale signal of T2 mapping image and DWI diffusion signal of part of cartilage in experimental group A were locally abnormal.In group experimental B and C,the color scale signal of T2mapping image in cartilage of knee joint was obviously abnormal and the diffusion of cartilage was obviously abnormal on DWI,and some of the patients were abnormal in cartilage morphology.3.The T2 values of global cartilage in the control group,experimental group A,and experimental group B were?40.99±6.55?ms,?46.66±7.59?ms,and?49.87±7.25?ms,respectively,and the ADC values were?1.59±0.07?×10-3 mm2/s,?1.68±0.11?×10-33 mm2/s and?1.79±0.11?×10-3 mm2/s,respectively.Comparing the T2 value of cartilage in each subgroup,the F values of patella,lateral femoral condyle,lateral tibial condyle,medial femoral condyle,medial tibial condyle and whole cartilage were 29.56,13.89,13.52,14.98,19.98 and 66.35,respectively.There was a significant difference,P<0.05.The ADC values of cartilage in each subgroup,the F values were 3.21,11.74,10.00,6.03,5.16,and 14.00,respectively.The P values were all<0.05,and the difference was statistically significant.Comparing T2 value groups in each Cartilage partition,except for the experimental group A and experimental group B of the patella,the difference between the groups was statistically significant?P<0.05?.For the articular cartilage ADC values,in addition to the patella and medial tibial condyle,there was no statistical difference between the control group and the experimental group A,and there was a statistically significant difference between the other two groups?P<0.05?.T2 value and ADC value were analyzed by ROC curve.The results showed that the area under the ROC curve?AUC?of the T2 value was0.81,the AUC of the ADC value was 0.75,P all<0.01.T2 value and ADC value had higher diagnostic efficacy for articular cartilage injury.4.The IPSG scores of all experimental groups were as follows:routine sequences showed that there were no hemosiderin deposition in 65?74.71%?joints,score 1 has 11?12.64%?joints,score 2?1.15%?has 1 joint,score 3 has 10?11.49%?joints;SWI sequence showed that there were 56?64.37%?joints without hemosiderin deposition,score 1 has 12?13.79%?joints,score 2 has 8?9.20%?joints,and score 3has 11?12.64%?joints.Comparison shows that SWI sequence in displaying rate of hemosiderin deposition in synovium was higher than that of routine sequences.Conclusion1.MRI T2 mapping and DWI can early detect cartilage damage in patients with hemophilic arthropathy,and it has a definite value in distinguishing different degrees of cartilage damage.2.The SWI sequence can sensitively detect the deposition of hemosiderin in the joint,which is of great significance for the accurate assessment of HA hemosiderin deposition. |
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