T2 mapping magnetic resonance imaging of cartilage in hemophilia

Benjamin A Brakel; Marshall S Sussman; Haris Majeed; Jerry Teitel; Carina Man; Tammy Rayner; Ruth Weiss; Rahim Moineddin; Victor Blanchette; Andrea S Doria

doi:10.1016/j.rpth.2023.102182

T2 mapping magnetic resonance imaging of cartilage in hemophilia

Res Pract Thromb Haemost. 2023 Aug 23;7(6):102182. doi: 10.1016/j.rpth.2023.102182. eCollection 2023 Aug.

Authors

Benjamin A Brakel¹, Marshall S Sussman², Haris Majeed^{1

3}, Jerry Teitel⁴, Carina Man¹, Tammy Rayner¹, Ruth Weiss¹, Rahim Moineddin⁵, Victor Blanchette^{6

7}, Andrea S Doria^{1

2}

Affiliations

¹ Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
³ Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada.
⁵ Division of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
⁷ Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada.

Abstract

Background: In hemophilia, recurrent hemarthrosis may lead to irreversible arthropathy. T2 mapping MRI may reflect cartilage changes at an earlier reversible stage of arthropathy as opposed to structural MRI.

Objectives: To evaluate interval changes of T2 mapping compared with the International Prophylaxis Study Group (IPSG) structural MRI scores of ankle cartilage in boys with hemophilia receiving prophylaxis.

Methods: Eight boys with hemophilia A (median age, 13; range, 9-17 years), 7 age- and sex-matched healthy boys (controls, median age, 15; range, 7-16 years). A multiecho spin-echo T2-weighted MRI sequence at 3.0T was used to obtain T2 maps of cartilage of boys with hemophilia and controls. Structural joint status was evaluated using the IPSG MRI score.

Results: T2 relaxation times of ankle cartilage increased significantly over time in both persons with hemophilia and controls (P = .002 and P = .00009, respectively). Changes in T2 relaxation time strongly correlated with changes in IPSG cartilage scores (r_s = 0.93 to r_s = 0.78 [P = .0007 to P = .023]), but not with changes in age (P = .304 to P = .840). Responsiveness of T2 relaxation times were higher than that of IPSG cartilage scores, with standardized response means >1.4 for T2 mapping in all regions-of-interest compared with 0.84 for IPSG cartilage scores. Baseline T2 relaxation time strongly correlated with timepoint 2 IPSG cartilage score (r_s = 0.93 to r_s = 0.82 [P = .001 to P = .012]) and T2 relaxation time (r_s = 0.98 to r_s = 0.88 [P = .00003 to P = .004]) changes in most regions-of-interest.

Conclusion: T2 mapping shows sensitivity to biochemical changes in cartilage prior to detectable damage using conventional MRI, offering potential for early detection of bleed-related cartilage damage in boys with hemophilia.

Keywords: International Prophylaxis Study Group MRI scale; T2 mapping; ankles; articular; biomarkers; cartilage; hemarthrosis; hemophilia A; joints; magnetic resonance imaging.