Radiological Challenges of T2 relaxation time in Hemophilic Arthropathy and its Consequences on Management: A Case Control Study

Abstract BackgroundHemophilia is x-linked disorder that affect knee joints. T2 mapping is a noninvasive quantitative MR sequence for early cartilage changes and decreased water content of the articular cartilage. SWI is a sensitive MR technique to micro bleeds within the joint spaces and inflamed synovium.AimThe purpose of our study was to assess the added value of T2 mapping and SWI to MRI protocol as well as ultrasonography in evaluation of knee arthropathic changes in pediatric hemophilic patients.MethodsThis prospective case-control study enrolled a group of 55 patients with hemophilia diagnosed by clinical examination and laboratory investigation. A control group of 50 healthy subjects of matched age group were also included. All the participants were subjected ultrasonographic as well as MRI examination. T2 mapping, SQI and filter phase were added to our MRI protocol.ResultsAfter quantitative assessment of T2 relaxation times at different portions of the knee joint. The mean T2 relaxation time were significantly longer in the patients than the control group. (p < 0.001*). Microbleeds could be detected in a significantly higher percentage of participants of the patients’ group (34.5% by conventional MRI and 52.7% by SWI) than the control group (2% and 4%, respectively). The HEAD-US scores showed strongly positive significant correlation with the MRI score (r = 0.855, p < 0.001*), also statistically high positive correlation was noted between T2 relaxation time and the MRI score of the studied participants.ConclusionT2 mapping is a novel MR sequence for detection of early cartilage biochemical changes in hemophilic arthropathy. SWI has a superior sensitivity in detecting microbleeds compared to conventional MRI and the strong correlation between HEAD-US and MRI scores validate the reliability of these imaging protocols.