Ultrasound Versus Magnetic Resonance Imaging for Haemophilic Arthropathy: A Systematic Review With Meta‐Analysis of Diagnostic Accuracy Across Joint Pathologies

INTRODUCTION: Haemophilic arthropathy (HA) is a debilitating consequence of recurrent intra-articular bleeding. While magnetic resonance imaging (MRI) is the established gold standard for joint assessment, musculoskeletal ultrasound (US) has emerged as a point-of-care alternative. AIM: To determine the reliability and diagnostic accuracy of US compared to MRI in detecting the various components of HA through systematic review and meta-analytic evidence. METHODS: A systematic literature search was conducted across PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Diagnostic performance metrics (sensitivity, specificity, and area under curve) were pooled using a bivariate random-effects model. Correlation coefficients for joint scores were meta-analyzed using Fisher's z transformation and random-effects model. RESULTS: Ten studies involving 294 patients and 710 joints were included. US demonstrated high diagnostic accuracy for synovitis (sensitivity 90.3%, specificity 95.6%, AUC 0.957) and osteochondral changes (sensitivity 82.7%, specificity 97.2%, AUC 0.969). Conversely, a significant sensitivity gap was identified for cartilage damage (sensitivity 57.6%, specificity 96.9%, AUC 0.834). For overall HA, US showed a pooled sensitivity of 81.5% and an AUC of 0.945. The pooled correlation between US and MRI total joint scores was strong (r = 0.7575). Significant heterogeneity was observed in some of the results. CONCLUSIONS: US is a highly specific and reliable tool for the point-of-care monitoring of active synovitis and osteochondral changes in haemophilia. However, due to its limited sensitivity in detecting cartilage damage, US should be utilized as a primary screening and monitoring tool. MRI remains necessary for the definitive staging of early osteochondral deterioration.