Daniel Windschall1, Paz Collado2, Jelena Vojinovic3, Silvia Magni-Manzoni4, Peter Balint5, George A W Bruyn6, Cristina Hernandez-Diaz7, Juan Carlos Nieto8, Viviana Ravagnani9, Nikolay Tzaribachev10, Annamaria Iagnocco11, Maria Antonietta D'Agostino12, Esperanza Naredo8. 1. Asklepios Hospital Weissenfels, Weissenfels, Germany. 2. Universitario Severo Ochoa, Madrid, Spain. 3. University of Nis, Nis, Serbia. 4. IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy. 5. National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. 6. MC Groep, Lelystad, The Netherlands. 7. Instituto Nacional de Rehabilitación, Mexico City, Mexico. 8. Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain. 9. ASST Mantova, C. Poma Hospital, Mantua, Italy. 10. Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany. 11. Università degli Studi di Torino, Turin, Italy. 12. APHP, Hôspital Ambroise Paré, 92100 Boulogne-Billancourt, INSERM U1173, UFR Simone Veil, and Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France.
Abstract
OBJECTIVE: To determine the intra- and interobserver reliability of ultrasound (US)-detected age-related joint vascularization and ossification grading in healthy children. METHODS: Following standardized image acquisition and machine setting protocols, 10 international US experts examined 4 joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into 4 age groups: 2-4, 5-8, 9-12, and 13-16 years). Gray-scale was used to detect the ossification grade, and power Doppler ultrasound (PDUS) was used to detect physiologic vascularization. Ossification was graded from 0 (no ossification) to 3 (complete ossification). A positive PDUS signal was defined as any PDUS signal inside the joint. Kappa statistics were applied for intra- and interobserver reliability. RESULTS: According to the specific joint and age, up to 4 solitary PDUS signals (mean 1.5) were detected within each joint area with predominant localization of the physiologic vascularization in specific anatomic positions: fat pad, epiphysis, physis, and short bone cartilage. The kappa values for ossification grading were 0.87 (range 0.85-0.91) and 0.58 for intra- and interobserver reliability, respectively. The bias-adjusted kappa values for intra- and interobserver reliability were 0.71 (range 0.44-1.00) and 0.69, respectively. CONCLUSION: Detection of normal findings (i.e., grading of physiologic ossification during skeletal maturation and identification of physiologic vessels) can be highly reliable by using clear definitions and a standardized acquisition protocol. These data will permit development of a reliable and standardized US approach for evaluating pediatric joint pathologies.
OBJECTIVE: To determine the intra- and interobserver reliability of ultrasound (US)-detected age-related joint vascularization and ossification grading in healthy children. METHODS: Following standardized image acquisition and machine setting protocols, 10 international US experts examined 4 joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into 4 age groups: 2-4, 5-8, 9-12, and 13-16 years). Gray-scale was used to detect the ossification grade, and power Doppler ultrasound (PDUS) was used to detect physiologic vascularization. Ossification was graded from 0 (no ossification) to 3 (complete ossification). A positive PDUS signal was defined as any PDUS signal inside the joint. Kappa statistics were applied for intra- and interobserver reliability. RESULTS: According to the specific joint and age, up to 4 solitary PDUS signals (mean 1.5) were detected within each joint area with predominant localization of the physiologic vascularization in specific anatomic positions: fat pad, epiphysis, physis, and short bone cartilage. The kappa values for ossification grading were 0.87 (range 0.85-0.91) and 0.58 for intra- and interobserver reliability, respectively. The bias-adjusted kappa values for intra- and interobserver reliability were 0.71 (range 0.44-1.00) and 0.69, respectively. CONCLUSION: Detection of normal findings (i.e., grading of physiologic ossification during skeletal maturation and identification of physiologic vessels) can be highly reliable by using clear definitions and a standardized acquisition protocol. These data will permit development of a reliable and standardized US approach for evaluating pediatric joint pathologies.
Authors: Helen E Foster; Jelena Vojinovic; Tamas Constantin; Alberto Martini; Pavla Dolezalova; Yosef Uziel; E M D Smith; Lovro Lamot; Carine Wouters; Tadej Avcin; Nico Wulffraat Journal: Pediatr Rheumatol Online J Date: 2018-12-07 Impact factor: 3.054