Reumatologia: pesquisas atuais
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Sonography for Assessment of Elbows in Hemophilic Children: A Systematic Protocol

Frederico Xavier, Ningning Zhang, Arun Mohanta, Pamela Hilliard, Carina Man, Debra Drossmann, Ann Marie Stain, Victor Blanchette and Andrea S Doria

Evaluation of joints using sensitive non-invasive tools is important for diagnosis and follow-up of hemophilic patients who are continuously at risk of development and/or progression of arthropathy. Because conventional radiography is inadequate for assessing early arthropathic changes in hemophilic patients, there has been an increasing interest in the development of systematic protocols and scoring systems using magnetic resonance imaging (MRI) and ultrasound for evaluating hemophilic arthropathy in recent years. Given some advantages of ultrasound over MRI for this purpose, namely easier access, lower costs and no need for sedation in younger patients, detailed sonographic protocols have recently been proposed for assessment of large joints, most notably knees and ankles, which are most frequently affected by hemophilic arthropathy. Due to the challenges that the elbow joint offers to the reproducibility of positioning of the extremity on ultrasound which is an operator dependent imaging modality, the elbow joint requires dedicated attention. In this paper, we present a systematic protocol for sonographic data acquisition of the elbow in hemophilic children along with examples of findings of joint effusion, synovial hypertrophy, hemosiderin deposition, surface erosions, subchondral cysts and cartilage loss. We also correlate the ultrasound findings with corresponding MR images demonstrating the anatomic planes used for imaging acquisition. The development of a systematic protocol for ultrasound imaging acquisition of elbows in hemophilic children opens avenues for the development/refinement of ultrasound scales for assessment of hemophilic arthropathy which should reduce the opportunity for inter-and intraoperator variability during acquisition of images. Further validation of the proposed systematic protocol for assessment of arthropathic changes in hemophilic elbows is required for its future use in cross-sectional and longitudinal clinical trials. Standardization and validation of such protocols is essential for comparison of results of clinical trials conducted in different hemophilia centres across the world.