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Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI
Author(s) -
Foppen W.,
Schaaf I. C.,
Beek F. J. A.,
Mali W. P. T. M.,
Fischer K.
Publication year - 2018
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.13524
Subject(s) - medicine , point of care , ultrasound , joint (building) , point of care ultrasound , radiology , point of care testing , magnetic resonance imaging , medical physics , pathology , architectural engineering , engineering
Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging ( MRI ) is associated with an increased risk of future joint bleeding. Aim The aim of this study was to investigate whether point‐of‐care ultrasound ( POC ‐ US ) is an accurate alternative for MRI for the detection of early joint changes. Methods In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X‐rays were scanned using POC ‐ US and 3 Tesla MRI . POC ‐ US was performed by 1 medical doctor, blinded for MRI , according to the “Haemophilia Early Arthropathy Detection with Ultrasound” ( HEAD ‐ US ) protocol. MRI s were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals ( CI ). Results Knees and ankles of 24 haemophilia patients (96 joints), aged 18‐34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC ‐ US for synovial tissue was correct (overall accuracy) in 97% ( CI : 91‐99) with a positive predictive value of 94% ( CI : 73‐100) and a negative predictive value of 97% ( CI : 91‐100). The overall accuracy of POC ‐ US for cartilage abnormalities was 91% ( CI : 83‐96) and for bone surface irregularities 97% ( CI : 91‐99). Conclusion POC ‐ US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC ‐ US is an accurate and available alternative for MRI , it can be used for routine evaluation of early joint changes.