A new study has demonstrated that ultrasound (US) using the HEAD-US scanning protocol is a reliable method to assess hemophilic arthropathy in children with hemophilia (HEM) compared with MRI.

The study, published in Haemophilia, suggests that HEAD-US could be safely incorporated into the regular screening protocols of pediatric patients with severe hemophilia.

“As the development of hemophilic arthropathy ordinarily begins during childhood, albeit with minimal changes, early detection is indispensable,” the authors wrote. “Ultrasound has been proven to be highly reliable in the assessment of early inflammatory and destructive joint changes in the adult hemophilic population, however, very few studies so far
focused on the reliability of US in the pediatric hemophilic population.”

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The research team used the HEAD-US protocol and scoring method to perform examinations on 10 patients aged 6 to 17 years with hemophilia and on prophylactic treatment with clotting factor concentrates. MRI examinations were also performed and scored according to the International Prophylaxis Study Group MRI scale.

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The authors assessed the 3 most commonly affected joints in pediatric patients with hemophilia: the ankles, knees, and elbows. The results showed an excellent correlation between US and MRI in all joints as well as excellent inter-rater reliability between US and MRI examination interpretations. The high specificity and sensitivity of US validated the method as a reliable tool for detecting hemophilic arthropathy.

The team notes that there were some differences in the detailed joint component analysis between US and MRI. The correlation was the lowest for assessment of cartilage and bone changes in the ankles as well as bone changes in the elbows compared with other joint components.

Given these results, along with the simplicity and availability of US, the authors recommend its use in the routine screening, diagnosis, and follow-up of children with hemophilia whenever possible.  


Plut D, Faganel Kotnik B, Pusnik L, et al. Reliability of haemophilia early arthropathy detection with ultrasound (HEAD-US) in children: a comparative magnetic resonance imaging (MRI) study. Radiol Oncol. Published online October 19, 2022. doi: 10.2478/raon-2022-0040