title: Toward Standardized Musculoskeletal Ultrasound in Pediatric Rheumatology: Normal Age-Related Ultrasound Findings.
abstract: OBJECTIVE
  The Outcome Measures in Rheumatology Ultrasound Task Force has recently started to work on the validation and standardization of musculoskeletal ultrasound (MSUS) examination in children in order to improve its applicability to joint examination.
  
  
  METHODS
  This was a prospective multicenter study performed by 4 experts in pediatric MSUS, who independently collected representative images using predefined scanning procedures of 4 joints (knee, ankle, wrist, and second metacarpophalangeal joint) in different predefined age groups. Researchers were allowed to use their own settings (B-mode and Doppler) in order to get the best quality image and highest sensitivity for low blood flow. Images were evaluated for quality parameters and an atlas was created with the best images. An equipment comparative study was performed by a single examiner using 2 different types of machines.
  
  
  RESULTS
  Sixty-four healthy children were scanned. The quality of evaluated images, obtained by predefined scanning positions, was highly comparable among the examiners. The B-mode images clearly showed age-related variations of joint findings, while Doppler images showed the presence of blood flow, particularly within the epiphyseal cartilage of the children at a younger age. There was a high to good level of consistency between images obtained from the 2 different ultrasound machines.
  
  
  CONCLUSIONS
  The study shows a systematic method for ultrasound examination of children at different age groups. Additionally, a baseline collection of images was developed, showing blood vessels in the joints examined. The present study could provide a framework for ongoing MSUS studies as well as for clinical practice in pediatric rheumatology.
authors.affiliation: Hospital Severo Ochoa, Madrid, Spain.
authors.forename: Paz
authors.initials: P
authors.lastname: Collado
authors.affiliation: University Clinical Center, University of Nis, Nis, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Vojinovic
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Nieto
authors.affiliation: Asklepios Hospital Weissenfels, Weissenfels, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Windschall
authors.affiliation: IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Magni-Manzoni
authors.affiliation: Medisch Centrum Leeuwarden, Leeuwarden, Friesland, The Netherlands.
authors.forename: George A W
authors.initials: GA
authors.lastname: Bruyn
authors.affiliation: Sapienza Università di Roma, Rome, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.affiliation: Université de Paris and Ambroise Paré Hospital, Paris, France.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D'agostino
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001271:Atlases as Topic; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging*; D008297:Male; D056888:Patient Positioning / Q000592:standards; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D013030:Spain; D014159:Transducers / Q000592:standards; D018608:Ultrasonography, Doppler / Q000295:instrumentation / Q000592:standards*