Juvenile Arthritis

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Power Doppler ultrasound may reliably predict joint vascularization in children

September 5, 2017

When used with clear definitions and a standardized acquisition protocol, ultrasound reliably detected age-related joint vascularization in children, according to findings.
10 international ultrasound investigators with at least 2 years of experience in pediatric ultrasound participated as sonographers. Investigators were members of the OMERACT pediatric sub-task force and originated from seven countries. The study population consisted of 12 healthy children. All children underwent unilateral dynamic B-mode and Power Doppler (PD) ultrasound of the wrist, second MCP joint (MCPII), knee and tibiotalar joint. Each ultrasonographer examined 11 predefined joint regions.
evaluated age-related vascularization in each joint region and scored the extent of maturation of the ossification nuclei. The researchers defined a positive PD signal as any PD signal inside the joint.

Researchers found PD signals were most prevalent in dorsal midline scans for the wrist, in lateral and volar scans for the MCP II in transverse lateral scans for the knee, and almost equally in the dorsal, lateral, midline and medial scans for the tibiotalar joint. Overall, the number of PD signals was highest in the wrist, followed by the tibiotalar joint, knee and MCP II. More vessels were detected in children aged 2 years to 12 years vs. those aged 13 years to 16 years. Overall, the highest number of detected vessels was identified in the epiphysis, but this varied by joint. The wrist joint had more small bone intra-cartilaginous vessels and fat pad vessels than the physis or epiphysis.
aturation. Advancing age was associated with the extent of ossification of all evaluated joints. The scoring system of the skeletal maturation of the various bones/joints had intra-observer reliability ranging from 86% to 92%. The interobserver reliability ranged from 41% to 83%.
Our study provided a new semi-quantitative scoring system for assessing the skeletal maturity of pediatric joints and demonstrated the high reliability of [ultrasound] US in the detection of normal joint vascularization,” the researchers wrote. “Larger studies with more models are required to validate our preliminary data with respect to side, sex and age dependency.” – by Jennifer Byrne

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