title: Preliminary Definitions for the Sonographic Features of Synovitis in Children.
abstract: Musculoskeletal ultrasonography (US) has the potential to be an important tool in the assessment of disease activity in childhood arthritides. To assess pathology, clear definitions for synovitis need to be developed first. The aim of this study was to develop and validate these definitions through an international consensus process.
  
  
  
  The decision on which US techniques to use and the components to be included in the definitions, as well as the final wording, were developed by 31 US experts in a consensus process. A Likert scale of 1-5 (where 1 = complete disagreement and 5 = complete agreement) was used. A minimum of 80% of the experts scoring 4 or 5 was required for final approval. The definitions were then validated on 120 standardized US images of the wrist, metacarpophalangeal joints, and tibiotalar joints, displaying various degrees of synovitis at various ages.
  
  
  
  B-mode and Doppler should be used for assessing synovitis in children. A US definition of the various components (i.e., synovial hypertrophy, effusion, and Doppler signal within the synovium) was developed. The definition was validated on still images with a median of 89% of participants (range 80-100) scoring it as 4 or 5 on a Likert scale.
  
  
  
  US definitions of synovitis and its elementary components covering the entire pediatric age range were successfully developed through a Delphi process and validated in a web-based still-images exercise. These results provide the basis for the standardized US assessment of synovitis in clinical practice and research.
authors.affiliation: Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Johannes
authors.initials: J
authors.lastname: Roth
authors.affiliation: ASST Mantova, C. Poma Hospital, Mantova, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Ravagnani
authors.affiliation: Park-Klinik Weissensee, