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Age-Related Vascularization and Ossification of Joints in Children: An International Pilot Study to Test
Daniel Windschall1, Paz Collado2, Jelena Vojinovic3
1Asklepios Hospital Weissenfels, Weissenfels, Germany.
Insights
Ultrasound (US) grading of normal joint ossification and vascularization in children is reliable with standardized protocols. This supports a dependable US method for assessing pediatric joint conditions.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Ultrasound
- Skeletal Development
Background:
- Accurate assessment of pediatric joint development is crucial for diagnosing pathologies.
- Standardized ultrasound (US) criteria for normal joint findings are needed to improve diagnostic consistency.
- Physiologic vascularization and ossification vary with age and skeletal maturation.
Purpose of the Study:
- To evaluate the reliability of ultrasound (US) in grading age-related joint ossification and vascularization in healthy children.
- To establish standardized protocols for pediatric musculoskeletal US assessments.
- To determine intra- and interobserver agreement for US-detected normal joint findings.
Main Methods:
- Ten international US experts assessed 4 joints in 12 healthy children across 4 age groups.
- Standardized protocols for image acquisition and machine settings were used.
- Gray-scale US for ossification grading (0-3) and power Doppler US (PDUS) for vascularization were employed. Kappa statistics assessed reliability.
Main Results:
- Physiologic vascularization was detected in specific joint areas (fat pad, epiphysis, physis, cartilage) with a mean of 1.5 PDUS signals per joint.
- Intraobserver reliability for ossification grading was high (kappa=0.87).
- Interobserver reliability for ossification grading was moderate (kappa=0.58), improving with bias adjustment (kappa=0.69).
Conclusions:
- Standardized ultrasound protocols and clear definitions enable highly reliable detection of normal pediatric joint ossification and vascularization.
- These findings support the development of a reliable and standardized US approach for evaluating pediatric joint pathologies.
- Consistent grading of physiologic ossification and vascularization is achievable with defined criteria.
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.
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