Definitions for the sonographic features of joints in healthy children

Area of Science:

• Pediatric Rheumatology
• Medical Imaging
• Anatomy

Background:

• Musculoskeletal ultrasonography (US) shows promise for evaluating disease activity and structural damage in pediatric arthritides.
• Establishing clear definitions for normal pediatric joint US characteristics is essential before assessing pathology.
• This study aimed to define the US features of healthy pediatric joints.

Purpose of the Study:

• To develop standardized definitions for the normal pediatric joint using musculoskeletal ultrasonography.
• To establish a baseline for identifying joint abnormalities in children.
• To support the accurate diagnosis and monitoring of pediatric rheumatic diseases.

Main Methods:

• A Delphi process was employed by an expert group to develop initial definitions.
• Definitions were refined based on Likert scale scoring of standardized knee and ankle US scans.
• A larger panel of experts validated the definitions through scoring stored images of multiple joints.

Main Results:

• Five key definitions were created, covering articular bone, cartilage, joint capsule, ossification centers, and synovial membrane.
• Initial agreement rates improved from below 80% to 81-97% after definition modification.
• Final validation demonstrated ≥80% agreement for definitions across multiple pediatric joints (shoulder, elbow, wrist, hip, knee, ankle, etc.).

Conclusions:

• Standardized US definitions for normal pediatric joints were successfully developed and validated using a Delphi process.
• These definitions provide a foundation for developing pathological criteria and standardizing US use in pediatric rheumatology.
• The validated definitions will enhance the reliability and consistency of US assessments in children with rheumatic conditions.