Arvind Kaur Shergill MBBS, Presenter: Nothing to Disclose

Marshall Stephen Sussman PhD, Abstract Co-Author: Nothing to Disclose

Denise A. Castro MD, Abstract Co-Author: Nothing to Disclose

Carina Man, Abstract Co-Author: Nothing to Disclose

Arun Mohanta, Abstract Co-Author: Nothing to Disclose

Andrea Schwarz Doria MD, Abstract Co-Author: Research Grant, Baxter International Inc Research Grant, Physicians Services Incorporated

Quantification of early soft tissue joint changes with MRI and ultrasound (US) techniques that enhance visualization of blood products are crucial for diagnosis and follow-up of arthropathy in hemophilic children. The purposes of this study are: 1. To compare UTE and conventional MRI sequences for assessing blood degradation products in hemophilic children with subacute and chronic bleeds. 2. To assess the echogenicity/color pixel amount of soft tissues in hemophiliac joints at different time points after bleeds using gray-scale and color doppler (CD) US in relation to corresponding MR images.

30 hemophilic boys (5-17 years) with history of a subacute (<1 week) joint bleed [group 1], no history of a recent (<4 weeks) joint bleed [group 2], and 13 healthy controls (9-18 years) underwent US and MRI scans using conventional and UTE sequences. For UTE scans, the images from two echo times were subtracted to produce a short-T2 image. Two blinded radiologists reviewed US and MRI examinations according to International Prophylaxis Study Group scores.

In group 1 (n=14) intra-articular blood on US appeared hypo, iso and hyperecho in (6/14) 42.9%, (1/14) 7.1%, and (3/14) 21% of cases, respectively. On MRI (T1/T2) it showed intermediate/high signal in (12/14) 86% and low signal in (2/14) 14% of cases. In group 2, intra-articular blood appeared hypo, iso and hyperechoic in (8/16) 50%, (1/16) 6%, and (2/16) 13% cases. On MRI (T1/T2) it appeared as low signal in (12/16) 75% and intermediate/high signal in (2/16) 12.5% of scans (which presented with superimposed recent bleeds). On CDUS, increased synovial vascularity was seen in 38% of ankles and 50% of knees in group 1, and in 13% of ankles and 60% of knees in group 2. In all available UTE images chronic blood products demonstrated intermediate signal as opposed to dark signal on MPGR MR images.

Conversely to conventional MRI, neither gray-scale nor CDUS could distinguish subacute from chronic bleeds in hemophilic joints. The use of UTE MRI holds promise for detecting minimal joint bleeds since the lack of susceptibility artifacts (in contrast to gradient-echo MRI) may improve its accuracy.

Gray-scale and CD US cannot stage timing of blood degradation products in hemophilic joints. UTE holds potential as an accurate MRI techinique for detection of subclinical joint bleeds, thus encouraging further investigation.

Shergill, A, Sussman, M, Castro, D, Man, C, Mohanta, A, Doria, A, Implementation of Novel Ultra-Short TE (UTE) and Conventional Imaging Techniques for Assessment of Blood Degradation Products in Hemophiliac Joints - Work in Progress.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007380.html