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Imaging for Early Assessment of Peripheral Joints in Juvenile Idiopathic Arthritis

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Book cover Evidence-Based Imaging in Pediatrics

Key Points

■ Plain radiographs are the standard imaging tools for the diagnosis of JIA; however, they show low sensitivity (50%) and moderate specificity (85%) for detection of cartilage destruction (strong evidence).

■ Both MRI and ultrasound (US) can detect synovial hypertrophy, cartilage erosions, and joint effusion in peripheral joints of children with JIA. Ultrasound is less sensitive than MRI for assessment of both soft tissue findings (sensitivity 62%) and superficial cartilage loss (sensitivity 60%) (moderate evidence).

■ Both MRI and ultrasound can demonstrate clinically meaningful response to treatment (moderate evidence).

■ Although dual-energy X-ray absorptiometry (DEXA) is the most commonly used quantitative imaging method for assessing bone mass, no standardized pediatric normative DEXA database is currently available for children under the age of 5 years and for hips and wrists of older children. Therefore, other imaging techniques such as peripheral quantitative ultrasound (QUS) and computed tomography (pQCT) have been investigated as alternative techniques to DEXA for evaluation of osteopenic changes in pediatric arthropathies. pQCT is more sensitive than QUS for evaluation of bone density changes (insufficient evidence) but has the disadvantage of using ionizing radiation.

■ Overall, MRI is the imaging modality of choice for evaluation of joints in children with JIA. However, US can be an excellent initial imaging tool for evaluation of young children who otherwise would require sedation for MR imaging (moderate evidence).

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Author information

Authors and Affiliations

  1. Department of Radiology, The Hospital for Sick Children, M5G 1X8, Toronto, ON, Canada

    Elka Miller

  2. Department of Diagnostic Imaging, The Hospital for Sick Children, M5G 1X8, Toronto, ON, Canada

    Andrea Doria MD, PhD, MSc (Clinician Scientist/General Radiologist)

Authors
  1. Elka Miller
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  2. Andrea Doria MD, PhD, MSc
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Correspondence to Elka Miller .

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Editors and Affiliations

  1. Dept. Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami , 33156, U.S.A.

    L. Santiago Medina

  2. Dept. Radiology, Riley Children's Hospital, Barnhill Drive 702 , Indianapolis, 46202-5200, U.S.A.

    Kimberly E. Applegate

  3. Harborview Medical Center, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, U.S.A.

    C. Craig Blackmore

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Miller, E., Doria, A. (2010). Imaging for Early Assessment of Peripheral Joints in Juvenile Idiopathic Arthritis. In: Medina, L., Applegate, K., Blackmore, C. (eds) Evidence-Based Imaging in Pediatrics. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-0922-0_16

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  • DOI: https://doi.org/10.1007/978-1-4419-0922-0_16

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