Datasets:

---

Recag

/

Rp_CommonC_124

like 0

ERROR: type should be string, got "https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly93d3cubWVkc2NhcGUuY29tL2Fuc3dlcnMvNDAxODQyLTE3NzMxOC93aGF0LWlzLXRoZS1yb2xlLW9mLW1yaS1pbi10aGUtd29ya3VwLW9mLWhlbW9waGlsaWE=\nDrugs & Diseases > Radiology > Imaging in Musculoskeletal Complications of Hemophilia Q&A\nWhat is the role of MRI in the workup of hemophilia?\nAuthor: Lars J Grimm, MD, MHS; Chief Editor: Felix S Chew, MD, MBA, MEd more...\nSoft-tissue changes are depicted well on MRI, including joint effusion, hemarthrosis, synovitis, and hemosiderin deposition (see the images below).\nMagnetic resonance image from a patient with hemophilia. This image shows dark, synovial masses that erode the cartilage and produce subchondral cysts (arrows).\nAxial gradient-echo magnetic resonance image from a patient with hemophilia. This image demonstrates hemosiderin deposition in the synovium as hypointense material that outlines the joint capsule. Image courtesy of Javier Beltran, MD.\nSagittal magnetic resonance image of the ankle joint in a patient with hemophilia. This image shows extension of abnormal joint fluid from the ankle joint into the subtalar joint. Note the dark hemosiderin posterior to the subtalar fluid (arrow).\nAxial T2-weighted magnetic resonance image of the pelvis. This image demonstrates a large pseudotumor of the pelvis with sacral extension. Image courtesy of Javier Beltran, MD.\nSagittal T2-weighted magnetic resonance image of the lower extremity in a patient with hemophilia. This image demonstrates hemosiderin-laden synovium with low signal intensity that outlines the capsule of the tibiotalar joint. Image courtesy of Javier Beltran, MD.\nCoronal T2-weighted magnetic resonance image of the knee in a patient with hemophilia. This image demonstrates pseudotumor of the knee, a lytic lesion in the lateral femoral condyle, as well as the characteristic manifestations of hemosiderin deposition in the knee joint and the subchondral cystic changes in the medial femoral condyle. Image courtesy of Javier Beltran, MD.\nMRI offers excellent soft-tissue contrast resolution and spatial resolution. Special techniques have been developed and are undergoing development to improve the visualization of articular cartilage.\nEffusion and synovitis may develop from causes other than hemophilia, such as trauma or infection. In patients with pigmented villonodular synovitis, hemosiderin deposition may look exactly like that which is caused by hemophilia in a given joint. Juvenile rheumatoid arthritis can cause knee deformity in a way that is similar to that in hemophilia, and bleeding may cause ectopic ossification in the soft tissues that looks like posttraumatic myositis ossificans.\nMasses are especially common in the pelvis. Starker described these masses as pseudotumors in 1918; they are seen in 2% of patients with hemophilia. [4]\nThe 3 forms of pseudotumor are intraosseous, subperiosteal (or cortical), and soft tissue. The intraosseous form is most common in the femur, pelvic bones, tibia, and hand bones; the lesions can be variably sized. The pseudotumor is usually well demarcated, but it may also be bubbly and destructive. The lesion may simulate malignancy such as that from Ewing sarcoma, metastasis, or infection because of the pseudotumor's aggressive appearance. The subperiosteal type leads to cortical atrophy, subperiosteal new-bone formation, and soft-tissue extension. This is seen most commonly in the fibula. The soft-tissue form of the mass is surrounded by a fibrous capsule and may cause deformity of the adjacent bone.\nRegarding other findings, calcification in hemosiderin may simulate other calcified masses on MRIs. Chondrocalcinosis occurs more commonly in calcium pyrophosphate deposition disease or primary hyperparathyroidism than in hemophilia. Septic arthritis can develop in a child with hemophilia; this may be a problem in early diagnosis. Contracture of soft tissues around joints may cause impingement on blood vessels or nerves.