Purpose or Case Report: Optimization of ultrasound (US) scanning planes for evaluation of different joint components of subjects with blood-induced arthropathy can decrease scanning time without compromising diagnostic information. The purpose of this study was to identify the most diagnostically informative set of US planes for assessment of arthropathy in growing joints of persons with hemophilia based on frequency of findings.
Methods & Materials: Unilateral knees (n=32), ankles (n=47) and elbows (n=11) of boys with hemophilia A and B (median age 13, range 7-17 years) were evaluated by US in five treatment centers (Brazil, n=3; China, n=2). US scans were performed by two operators at each center. All examinations were blindly reviewed and final results agreed upon by consensus. Soft-tissue (effusion, synovial hypertrophy, synovial hyperemia, and hemosiderin) and osteochondral (erosions, subchondral cysts, and cartilage loss) joint components were analyzed using different US planes at three levels (L1=above, L2=at, and L3=below the joint level).
Results: Synovial hypertrophy was the most frequent finding in all index joints. For knees, L1-sagittal-posterior-central, L2-coronal-medial and lateral, L2-sagittal-anterior-lateral and L1-sagittal-anterior-central planes demonstrated highest frequencies of synovial hypertrophy, followed by hemosiderin-rich synovium and synovial hyperemia. Soft tissue findings were most frequently observed in the L2-sagittal-anterior and posterior-central and medial planes in the ankles, and the L1-sagittal-anterior-medial, L2-sagittal-anterior-lateral, L1-sagittal-posterior-central, and the L2-sagittal-posterior-medial planes in the elbows. Osteochondral findings were most frequently noted in the L1-sagittal-anterior-lateral, L2-sagittal-posterior-lateral and medial, and L1-sagittal-anterior-medial planes in all joints.
Conclusions: L1 and L2 sagittal US planes showed the highest frequencies of abnormalities in all joints. Future research investigating different levels of severity is needed for developing practical protocols for US assessment of joints of subjects with blood-induced arthropathy receiving different treatment strategies. This evidence-based approach for assessment of imaging acquisition protocols for joints of patients with blood-induced arthropathies should assist in optimizing and reducing the false negative rates of point-of-care ultrasound protocols that use a limited set of ultrasound planes to address specific clinical questions.