Normative ultrasound references for the paediatric wrist; dorsal soft tissues

Rosendahl, Karen; Bruserud, Ingvild Sævold; Oehme, Ninnie Helén Bakken; Júlíusson, Pétur Benedikt; Horatio, Laura Tanturri de; Müller, Lil-Sofie Ording; Magni‐Manzoni, Silvia

doi:10.1136/rmdopen-2017-000642

Cited by 22 publications

(16 citation statements)

References 18 publications

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“…The JADE protocol was developed to follow joint health of patients with hemophilia longitudinally in a systematic and quantitative manner, focusing on soft tissue expansion, inflammation, and osteochondral alterations, to provide precise, patient‐specific assessments complementing semiquantitative scoring algorithms . Two‐dimensional measurements of osteochondral and soft tissue evaluation in musculoskeletal medicine have become increasingly attractive, since they take advantage of the high spatial and tissue contrast resolution inherent to continuously improving US technology, enabling precise measurements in 0.1‐ to 0.2‐mm increments with higher‐frequency transducers (>12 MHz). Here we report the intra‐ and inter‐rater reliability as well as inter‐operator reliability of the JADE protocol, incorporating direct measurements by hemophilia care providers trained in musculoskeletal US, in alignment with OMERACT recommendations for the validation of imaging protocols .…”

Section: Discussionmentioning

confidence: 99%

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Volland

Zhou

Barnes

et al. 2018

J of Ultrasound Medicine

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Objectives Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. Methods Thirty‐one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra‐ and inter‐rater reliability, 8 musculoskeletal US–experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty‐three musculoskeletal US–inexperienced providers performed similar assessments. Inter‐operator reliability was established by 6 musculoskeletal US–experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. Results The musculoskeletal US–experienced providers showed excellent intra‐and inter‐rater reliability for tissue measurements (ICCs, 0.94–0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87‐0.94). Inter‐operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US–inexperienced providers showed excellent inter‐rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). Conclusions The JADE protocol appears feasible for quantifying hemophilic intra‐articular abnormalities. Musculoskeletal US–trained hemophilia providers showed high intra‐rater, inter‐rater, and inter‐operator reliability, supporting JADE as a protocol for clinical management and research.

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Section: Discussionmentioning

confidence: 99%

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Volland

Zhou

Barnes

et al. 2018

J of Ultrasound Medicine

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“…Radiography is not sensitive for detecting early joint changes [55]. [32] Collado et al [33] Roth et al [34] Ording Muller et al [35] Avenarius et al [36] Hip NA Rohrschneider et al [37] Robben [38] NA Knee NA Collado et al [33] Roth et al [34] Keshava et al [39] Spannow et al [40] Hemke et al [41] Concerning the cervical joints, there are no published studies on the use of US in JIA.…”

Section: Spinementioning

confidence: 99%

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

et al. 2020

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Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. Key Points • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.

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“…There are no normal standards for whole-body MRI, which poses particular problems for diagnosing abnormalities [30]. In other areas of musculoskeletal imaging, recent advances have been made regarding image-based classification systems for juvenile dermatomyositis [31] and establishment of normal US-based references for the wrist [32].…”

Section: Overarching Strategymentioning

confidence: 99%

European Society of Paediatric Radiology 2019 strategic research agenda: improving imaging for tomorrow’s children

et al. 2019

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The European Society of Paediatric Radiology (ESPR) research committee was established to initiate, drive forward and foster excellence in paediatric imaging, paediatric image-guided intervention and radiation protection research, by facilitating more evidence-based standards, protocols and multi-institutional collaborations. The ESPR Strategic Research Agenda outlines our current research approach, highlighting several areas of paediatric imaging where the society can help guide current and future research, and emphasizing those areas where early research (“seed”) funding may need to be allocated by this and other societies as precursors to larger grant applications. The key aims are to evaluate normal variation in order to be able to confidently diagnose disease states, develop robust image-based classification systems to aid diagnosis and treatment monitoring, and help develop evidence-based clinical guidelines using current literature and experience to identify knowledge gaps. For this reason, the development of evidence-based imaging pipelines, broken down step-by-step to include diagnosis, classification and clinical effectiveness, should be the end goal for each disease entity for each affected child. Here, we outline the 2019 ESPR Strategic Research Agenda along three points in the clinical imaging pipeline: clinical referral, disease diagnosis and evolution, and clinical therapeutic evaluation and effectiveness. Through multicentre trials, using existing high-level experience and expertise, and nurturing the next generation of researchers, we will be able to achieve these aims.

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Normative ultrasound references for the paediatric wrist; dorsal soft tissues

Cited by 22 publications

References 18 publications

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider

European Society of Paediatric Radiology 2019 strategic research agenda: improving imaging for tomorrow’s children

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