\nNational Heart, Lung, and Blood Institute. Hemophilia. NHLBI Diseases and Conditions Index. Available at http://www.nhlbi.nih.gov/health/dci/Diseases/hemophilia/hemophilia_all.html. Accessed: August 30, 2007.\nTobase P, Lane H, Siddiqi AE, Ingram-Rich R, Ward RS, Universal Data Collection Joint Outcome Working Group, et al. Declining trends in invasive orthopedic interventions for people with hemophilia enrolled in the Universal Data Collection program (2000-2010). Haemophilia. 2016 Jul. 22 (4):604-14. [Medline].\nKapadia BH, Boylan MR, Elmallah RK, Krebs VE, Paulino CB, Mont MA. Does Hemophilia Increase the Risk of Postoperative Blood Transfusion After Lower Extremity Total Joint Arthroplasty?. J Arthroplasty. 2016 Jul. 31 (7):1578-82. [Medline].\nResnick D. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, Pa: WB Saunders Co; 2002.\nRodriguez-Merchan EC. Prevention of the musculoskeletal complications of hemophilia. Adv Prev Med. 2012. 2012:201271. [Medline]. [Full Text].\nRoosendaal G, Lafeber FP. Blood-induced joint damage in hemophilia. Semin Thromb Hemost. 2003 Feb. 29(1):37-42. [Medline].\nRodriguez-Merchan EC, Valentino LA. Orthopedic disorders of the knee in hemophilia: A current concept review. World J Orthop. 2016 Jun 18. 7 (6):370-5. [Medline].\nPergantou H, Matsinos G, Papadopoulos A, Platokouki H, Aronis S. Comparative study of validity of clinical, x-ray and magnetic resonance imaging scores in evaluation and management of haemophilic arthropathy in children. Haemophilia. 2006 May. 12(3):241-7. [Medline].\nPoonnoose PM, Hilliard P, Doria AS, Keshava SN, Gibikote S, Kavitha ML, et al. Correlating clinical and radiological assessment of joints in haemophilia: results of a cross sectional study. Haemophilia. 2016 Jul 7. [Medline].\nNuss R, Kilcoyne RF. Diagnosis by imaging of haemophilic joints. Rodriguez-Merchan EC, ed. The Haemophilic Joints: New Perspectives. Malden, England: Blackwell Publishing; 2003. 24-9.\nPettersson H, Ahlberg A, Nilsson IM. A radiologic classification of hemophilic arthropathy. Clin Orthop Relat Res. 1980 Jun. 149:153-9. [Medline].\nKeshava SN, Gibikote S, Doria AS. Imaging evaluation of hemophilia: musculoskeletal approach. Semin Thromb Hemost. 2015 Nov. 41 (8):880-93. [Medline].\nBernabeu-Taboada D, Martin-Hervas C. Sonography of haemophilic joints. Rodriguez-Merchan EC, ed. The Haemophilic Joints: New Perspectives. Malden, England: Blackwell Publishers; 2003. 30-5.\nSierra Aisa C, Lucía Cuesta JF, Rubio Martínez A, Fernández Mosteirín N, Iborra Muñoz A, Abío Calvete M, et al. Comparison of ultrasound and magnetic resonance imaging for diagnosis and follow-up of joint lesions in patients with haemophilia. Haemophilia. 2014 Jan. 20 (1):e51-7. [Medline].\nGoto M, Takedani H, Nitta O, Kawama K. Joint Function and Arthropathy Severity in Patients with Hemophilia. J Jpn Phys Ther Assoc. 2015. 18 (1):15-22. [Medline].\nLee A, Boyd SK, Kline G, Poon MC. Premature changes in trabecular and cortical microarchitecture result in decreased bone strength in hemophilia. Blood. 2015 Mar 26. 125 (13):2160-3. [Medline].\nZukotynski K, Jarrin J, Babyn PS, et al. Sonography for assessment of haemophilic arthropathy in children: a systematic protocol. Haemophilia. 2007 May. 13(3):293-304. [Medline].\nNuss R, Kilcoyne RF, Geraghty S, et al. MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage. Haemophilia. 2000 May. 6(3):162-9. [Medline].\nDoria AS, Babyn PS, Lundin B, et al, for the Expert MRI Working Group of the International Prophylaxis Study Group. Reliability and construct validity of the compatible MRI scoring system for evaluation of haemophilic knees and ankles of haemophilic children. Haemophilia. 