Objective. Musculoskeletal (MS) ultrasound (US) is increasingly being used as an extension of paediatric clinical practice, particularly in the clinical management of children with juvenile idiopathic arthritis (JIA). MSUS is most commonly used in the assessment of effusion and synovial hypertrophy and detection of soft tissue disorders. It can also be used to visualise other structures, such as hyaline cartilage and bone surfaces. Given the unique anatomy of the growing skeleton, many of the difficulties encountered in its use result from misinterpretation of MSUS images. Thus, a detailed knowledge of anatomy in healthy children, both in B-mode and Doppler mode, is mandatory. Additionally, as US is the most operator-dependent imaging modality, the experience and expertise of the examiner will determine the value of the diagnostic information obtained from this technique. Incorrect acquisition and interpretation of images may result in inappropriate disease management. Thus, a systematic scanning method and a standardised evaluation procedure are essential in children.
The chapter shows a brief description of the components of the paediatric healthy joint and a systematic method for ultrasound examination of the paediatric population.
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Colebatch-Bourn AN, Edwards CJ, Collado P, D’Agostino M-A, Hemke R, Jousse-Joulin S, et al. EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice. Ann Rheum Dis. 2015;74:1946–57.CrossRefPubMedGoogle Scholar
Collado P, Jousse-Joulin S, Alcalde M, Naredo E, D’Agostino MA. Is ultrasound a validated imaging tool for the diagnosis and management of synovitis in juvenile idiopathic arthritis? A systematic literature review. Arthritis Care Res (Hoboken). 2012;64:1011–9.Google Scholar
Magni-Manzoni S, Epis O, Ravelli A, Klersy C, Visconti C, Lanni S, et al. Comparison of clinical versus ultrasound- determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum. 2009;61:1497–504.CrossRefPubMedGoogle Scholar
Filippou G, Cantarini L, Bertoldi I, Picerno V, Frediani B, Galeazzi M. Ultrasonography vs. clinical examination in children with suspected arthritis. Does it make sense to use poliarticular ultrasonographic screening? Clin Exp Rheumatol. 2011;29:345–50.PubMedGoogle Scholar
Pascoli L, Wright S, Mcallister C, Rooney M. Prospective evaluation of clinical and ultrasound findings in ankle disease in juvenile idiopathic arthritis: importance of ankle ultrasound. J Rheumatol. 2010;37:2409–14.CrossRefPubMedGoogle Scholar
Collado P, Naredo E, Calvo C, Gamir ML, Calvo I, Garcia ML, et al. Reduced joint assessment vs comprehensive assessment for ultrasound detection of synovitis in juvenile idiopathic arthritis. Rheumatology (Oxford). 2013;52:1477–84.CrossRefGoogle Scholar
Jousse-Joulin S, Breton S, Cangemi C, et al. Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis. Arthritis Care Res. 2011;63:849–55.CrossRefGoogle Scholar
Breton S, Jousse-Joulin S, Cangemi C, et al. Comparison of clinical and ultrasonographic evaluations for peripheral synovitis in juvenile idiopathic arthritis. Semin Arthritis Rheum. 2011;41:272–8.CrossRefPubMedGoogle Scholar
Laurell L, Court-Payen M, Nielsen S, Zak M, Fasth A. Ultrasonography and color Doppler in juvenile idiopathic arthritis: diagnosis and follow-up of ultrasound-guided steroid injection in the wrist region. A descriptive interventional study. Pediatr Rheumatol Online J. 2012;10:11.CrossRefPubMedPubMedCentralGoogle Scholar
Laurell L, Court-Payen M, Nielsen S, Zak M, Boesen M, Fasth A. Comparison of ultrasonography with Doppler and MRI for assessment of disease activity in juvenile idiopathic arthritis: a pilot study. Pediatr Rheumatol Online J. 2012;10:2.CrossRefGoogle Scholar
Pradsgaard DØ, Spannow AH, Heuck C, Herlin T. Decreased cartilage thickness in juvenile idiopathic arthritis assessed by ultrasonography. J Reumatol. 2013;40:1596–603.Google Scholar
Roth J, Jousse-Joulin S, Magni-Manzoni S, Rodriguez A, Tzaribachev N, Iagnocco A, et al. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res. 2015;67:136–42.CrossRefGoogle Scholar
Collado P, Vojinovic J, Nieto JC, Windschall D, Magni-Manzoni S, Bruyn GAW, et al. Toward standardized musculoskeletal ultrasound in pediatric rheumatology: normal age-related ultrasound findings. Arthritis Care Res. 2016;68:348–56.CrossRefGoogle Scholar
Collado P, Windschall D, Vojinovic J, Magni-Manzoni S, Balin P, Bruyn GAW, et al. OMERACT ultrasound subtask force on pediatric. Amendment of the OMERACT ultrasound definitions of joints’ features in healthy children when using the DOPPLER technique. Pediatr Rheumatol Online J. 2018;16(1):23.CrossRefPubMedPubMedCentralGoogle Scholar
Windschall D, Collado P, Vojinovic J, Magni-Manzoni S, Balin P, Bruyn GAW, et al. Age-related vascularization and ossification of joints in children: an international pilot study to test multi-observer ultrasound reliability. Arthritis Care Res. 2017; https://doi.org/10.1002/acr.23335.
Roth J, Ravagnani V, Backhaus M, Balint P, Bruns A, Bruyn GA, et al. Preliminary definitions for the sonographic features of synovitis in children. Arthritis Care Res. 2017;69:1217–23.CrossRefGoogle Scholar
Windschall D, Pommerenke M, Haase R. Ultrasound assessment of the skeletal development of the proximal femoral, distal femoral and proximal tibial epiphyses in premature and mature neonates. Ultrasound Med Biol. 2016;42:451–8.CrossRefPubMedGoogle Scholar
Windschall D, Trauzeddel R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Berendes R, et al. Pediatric musculoskeletal ultrasound: age- and sex-related normal B-mode findings of the knee. Rheumatol Int. 2016;36:1569–77.CrossRefPubMedGoogle Scholar
Collado P, Naredo E. Sonographic images of children’s joints. EUROMEDICE, Ediciones Medicas SL: Badalona (Spain); 2007.Google Scholar
Weiss PF, Chauvin NA, Klink AJ, et al. Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheumatol. 2014;66:218–27.CrossRefPubMedPubMedCentralGoogle Scholar
Chauvin NA, Ho-Fung V, Jaramillo D, et al. Ultrasound of the joints and entheses in healthy children. Pediatr Radiol. 2015;45:1344–54.CrossRefPubMedGoogle Scholar
Lanni S, Bovis F, Ravelli A, Viola S, Magnaguagno F, Pistorio A, et al. Delineating the application of ultrasound in detecting synovial abnormalities of the subtalar joint in juvenile idiopathic arthritis. Arthritis Care Res. 2016;68:1346–53.CrossRefGoogle Scholar