Radiological challenges of T2 relaxation time in hemophilic arthropathy and its consequences on management: a case control study

Abstract Background Hemophilia is an x-linked disorder that affects knee joints. T2 mapping is a novel noninvasive quantitative MR sequence for early cartilage changes and decreased water content of the articular cartilage. SWI is a s4ensitive MR parameter to micro bleeds within the joint spaces and the inflamed synovium. Aim The purpose of this study was to assess the added value of T2 mapping and SWI to Magnetic Resonance Imaging (MRI) protocol as well as ultrasonography in the evaluation of knee arthropathic changes in pediatric hemophilic patients for early cartilage changes in hemophilic arthropathic patients. Methods This 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 was also included. All the participants were subjected to the following; Clinical assessment by pediatric hematology consultant at hematology unit of pediatric department of our university hospital institute, followed by laboratory evaluation, ultrasonographic assessment of the knee joints,as well as MRI examination. T2 mapping, SQI, and filter phase were added to our MRI protocol. Results After quantitative assessment of T2 relaxation times at different portions of the knee joint, the mean T2 relaxation time was significantly longer in the patients than in the control group ( p < 0.001*). Micro bleeds could be detected in a significantly higher percentage of participants in the patients’ group (34.5% by conventional MRI and 52.7% by SWI) than in the control group (2% and 4%, respectively). The HEAD-US scores showed a strongly positive significant correlation with the MRI score ( r = 0.855, p < 0.001*); also, a statistically high positive correlation was noted between T2 relaxation time and the MRI score of the studied participants. Conclusion T2 mapping is a novel MR sequence for the detection of early cartilage biochemical changes in hemophilic arthropathy. SWI has a superior sensitivity in detecting micro bleeds compared to conventional MRI, and the strong correlation between HEAD-US and MRI scores validates the reliability of these imaging protocols.