2006 Sep. 12(5):503-13. [Medline].\nKilcoyne RF, Lundin B, Pettersson H. Evolution of the imaging tests in hemophilia with emphasis on radiography and magnetic resonance imaging. Acta Radiol. 2006 Apr. 47(3):287-96. [Medline].\nLundin B, Berntorp E, Pettersson H, et al. Gadolinium contrast agent is of limited value for magnetic resonance imaging assessment of synovial hypertrophy in hemophiliacs. Acta Radiol. 2007 Jun. 48(5):520-30. [Medline].\nKnee radiograph in a 37-year-old man with moderate factor IX hemophilia. This image shows bony excrescence on the lateral side of the femur is a hemophilic pseudotumor.\nRadiograph of the lower extremity of the 3-year-old daughter of the patient in the previous image. This image shows talar tilt. The girl not only inherited 1 diseased X chromosome with mild factor IX hemophilia from her father, but she also has Turner (XO) syndrome. The child's only X chromosome had the hemophilia gene.\nAnteroposterior radiograph from a patient with hemophilia. This image demonstrates hemarthrosis with hemosiderin deposition. Note the irregularity of the articular surfaces and the presence of subchondral sclerosis with cysts. Image courtesy of Javier Beltran, MD.\nLateral radiograph from the same patient as in the previous image. This image shows a large hemarthrosis that is distending the suprapatellar recess. Image courtesy of Javier Beltran, MD.\nRadiograph in a patient with hemophilia. This image depicts a pseudotumor that is deforming the cortex of the femur (arrow). Other ossified masses in the soft tissues (arrowheads) are probably soft-tissue pseudotumors.\nComputed tomography scan of the pelvis in a patient with hemophilia. This image demonstrates a giant pseudotumor (a large expansile lytic lesion that involves the right iliac bone and extends into the sacrum, with inhomogeneous internal attenuation). Image courtesy of Javier Beltran, MD.\nLateral elbow radiograph in a patient with hemophilia. This image shows an opaque joint effusion due to the presence of iron in the synovium (arrows).\nRadiograph of the ankle in a 20-year-old patient with hemophilia. This image shows the development of osteonecrosis (arrow) in the talar dome.\nRadiograph of the shoulder of a 35-year-old man with hemophilia. This image shows advanced degenerative joint disease. The infiltrate in the lung is due to a fungal infection as a complication of the patient's positive human immunodeficiency virus (HIV) status.\nRadiograph of the leg in a patient with hemophilia. This image depicts stage III joint disease, as determined by the Arnold-Hilgartner classification.\nRadiograph of the leg in a patient with hemophilia. This image depicts stage IV joint disease, as determined by the Arnold-Hilgartner classification.\nLars J Grimm, MD, MHS Assistant Professor, Department of Diagnostic Radiology, Duke University Medical Center\nBernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand\nJavier Beltran, MD Chair, Department of Radiology, Maimonides Medical Center\nFelix S Chew, MD, MBA, MEd Professor, Department of Radiology, Vice Chairman for Academic Innovation, Section Head of Musculoskeletal Radiology, University of Washington School of Medicine\nFelix S Chew, MD, MBA, MEd is a member of the following medical societies: American Roentgen Ray Society, Association of University Radiologists, Radiological Society of North America\nAmilcare Gentili, MD Professor of Clinical Radiology, University of California, San Diego, School of Medicine; Consulting Staff, Department of Radiology, Thornton Hospital; Chief of Radiology, San Diego Veterans Affairs Healthcare System\nAmilcare Gentili, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, Society of Skeletal Radiology\nencoded search term (What is the role of MRI in the workup of hemophilia?) and What is the role of MRI in the workup of hemophilia?"