Pediatric Ultrasound



This chapter reviews the principles relevant to assessing musculoskeletal structures in the pediatric patient at the point of care. Normal ultrasound anatomy (joint, cartilage, tendon and enthesis, ligament, capsule) and Doppler activity of pediatric patients will be reviewed. Relevant pediatric sonopathology seen in conditions such as apophysitis, reactive arthritis, and juvenile idiopathic arthritis will also be reviewed.


Musculoskeletal Ultrasonography Pediatric Rheumatology Cartilage Ossification Doppler 


  1. 1.
    Haslam KE, McCann LJ, Wyatt S, Wakefield RJ. The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology (Oxford). 2010;49(1):123–7.Google Scholar
  2. 2.
    Rooney ME, McAllister C, Burns JF. Ankle disease in juvenile idiopathic arthritis: ultrasound findings in clinically swollen ankles. J Rheumatol. 2009;36(8):1725–9.Google Scholar
  3. 3.
    Nistala K, Babar J, Johnson K, Campbell-Stokes P, Foster K, Ryder C, McDonagh JE. Clinical assessment and core outcome variables are poor predictors of hip arthritis diagnosed by MRI in juvenile idiopathic arthritis. Rheumatology (Oxford). 2007;46(4):699–702.Google Scholar
  4. 4.
    Miller E, Uleryk E, Doria AS. Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis. AJR Am J Roentgenol. 2009;192(5):1209–18.Google Scholar
  5. 5.
    Doria AS, Babyn PS, Feldman B. A critical appraisal of radiographic scoring systems for assessment of juvenile idiopathic arthritis. Pediatr Radiol. 2006;36(8):759–72.Google Scholar
  6. 6.
    Damasio MB, Malattia C, Martini A, Toma P. Synovial and inflammatory diseases in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol. 2010;40(6):985–98.Google Scholar
  7. 7.
    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(7):1011–9.Google Scholar
  8. 8.
    Roth J, Jousse-Joulin S, Magni-Manzoni S, Rodriguez A, Tzaribachev N, Iagnocco A, Naredo E, D’Agostino MA, Collado P. Omeract definitions for the sonographic features of the normal pediatric joint. Arthritis Care Res (Hoboken). 2015;67(1):136–42.Google Scholar
  9. 9.
    Lee SK, Kim YS, Oh HS, Yang KH, Kim EC, Chi JG. Prenatal development of the human mandible. Anat Rec. 2001;263:314–25.Google Scholar
  10. 10.
    Ogden JA, Hempton RF, Southwick WO. Development of the tibial tuberosity. Anat Rec. 1974;182:431–46.Google Scholar
  11. 11.
    Ogden JA, Southwick WO. Osgood-Schlatter’s disease and tibial tuberosity development. Clin Orthop Relat Res. 1976;116:180–9.Google Scholar
  12. 12.
    Ogden JA. Radiology of postnatal skeletal development IX. Proximal tibia and fibula. Skeletal Radiol. 1984;11(4):169–77.Google Scholar
  13. 13.
    Ogden JA. Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skeletal Radiol. 1984;11(4):246–57.Google Scholar
  14. 14.
    Ogden JA, McCarthy SM. Radiology of postnatal skeletal development. VIII. Distal tibia and fibula. Skeletal Radiol. 1983;10(4):209–20.Google Scholar
  15. 15.
    McCarthy SM, Ogden JA. Radiology of postnatal skeletal development. VI. Elbow joint, proximal radius, and ulna. Skeletal Radiol. 1982;9(1):17–26.Google Scholar
  16. 16.
    McCarthy SM, Ogden JA. Radiology of postnatal skeletal development. V. Distal humerus. Skeletal Radiol. 1982;7(4):239–49.Google Scholar
  17. 17.
    Miller B, Bonel H, Rotzetter M, Villiger PM, Ziswiler HR. Measuring finger joint cartilage by ultrasound as a promising alternative to conventional radiograph imaging. Arthritis Rheum. 2009;61:435–41.Google Scholar
  18. 18.
    Torp-Pedersen S, Bartels EM, Wilhjelm J, Bliddal H. Articular cartilage thickness measured with US is not as easy as it appears: a systematic review of measurement techniques and image interpretation. Ultraschall Med. 2011;32(1):54–61. Epub 2010 May 28.Google Scholar
  19. 19.
    Sureda D, Quiroga S, Arnal C, Boronat M, Andreu J, Casas L. Juvenile rheumatoid arthritis of the knee: evaluation with US. Radiology. 1994;190(2):403–6.Google Scholar
  20. 20.
    Spannow AH, Pfeiffer-Jensen M, Andersen NT, Herlin T, Stenbog E. Ultrasonographic measurements of joint cartilage thickness in healthy children: age- and sex-related standard reference values. J Rheumatol. 2010;37:2595–601.Google Scholar
  21. 21.
    Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S. The “enthesis organ” concept: Why enthesopathies may not present as focal insertional disorders. Arthritis Rheum. 2004;50:3306–13.Google Scholar
  22. 22.
    Fornage BD. Achilles tendon: US examination. Radiology. 1986;159:759–64.Google Scholar
  23. 23.
    Grechenig W, Mayr JM, Peicha G, Hammerl R, Schatz B, Grechenig S. Sonoanatomy of the Achilles tendon insertion in children. J Clin Ultrasound. 2004;32:338–43.Google Scholar
