Hemophilia MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]; Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[3]

Overview

MRI may be helpful in the diagnosis of hemophilia. Findings on MRI suggestive of hemophilic arthropathy include effusion, synovial hypertrophy, erosion, subchondral cyst, cartilage loss, osteonecrosis, fibrocartilage tear, ligament tear, loose body.

MRI

The additive European MRI scoring system^[1]


Type of change	Score

Subchondral cysts Present in at least one bone Present in at least two bones More than three cysts in at least one bone More than three cysts in at least two bones Largest size > 4 mm in at least one bone Largest size > 4 mm in at least two bones	1 1 1 1 1 1
Irregularity/erosion of subchondral cortex Present in at least one bone Present in at least two bones Involves more than half of joint surface in at least one bone Involves more than half of joint surface in at least two bones	1 1 1 1
Chondral destruction Present in at least one bone Present in at least two bones Full-thickness defect in at least one bone Full-thickness defect in at least two bones Full-thickness defect involves more than one-third of joint surface in at least one bone Full-thickness defect involves more than one-third of joint surface in at least two bones	1 1 1 1 1 1
Effusion/hemarthrosis	Absent = 0 Equivocal = 1 Small = 2 Moderate = 3 Large = 4
Synovial hypertrophy	Absent = 0 Equivocal = 1 Small = 2 Moderate = 3 Large = 4
Hemosiderin	Absent = 0 Equivocal = 1 Small = 2 Moderate = 3 Large = 4

The progressive Denver MRI scoring system^[2]


Type of change	Findings and Score

Effusion	Absent = 0 Small = 1 Moderate = 2 Large = 3
Hemarthrosis	Absent = 0 Small = 1 Moderate = 2 Large = 3
Synovial hyperplasia	Absent = 0 Small = 4 Moderate = 5 Large = 6
Hemosiderin	Absent = 0 Small = 4 Moderate = 5 Large = 6
Erosion	Absent = 0 Partial-surface erosion = 7 Full-surface erosion = 8
Subchondral cyst	Absent = 0 1 cyst = 7 >1 cyst = 8
Cartilage loss	Absent = 0 >50% loss = 9 ≥ 50% loss = 10

Ancillary findings of Denver MRI scale^[2]

References

↑ Lundin B, Pettersson H, Ljung R (July 2004). “A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy”. Haemophilia. 10 (4): 383–9. doi:10.1111/j.1365-2516.2004.00902.x. PMID 15230954.
↑ ^2.0 ^2.1 Nuss R, Kilcoyne RF, Geraghty S, Shroyer AL, Rosky JW, Mawhinney S, Wiedel J, Manco-Johnson M (May 2000). “MRI findings in haemophilic joints treated with radiosynoviorthesis with development of an MRI scale of joint damage”. Haemophilia. 6 (3): 162–9. PMID 10792474.

Overview