Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jun 1;62(6):2239-2246.
doi: 10.1093/rheumatology/keac622.

Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle

Patricia Vega-Fernandez  1 , Deirdre De Ranieri  2 , Edward Oberle  3 , Matthew Clark  4 , Hulya Bukulmez  5 , Clara Lin  6 , Susan Shenoi  7 , Akaluck Thatayatikom  8 , Leandra Woolnough  9 , Heather Benham  10 , Emily Brunner  11 , Michael Henrickson  1 , Laura R Pratt  12 , Jean-Philippe Proulx-Gauthier  13 , Ginger Janow  14 , Amy Cassedy  15 , Tracy V Ting  1 , Johannes Roth  16
Affiliations
Review

Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle

Patricia Vega-Fernandez et al. Rheumatology (Oxford). .

Abstract

Objective: The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle.

Methods: As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC).

Results: Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97).

Conclusion: A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.

Keywords: JIA; ankle; diagnostic imaging; musculoskeletal ultrasound.

PubMed Disclaimer

References

    1. Ravelli A, Martini A.. Juvenile idiopathic arthritis. Lancet 2007;369:767–78. - PubMed
    1. Hemke R, Nusman CM, van der Heijde DM. et al. Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: implications for MR imaging as outcome measure. Rheumatol Int 2015;35:351–7. - PubMed
    1. Javadi S, Kan JH, Orth RC, DeGuzman M.. Wrist and ankle MRI of patients with juvenile idiopathic arthritis: identification of unsuspected multicompartmental tenosynovitis and arthritis. AJR Am J Roentgenol 2014;202:413–7. - PubMed
    1. Lanni S, Marafon DP, Civino A. et al. Comparison between clinical and ultrasound assessment of the ankle region in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2021;73:1180–6. - PubMed
    1. Romeo DM, Lucibello S, Musto E. et al. Assessing joint hypermobility in preschool-aged children. J Pediatr 2016;176:162–6. - PubMed

Publication types