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Doctoral Thesis
DOI
Document
Author
Full name
Andréa Fernandes Magalhães
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Engel, Edgard Eduard (President)
Clé, Diego Villa
Maranho, Daniel Augusto Carvalho
Pagnano, Rodrigo Gonçalves
Title in Portuguese
Avaliação quantitativa da membrana sinovial nos tornozelos e joelhos de pacientes com hemofilia submetidos à radiosinoviortese com ítrio
Keywords in Portuguese
Artropatia hemofílica
Hemartrose
Processamento de imagens
Radiosinoviortese
Ressonância magnética
Sinovite
Abstract in Portuguese
Introdução: A radiosinoviortese (RS) é uma opção de tratamento para a hemartrose recorrente em pacientes com hemofilia (PCH). Objetivo: Avaliar os efeitos da RS com ítrio- 90 no volume da membrana sinovial nos tornozelos e joelhos de PCH e as características clínicas relacionadas ao desfecho da RS. Métodos: Um estudo de coorte prospectivo examinou as 25 articulações de 22 PCH que apresentavam articulações alvo (três ou mais hemartroses em seis meses) e foram submetidos à RS. Dois grupos foram comparados: aqueles que mantiveram as articulações alvo após a RS, e aqueles que não. Imagens de ressonância magnética (RM) de seis tornozelos e seis joelhos foram adquiridas antes e seis meses após a RS para avaliar o volume da membrana sinovial, graduar a escala de ressonância magnética da artropatia hemofílica e avaliar uma possível correlação com a dose de ítrio-90 injetada. Os grupos foram analisados por idade, tipo e gravidade da hemofilia, índice de massa corporal, (IMC), presença de inibidor e quanto ao Estado de Saúde Articular da Hemofilia (HJHS). Resultados: O volume da membrana sinovial mostrou redução significativa após a RS (p = 0,03), mas não houve correlação com a dose de ítrio empregada. Pacientes mais jovens e com menor HJHS (p <0,05) mantiveram as hemartroses após a RS. Presença de inibidor, tipo de articulação, IMC, tipo e gravidade da doença não mostraram diferenças significativas entre os grupos que tiveram redução ou não das hemartroses. Conclusão: O volume da membrana sinovial apresenta redução após a RS, independentemente da dose efetiva do ítrio-90. Pacientes mais jovens e com estado articular mais saudável retiveram as articulações alvo após a RS, sugerindo a necessidade de uma supervisão mais rigorosa desses pacientes
Title in English
Quantitative assessment of the synovial membrane in ankles and knees of patients with haemophilia subjected to radiosynoviorthesis with yttrium
Keywords in English
Haemarthrosis
Haemophilic arthropathy
Image processing
Magnetic resonance imaging
Radiosynoviorthesis
Abstract in English
Introduction: Radiosynoviorthesis (RSO) is one treatment option to recurrent haemarthrosis in patients with haemophilia (PWH). Aim: To evaluate the effects of RSO with yttrium-90 on synovial membrane volume in the ankles and knees of PWH and patients characteristics' related to RSO outcome. Methods: A prospective cohort study examined the 25joints of 22 PWH who presented target joints and were subjected to RS. Two groups were compared: those who retained target joints (three or more haemarthrosis in six months follow-up) following RSO, and those who did not. Magnetic resonance images (MRI) of six ankles and six knees were acquired prior to, and 6 months after RSO, to assess synovial membrane volume, haemophilia arthropathy MRI scale, and correlations with the yttrium-90 dose injected. Groups were analysed by age, haemophilia type and severity, joint, body mass index (BMI), inhibitor and Haemophilia Joint Health Score (HJHS). Results: Synovial membrane volume showed significant reduction after RSO (p = 0.03), but no correlation with the yttrium dose. Younger patients with a lower HJHS (p < .05) retained target joints after RSO. Inhibitor, joint type, BMI, type and severity of disease showed no significant differences between groups that remained with haemarthrosis and those who did not. Conclusion: Synovial membrane volume is reduced after RS, regardless of the effective yttrium-90 dose. Younger patients with healthier articular status retained target joints after RSO, suggesting the need for a closer view of these patients
 
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Publishing Date
2019-09-04
 
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