Normal sonoanatomy of the paediatric entheses including echostructure and vascularisation changes during growth
Sandrine Jousse-Joulin1, Claire Cangemi, Stéphanie Gerard
1Department of Rheumatology, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France.
Insights
This study details normal ultrasound anatomy of pediatric lower limb entheses, finding cartilage thickness varies with age and gender, while tendon thickness does not. These findings establish crucial reference data for pediatric rheumatology.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Ultrasound
- Rheumatology Imaging
Background:
- Entheses are crucial anatomical structures commonly affected in pediatric spondyloarthritis.
- Understanding normal entheseal sonoanatomy in children is vital for accurate diagnosis and monitoring.
- Previous studies lack comprehensive ultrasound data on pediatric entheses across different age groups and genders.
Purpose of the Study:
- To characterize the normal sonoanatomy of pediatric lower limb entheses.
- To investigate the influence of age and gender on entheseal and cartilage thickness and vascularization.
- To establish normative ultrasound reference ranges for pediatric entheses.
Main Methods:
- Ultrasound examination of lower limb entheses in 41 healthy children (2-15 years).
- Children were stratified into four age groups (2-4, 5-7, 8-12, 13-15 years).
- Assessment of echostructural components, thickness, and vascularization of entheses and cartilage in transverse and longitudinal views.
Main Results:
- Tendon and cartilage thickness correlated significantly with age (P < 0.0001).
- Cartilage thickness was significantly greater in boys than girls (P ≤ 0.05); tendon thickness was gender-independent.
- Intra-cartilaginous vascularization varied across age groups, with visible blood vessels observed.
Conclusions:
- This study presents the first comprehensive data on normal entheseal sonoanatomy and vascularization in children.
- Established normative ultrasound data can aid in differentiating normal findings from pathology in pediatric enthesopathies.
- Findings highlight age and gender-specific variations in pediatric entheseal cartilage, important for rheumatologic assessments.
Objectives:
To describe the sonoanatomy of paediatric lower-limb entheses according to age and gender. We studied sites that most commonly involved entheses in spondyloarthritis.
Methods:
We studied 41 consecutive healthy children (20 girls, 21 boys; age 2-15 years) divided into four age groups: 2-4 years (n = 9), 5-7 years (n = 11), 8-12 years (n = 12) and 13-15 years (n = 9). Ultrasound was used to obtain both transverse and longitudinal views of each enthesis. We assessed the echostructural components of the lower limb entheses and the vascularisation of the entheses and cartilage according to the different anatomical sites and age and gender.
Results:
At all sites on B-mode, cartilage and tendon thicknesses showed positive or negative correlations with age (P < 0.0001). Side-to-side correlations were good (P < 0.0001 overall) and stronger for cartilage (r, 0.77-0.97) than for tendon thickness (r, 0.58-0.63). Agreement between the two sides for discrete data was very good to excellent (kappa, 0.77-1). Cartilage thickness at the various sites was significantly greater in boys than in girls (P ≤ 0.05). Tendon thickness was not significantly influenced by gender. Blood vessels were seen within the cartilage with differences across age groups.
Conclusions:
This study provides the first data on normal entheseal sonoanatomy and vascularisation in children.
Key Points:
• The tendons of children exhibit the same fibrillar structure as adults • Tendon thickness at enthesis insertion in children is not influenced by gender • Cartilage thickness in children decreases with advancing age and varies with gender.
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