Age-related vascularization and ossification of joints in children: an international pilot study to test multi-observer ultrasound reliability

OMERACT paediatric ultrasound subtask force

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Abstract

OBJECTIVE: To determine the intra- and inter-observer 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 four joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into four age groups: 2-4, 5-8, 9-12, and 13-16 years). Grey-scale was used to detect the ossification grade, and power Doppler (PD) US was used to detect physiological vascularization. Ossification was graded from grade 0 (no ossification) to grade 3 (complete ossification). A positive PD signal was defined as any PD signal inside the joint. Kappa statistics were applied for intra- and inter-observer reliability.

RESULTS: According to the specific joint and age, up to four solitary PD signals (mean, 1.5) were detected within each joint area with predominant localization of the physiological 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 inter-observer reliability, respectively. The bias-adjusted kappa values for intra- and inter-observer reliability were 0.71 (range, 0.44-1.00) and 0.69, respectively.

CONCLUSION: Detection of normal findings (i.e., grading of physiological ossification during skeletal maturation and identification of physiological 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 paediatric joint pathologies. This article is protected by copyright. All rights reserved.

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Osteogenesis
Joints
Wrist Joint
Metacarpophalangeal Joint
Doppler Ultrasonography
Epiphyses
Ankle
Cartilage
Adipose Tissue
Knee
Age Groups
Pediatrics
Pathology
Bone and Bones

Cite this

@article{08a5ab18431b4611bedc63eb3a2cb939,
title = "Age-related vascularization and ossification of joints in children: an international pilot study to test multi-observer ultrasound reliability",
abstract = "OBJECTIVE: To determine the intra- and inter-observer 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 four joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into four age groups: 2-4, 5-8, 9-12, and 13-16 years). Grey-scale was used to detect the ossification grade, and power Doppler (PD) US was used to detect physiological vascularization. Ossification was graded from grade 0 (no ossification) to grade 3 (complete ossification). A positive PD signal was defined as any PD signal inside the joint. Kappa statistics were applied for intra- and inter-observer reliability.RESULTS: According to the specific joint and age, up to four solitary PD signals (mean, 1.5) were detected within each joint area with predominant localization of the physiological 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 inter-observer reliability, respectively. The bias-adjusted kappa values for intra- and inter-observer reliability were 0.71 (range, 0.44-1.00) and 0.69, respectively.CONCLUSION: Detection of normal findings (i.e., grading of physiological ossification during skeletal maturation and identification of physiological 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 paediatric joint pathologies. This article is protected by copyright. All rights reserved.",
author = "{OMERACT paediatric ultrasound subtask force} and Daniel Windschall and Paz Collado and Jelena Vojinovic and Silvia Magni-Manzoni and Peter Balint and Bruyn, {George A W} and Cristina Hernandez-Diaz and Nieto, {Juan Carlos} and Viviana Ravagnani and Nikolay Tzaribachev and Annamaria Iagnocco and D'Agostino, {Maria Antonietta} and Esperanza Naredo",
note = "This article is protected by copyright. All rights reserved.",
year = "2017",
month = "8",
day = "4",
doi = "10.1002/acr.23335",
language = "English",
journal = "Arthritis care and research : the official journal of the Arthritis Health Professions Association",
issn = "0893-7524",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Age-related vascularization and ossification of joints in children

T2 - an international pilot study to test multi-observer ultrasound reliability

AU - OMERACT paediatric ultrasound subtask force

AU - Windschall, Daniel

AU - Collado, Paz

AU - Vojinovic, Jelena

AU - Magni-Manzoni, Silvia

AU - Balint, Peter

AU - Bruyn, George A W

AU - Hernandez-Diaz, Cristina

AU - Nieto, Juan Carlos

AU - Ravagnani, Viviana

AU - Tzaribachev, Nikolay

AU - Iagnocco, Annamaria

AU - D'Agostino, Maria Antonietta

AU - Naredo, Esperanza

N1 - This article is protected by copyright. All rights reserved.

PY - 2017/8/4

Y1 - 2017/8/4

N2 - OBJECTIVE: To determine the intra- and inter-observer 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 four joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into four age groups: 2-4, 5-8, 9-12, and 13-16 years). Grey-scale was used to detect the ossification grade, and power Doppler (PD) US was used to detect physiological vascularization. Ossification was graded from grade 0 (no ossification) to grade 3 (complete ossification). A positive PD signal was defined as any PD signal inside the joint. Kappa statistics were applied for intra- and inter-observer reliability.RESULTS: According to the specific joint and age, up to four solitary PD signals (mean, 1.5) were detected within each joint area with predominant localization of the physiological 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 inter-observer reliability, respectively. The bias-adjusted kappa values for intra- and inter-observer reliability were 0.71 (range, 0.44-1.00) and 0.69, respectively.CONCLUSION: Detection of normal findings (i.e., grading of physiological ossification during skeletal maturation and identification of physiological 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 paediatric joint pathologies. This article is protected by copyright. All rights reserved.

AB - OBJECTIVE: To determine the intra- and inter-observer 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 four joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into four age groups: 2-4, 5-8, 9-12, and 13-16 years). Grey-scale was used to detect the ossification grade, and power Doppler (PD) US was used to detect physiological vascularization. Ossification was graded from grade 0 (no ossification) to grade 3 (complete ossification). A positive PD signal was defined as any PD signal inside the joint. Kappa statistics were applied for intra- and inter-observer reliability.RESULTS: According to the specific joint and age, up to four solitary PD signals (mean, 1.5) were detected within each joint area with predominant localization of the physiological 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 inter-observer reliability, respectively. The bias-adjusted kappa values for intra- and inter-observer reliability were 0.71 (range, 0.44-1.00) and 0.69, respectively.CONCLUSION: Detection of normal findings (i.e., grading of physiological ossification during skeletal maturation and identification of physiological 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 paediatric joint pathologies. This article is protected by copyright. All rights reserved.

U2 - 10.1002/acr.23335

DO - 10.1002/acr.23335

M3 - Article

C2 - 28777893

JO - Arthritis care and research : the official journal of the Arthritis Health Professions Association

JF - Arthritis care and research : the official journal of the Arthritis Health Professions Association

SN - 0893-7524

ER -