Synovial tissue proliferation invariably corresponds to haemosiderin-enriched tissue as assessed on gradient-echo MRI sequences, and may be a key feature, possibly representing under-treatment related to insufficient therapy regimens or non-compliant patients. Distinction between synovium and effusion can be readily accomplished with ultrasound. The main limitation of ultrasound for the detection of joint damage is related to its inability to offer a complete evaluation of the articular surfaces due to problems of access for the ultrasound beam. Some weight-bearing areas masked by bone cannot be assessed, but

this does not LDK378 seem to be a relevant limitation in the context of haemophilic arthropathy as damage establishes diffusely across the joint, involving the peripheral parts of the osteochondral surfaces. Compared to ultrasound, MRI can be considered equally able to reveal signs of disease activity (i.e. joint effusion

and synovitis) and effectively provides a comprehensive evaluation of the joint surfaces (including the weight-bearing areas located centrally in the joint and the medullary bone). Nevertheless, it cannot evaluate more than one joint in a single study, the examination time Tamoxifen cell line is at least 30 min per joint to provide accurate information on the status of the articular surfaces, and joint positioning for examination may be difficult and uncomfortable for patients with advanced osteoarthritis. In addition, MRI may require sedation in

children, is a high-cost modality with long-waiting lists (no time for efficient feedback), cannot be used for serial follow-up studies and needs intra-articular contrast injection to depict initial osteochondral changes with accuracy. Although often regarded as the imaging technique of choice, MRI is not the optimal imaging technique for the assessment of disease characteristics of joint damage in haemophilia and cannot be considered a real competitor to ultrasound as a screening method for multi-joint assessment and repeated follow-up examinations. Recently, a simplified HEAD-US (Haemophilia Early Arthropathy Detection with UltraSound) scanning protocol and scoring system have been developed for non-imaging specialists to enable them to 上海皓元医药股份有限公司 analyse the joint recesses and the osteochondral surfaces of the elbow, knee and ankle in adult and paediatric patients after a short period of training [47]. The HEAD-US method includes systematic evaluation of the recesses of the elbow (radial, coronoid, annular and olecranon), knee (suprapatellar, medial and lateral parapatellar) and ankle (anterior and posterior recesses of the tibiotalar and subtalar joints). This systematic evaluation provides high sensitivity in the detection of joint effusion and synovial proliferation (disease activity items).