  24. 24.
    Murphy KJ, Rubin JM. Power Doppler: it’s a good thing. Semin Ultrasound CT MR. 1997;18(1):13–21.Google Scholar
  25. 25.
    Terslev L, Torp-Pedersen S, Savnik A, von der Recke P, Quvistgard E, Danneskiold-Samsoe B, Bliddal H. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis: a comparative study. Arthritis Rheum. 2003;48(9):2434–41.Google Scholar
  26. 26.
    Szkudlarek M, Court-Payen M, Strandberg C, Klarlund M, Klausen T, Ostergaard M. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum. 2001;44(9):2018–23.Google Scholar
  27. 27.
    Schmidt WA, Volker L, Zacher J, Schlafke M, Ruhnke M, Gromnica-Ihle E. Colour Doppler ultrasonography to detect pannus in knee joint synovitis. Clin Exp Rheumatol. 2000;18(4):439–44.Google Scholar
  28. 28.
    Walther M, Harms H, Krenn V, Radke S, Faehndrich TP, Gohlke F. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum. 2001;44(2):331–8.Google Scholar
  29. 29.
    Walther M, Harms H, Krenn V, Radke S, Kirschner S, Gohlke F. Synovial tissue of the hip at power Doppler US: correlation between vascularity and power Doppler US signal. Radiology. 2002;225(1):225–31.Google Scholar
  30. 30.
    Albrecht K, Muller-Ladner U, Strunk J. Quantification of the synovial perfusion in rheumatoid arthritis using Doppler ultrasonography. Clin Exp Rheumatol. 2007;25(4):630–8.Google Scholar
  31. 31.
    Marston BA, James KE, Siegel DM. Power Doppler visualization of epiphyseal and growth plate vascularity in affected and contralateral unaffected joints in patients with juvenile idiopathic arthritis. Arthritis Rheum. 2014;66 Suppl 11:S116.Google Scholar
  32. 32.
    Jousse-Joulin S, Breton S, Cangemi C, Fenoll B, Bressolette L, de Parscau L, Saraux A, Devauchelle-Pensec V. Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2011;63(6):849–55.Google Scholar
  33. 33.
    Weiss PF, Chauvin NA, Klink AJ, Localio R, Feudtner C, Jaramillo D et al. Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheum. 2014;66(1):218–27.Google Scholar
  34. 34.
    Roth J, Digeso L. Power and colour Doppler findings in lower extremity entheses of healthy children-effect of measurement distance from insertion and joint position. Arthritis Rheum. 2014;66 Suppl 11:S45.Google Scholar
  35. 35.
    Volpon JB, de Carvalho Filho G. Calcaneal apophysitis: a quantitative radiographic evaluation of the secondary ossification center. Arch Orthop Trauma Surg. 2002;122:338–41.Google Scholar
  36. 36.
    Robben SG, Lequin MH, Diepstraten AF, den Hollander JC, Entius CA, Meradji M. Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology. 1999;210(2):499–507.Google Scholar
  37. 37.
    Petty RE, Southwood TR, Manners P, International League of Associations for Rheumatology, et al. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis, 2nd revision, Edmonton, 2001. J Rheumatol. 2004;31:390–2.Google Scholar
  38. 38.
    Rebollo-Polo M, Koujok K, Weisser C, Jurencak R, Bruns A, Roth J. Ultrasound findings on patients with juvenile idiopathic arthritis in clinical remission. Arthritis Care Res (Hoboken). 2011;63(7):1013–9.Google Scholar
  39. 39.
    Magni-Manzoni S, Scirè CA, Ravelli A, Klersy C, Rossi S, Muratore V et al. Ultrasound-detected synovial abnormalities are frequent in clinically inactive juvenile idiopathic arthritis, but do not predict a flare of synovitis. Ann Rheum Dis. 2013;72(2):223–8. Epub 2012 Jun 26.Google Scholar
  40. 40.
    Backhaus M, Burmester GR, Gerber T, Working Group for Musculoskeletal Ultrasound in the EULAR Standing Committee on International Clinical Studies including Therapeutic Trials, et al. Guidelines for Musculoskeletal Ultrasound in Rheumatology. Ann Rheum Dis. 2001;60(7):641–9.Google Scholar
  41. 41.
    D'Agostino MA, Said-Nahal R, Hacquard-Bouder C, Brasseur JL, Dougados M, Breban M. Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler. Arthritis Rheum. 2003;48:523–33.Google Scholar
  42. 42.
    Moore CP, Sarti DA, Louie JS. Ultrasonographic demonstration of popliteal cysts in rheumatoid arthritis. A noninvasive technique. Arthritis Rheum. 1975;18(6):577–80.Google Scholar
  43. 43.
    Roth J, Scheer I, Kraft S, Keitzer R, Riebel T. Uncommon synovial cysts in children. Eur J Pediatr. 2006;165(3):178–81.Google Scholar
  44. 44.
    Karmazyn B, Bowyer SL, Schmidt KM, Ballinger SH, Buckwalter K, Beam TT, Ying J. US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis. Pediatr Radiol. 2007;37(5):475–82. Epub 2007 Mar 20.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Pediatric RheumatologyChildren’s Hospital of Eastern OntarioOttawaCanada
  2. 2.University of OttawaOttawaCanada

Personalised recommendations