UTILITY OF MAGNETIC-RESONANCE-IMAGING FOR MANAGEMENT OF HEMOPHILIC ARTHROPATHY IN CHILDREN

We hypothesized that magnetic resonance imaging (MRI) would improve cl inical and plain-radiograph assessments of children with hemophilic ar thropathy. Thirteen children, aged 7 to 16 years, with severe factor V III deficiency and one or more target joints were identified. A target joint was defined as a joint into which hemorrhage had occurred at le ast twice a month for at least the previous 6 months. After review of history, examination, and plain radiography, a recommendation regardin g synovectomy or prophylaxis with factor VIII concentrate was made for each target joint. The MRI of each target joint was then reviewed. Fo urteen target joints (three elbows, three knees, eight ankles) were ev aluated. On the basis of clinical and plain-radiograph data, synovecto my was recommended for five and prophylaxis for seven joints. Disconti nuation of prophylaxis was recommended for two ankles in one child. Th e MRI examination confirmed that four of five potential synovectomy ca ndidates had markedly hypertrophied synovium and could benefit from su rgery; one of five was excluded from synovectomy because synovial hype rtrophy was minimal. Two of seven children recommended for prophylaxis were given substantially altered plans after MRI. In all, approximate ly 40% of joint assessments were modified as a result of the MRI findi ngs. We conclude that MRI should be included in the evaluation of some children with hemophilic arthropathy.