Magnetic Resonance Imaging Changes and Clinical Response in Chinese Haemophilic Joints Treated with Yttrium 90 Radiosynoviorthesis
RKL Lee, WCW Chu, JHY Leung, AWH Ng, HKY Tam, PPY Lui, AWK Leung, MKM Kam, MK Shing, CK Li
Hong Kong J Radiol 2013;16:27-33
DOI: 10.12809/hkjr1312146
Objective: Radiosynoviorthesis has been shown to be effective in decreasing bleeding frequency, reducing pain, and improving quality of life in haemophilic patients. The aim of this study was to evaluate the clinical response and magnetic resonance imaging (MRI) changes in Chinese haemophilic joints after Yttrium 90 (Y-90) radiosynoviorthesis.
Methods:We retrospectively reviewed Chinese haemophilic patients treated by Y-90 radiosynoviorthesis between 2004 and 2011. A total of nine joints in six patients (all males; mean age, 17 years; age range, 5-27 years) with recurrent joint bleeding were studied. The joints consisted of three knees, three elbows, two ankles, and one hip. The frequency of bleeding episodes, pain, and MRI features of pre-synovectomy (within 1 month before the procedure) and post-synovectomy (12-18 months after the procedure) were compared. Presence of effusion / haemarthrosis, synovial hypertrophy, haemosiderin, subchondral cysts / erosion and cartilage loss on MRI were evaluated. The Denver MRI scales before and after synovectomy were also compared.
Results:Clinically, all joints showed improvement in frequency of bleeding episodes (p < 0.001) and pain. The majority (89%, 8/9 joints) of the joints showed a decrease in effusions / haemarthrosis and synovial thickening / enhancement while more than half (56%, 5/9 joints) of the joints yielded a decrease in the extent of haemosiderin deposits. Only one joint (11%) showed progression of subchondral cyst / erosion and cartilage loss while the rest (89%, 8/9 joints) of the joints had no worsening of degenerative changes. The difference in Denver MRI scores showed no statistically significant changes in scores before and after synovectomy (median pre-score: 9 vs. postscore: 10; p = 0.347).
Conclusions:Clinical together with MRI improvements in terms of effusions / haemarthrosis, synovial hypertrophy, and haemosiderin were found in majority of haemophilic joints treated by Y-90 radiosynoviorthesis. Majority of joints also showed no further worsening of joint degeneration (including subchondral cysts / erosions and cartilage loss) though none of above-mentioned changes were considered reversible or important for ultimate joint function.
中文摘要
血友病華籍患者以90釔放射治療關節滑膜炎後出現的磁共振 影像學變化和臨床反應
李嘉樂、朱昭穎、梁凱瑩、伍永鴻、譚家盈、呂沛欣、梁永堃、甘冠明、成明光、李志光
目的：放射治療血友病患者關節滑膜炎已被證實可降低其出血頻率、減輕痛楚及改善生活質量。本 研究目的是評估血友病華籍患者以90釔（Y-90）放射治療關節滑膜炎後所出現的臨床反應和磁共振 影像學（MRI）變化。
方法：本研究回顧了2004至2011年期間接受Y-90放射治療關節滑膜炎的血友病華籍患者。研究對象 為6名男性血友病患者（共9例關節），他們介乎5至27歲，平均年齡17歲，全部患者均有關節反覆出 血的情況，關節部位為膝關節3例、肘關節3例、踝關節2例和髖關節1例。比較滑膜切除術前1個月 及術後12至18個月的出血頻率、疼痛程度和MRI特徵。然後評估患者MRI影像有否出現關節積液/積 血、滑膜增生肥厚、含鐵血黃素沉積、軟骨下囊腫/侵蝕和軟骨缺失。同時比較滑膜切除術前及術後 關節MRI表現的Denver評分。
結果：臨床方面，所有關節在出血頻率（p < 0.001）及疼痛程度方面都有改善。大部份關節（89%， 8例）減少出現積液/積血及滑膜增厚/強化，超過一半關節（56%，5例）含鐵血黃素沉積程度亦減 輕了。只有1例（11%）的軟骨下囊腫/侵蝕和軟骨缺失有惡化情況，而其餘（89%，8例）關節的 退行性變並無惡化跡象。滑膜切除術前及術後關節MRI表現的Denver評分差異並不顯著（得分中位 數：術前為9，術後為10；p = 0.347）。
結論：大部份血友病患者接受Y-90放射治療滑膜炎後，臨床及MRI均顯示關節積液/積血、滑膜肥 厚、含鐵血黃素沉積等現象有改善。儘管上述任何病變均是不可逆的，或者說對最終的關節功能並 無重要影響，但絕大部份患者的關節退行性變（包括軟骨下囊腫/侵蝕和軟骨缺失）無進一步惡化。