ABSTRACT
The purpose of this review was to summarize the current knowledge on the utilization of magnetic resonance imaging (MRI) and ultrasound (US) for assessing arthropathy in children and adolescents with haemophilia and to recognize the limitations of each imaging modality and pitfalls in the diagnosis of soft tissue and osteochondral abnormalities. Awareness of MRI and US limitations and pitfalls in the assessment of joints in persons with haemophilia is essential for accurate diagnosis and optimal management of haemophilic arthropathy.
Subject(s)
Hemarthrosis/diagnostic imaging , Hemarthrosis/etiology , Hemophilia A/complications , Hemophilia B/complications , Hemarthrosis/pathology , Humans , Image Interpretation, Computer-Assisted , Magnetic Resonance Imaging/standards , Reproducibility of Results , Sensitivity and Specificity , Severity of Illness Index , Ultrasonography/standardsABSTRACT
The study was undertaken to document cartilage and soft tissue changes/findings in ankles and knees of normal children of different age groups to be used for comparison in the assessment of children with haemophilia. Cartilage thickness and soft tissue changes were recorded at predetermined sites of ankles/knees on both US and MRI in healthy boys in three age groups: 7-9; 10-14; and 15-18 years. To assess the validity of the ultrasound and MRI measurements, an ex vivo study was done using agar phantoms with techniques and scanners similar to those applied in vivo. Twenty (48%) knees and 22 (52%) ankles of 42 boys, were evaluated. There was a reduction in the thickness of joint cartilage with age. A difference in cartilage measurements was noted in most sites between the age groups on both US and MRI (P < 0.05 each), but such difference was not noted for joint fluid in ankles or knees (P = 0.20, P = 0.68 or P = 0.75, P = 0.63 for US, MRI, respectively). Although cartilage measurements were smaller on US than on MRI for both ankles and knees (P < 0.05 each), this observation was not recorded for fluid in knees (P = 0.02). For diminutive measurements (2 mm) mean US measurements were smaller than corresponding phantom's measurements, P = 0.02. Age-related measurements were noted for cartilage thickness on US and MRI in ankles and knees. US measurements were smaller than corresponding MRI measurements at most joint sites, which were supported by results on small-diameter phantoms.
Subject(s)
Ankle Joint/pathology , Hemarthrosis/diagnosis , Hemarthrosis/etiology , Hemophilia A/complications , Knee Joint/pathology , Magnetic Resonance Imaging , Ultrasonography , Adolescent , Case-Control Studies , Child , Female , Humans , Image Processing, Computer-Assisted , Male , Reproducibility of ResultsABSTRACT
253 cases of late onset epilepsy were studied prospectively. 27 cases (10.7%) had space-occupying lesion, 19 cases (7.5%) had cerebrovascular disease, 13 cases (5.1%) cerebral cysticercosis and 4 cases (1.6%) had diffuse cerebral atrophy. No cause could be detected in 190 cases (75.1%). Analysis of clinical data and radiological studies showed that a majority (85%) of patients with 'tumour' who presented with epilepsy had focal neurological deficit and/or papilloedema. Focal slow-wave abnormality in EEG also gave an indication of an organic lesion. Patients who had epilepsy for more than 1 year, infrequent attacks and partial complex seizures, were less likely to have a tumour. The role of careful clinical examination is stressed.
