肌肉骨骼超声与磁共振成像在血友病关节内出血中的诊断价值OA

Objective To compare the sensitivity and differential diagnostic efficacy of musculoskeletal ultrasound(MSKUS)and magnetic resonance imaging(MRI)in detecting intra-articular hemorrhage in hemophilia.Methods Analyses were performed at two levels:human ex vivo metatarsophalangeal(MTP)joint models and clinical cases.Six human ex vivo MTP joint specimens were selected,and normal saline(0%blood concentration)was mixed with fresh human blood and diluted to different concentrations(5%,10%,50%and 100%)before injected into MTP joint models.MSKUS and MRI examinations were performed at preset time points(0 to 4 hours,3 to 4 days,7 days),the echo type,changes in echo pattern and material compressibility of MSKUS and MRI signal characteristics of blood with different concentrations within the MTP joints were observed,and the detection rates of low concentration blood,and the diagnostic accuracy for differentiating hemorrhagic and non-hemorrhagic fluids by MSKUS and MRI were compared.Eighteen patients with hemophilia admitted to our hospital from August 2019 to July 2024 were enrolled as clinical subjects.The intra-articular echo patterns of MSKUS and signal differences of MRI between hemorrhagic and non-hemorrhagic fluids were observed.Results MSKUS could detect blood at concentrations as low as 5%,which presented as characteristic hypoechoic spots.Moreover,hemorrhagic and non-hemorrhagic fluids could be distinguished via virtual touch imaging.Blood concentrations were negatively correlated with ultrasound gray scale values,and a significant difference in gray scale values could be observed between 5%concentration blood solution and normal saline(P<0.05).Conventional MRI sequences could not distinguish hemorrhagic fluids from non-hemorrhagic fluids.The detection rate of MSKUS for 5%low concentration blood was 88.9%,which was significantly higher than 11.1%of conventional MRI sequences(P<0.001).The diagnostic accuracy for differentiating hemorrhagic and non-hemorrhagic fluids was 95.8%for MSKUS,significantly higher than 54.2%for conventional MRI sequences(P<0.001).Conclusion MSKUS exhibits significantly higher sensitivity than conventional MRI sequences in detecting low concentration intra-articular hemorrhage,and it can serve as a preferred tool for rapid bedside clinical differentiation between hemorrhagic and non-hemorrhagic fluids.