Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle

Abstract

Objective The clinical decision-making process in pediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop an ultrasound (US) scanning protocol and assess the reliability of B-Mode and Doppler scoring systems for inflammatory lesions of the pediatric ankle. Methods As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 pediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the pediatric ankle. Three rounds of scoring of still-images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). Results Of the thirty-seven initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (Confidence Interval, CI, 0.92–0.94), talonavicular joint ICC: 0.86 (CI 0.81–0.90), subtalar joint ICC: 0.91 (CI 0.88–0.93), tendons ICC: 0.96 (CI 0.95–0.97). Conclusion A comprehensive and reliable pediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.

Ultraschalluntersuchungen in der Kinderrheumatologie

“…Im Rahmen einer Polyarthritis sieht man auch häufiger eine Beteiligung der ventralen Strecksehnen, die durch den ventralen Transversalschnitt sehr sicher erfasst werden können. Die nordamerikanische Ultraschallgruppe der CARRA hat kürzlich einen zeitsparenden Vorschlag für eine standardisierte Ultraschalluntersuchung des Sprunggelenkes bei Arthritis publiziert 23 . Nicht selten zeigt sich im Rahmen einer Polyarthritis und Enthesitis-assoziierten Arthritis die Beteiligung der kleinen Mittelfußgelenke, die insbesondere bei der Polyarthritis klinisch silent betroffen sein können.…”

“…Zur Quantifizierung der Synovitis am kindlichen Sprunggelenk wurden 2 semiquantitative Bewertungssysteme publiziert, die die Synovitis von 0 (normal) über mild (1), moderat (2) bis 3 (stark) sowohl für den B-Mode-als auch für die Doppler-Untersuchung graduieren [6,7]. Eines dieser Systeme wurde zur Verbesserung der Reliabilität speziell für das Sprunggelenk modifiziert [23]. Für die Quantifizierung der Befunde an den Enthesen gibt es verschiedene Vorschläge [24,25].…”

Diagnostic Accuracy Study of the Pediatric‐Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis

“…10 Reliable joint-specific scanning protocols and scoring systems for all other peripheral joints (except the temporomandibular joint) were also recently proposed by the CARRA JIA-US subgroup. 11,12 In addition, a focused MSUS examination of bilateral second and third metacarpophalangeal joints, wrists, knees, and ankles was found to identify all patients with active arthritis by full-body clinical and MSUS examination. 13 Pilot efforts assessing the relationship between clinically determined arthritis and MSUS-determined arthritis suggest that 30% of the joints determined as healthy by clinical examination exhibited the abnormal sonographic findings of synovitis, as defined by the Outcome Measures in Rheumatology (OMERACT) Ultrasound Group.…”

“…In 2019, our group described a novel, reliable, and reproducible US image acquisition protocol and scoring system for the pediatric knee 10 . Reliable joint‐specific scanning protocols and scoring systems for all other peripheral joints (except the temporomandibular joint) were also recently proposed by the CARRA JIA‐US subgroup 11,12 . In addition, a focused MSUS examination of bilateral second and third metacarpophalangeal joints, wrists, knees, and ankles was found to identify all patients with active arthritis by full‐body clinical and MSUS examination 13 .…”