Definitions for the Sonographic Features of Joints in Healthy Children

Abstract

Objective. Musculoskeletal ultrasonography (US) has potential in the assessment of disease activity and structural damage in childhood arthritides. In order to assess pathology, the US characteristics of joints in healthy children need to be defined first. The aim of this study was to develop definitions for the various components of the normal pediatric joint. Methods. The definitions were developed by an expert group and applicability was assessed on a collection of standardized scans of the knee and ankle joints by scoring the scans on a Likert scale. The definitions were then modified and applicability was reassessed before sending the definitions for approval to a larger panel of experts. A final scoring on stored images of all relevant joints at different ages followed. Results. Five definitions were developed addressing the articular bone, cartilage, joint capsule, epiphyseal ossification center, and synovial membrane. In total, 224 US images of knees and ankles were acquired, of which 172 were selected for scoring. An agreement of >80% was not met for any of the definitions, but after modifications, 81-97% agreement was reached. This version of the definitions was approved by 15 US experts. In the final validation exercise, all definitions reached an agreement of >80% for the shoulder, elbow, wrist, metacarpophalangeal hip, knee, ankle and metatarsophalangeal joint. Conclusion. US definitions for the normal pediatric joint were successfully developed through a Delphi process and validated in a practical exercise. These results provide the basis to develop definitions for pathology and to support the standardized use of US in pediatric rheumatology.

Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age‐Related Ultrasound Findings

“…Since many MSUS publications focused on pediatrics have included the hip joint, we decided not to include it in the present study (7,8). The children were divided into 4 groups according to age-related changes reported previously by Roth et al (5) and based on the knowledge of appearance of bone ossification as detected by radiography (9)(10)(11)(12).…”

“…This task force has developed a stepwise process: first, the development and validation, using the Delphi process, of definitions for US findings in healthy children and patients with JIA, and second, creating a consensus agreement on a precise scanning method in different age groups, with the collection of images showing the sonographic appearance of blood vessels in several joints, to be included in an atlas format. Recently, normal definitions of gray-scale US findings were published (5).…”

Juvenile idiopathic arthritis: what is the utility of ultrasound?

“…Work carried out by Roth et al 22 has provided the first ultrasound definitions of joints in healthy children ( Table 3). The growing skeleton is composed of an initially cartilaginous epiphysis, physis (growth plate), metaphysis and diaphysis ( Figure 3).…”

The OMERACT Ultrasound Working Group 10 Years On: Update at OMERACT 12

“…A core domain set for pediatric pathology has yet to be determined. The US definitions of joints of healthy children have recently been published 21 . The next step is to define synovitis in children with juvenile idiopathic arthritis (JIA), which shall be done by consensus through consecutive Delphi rounds.…”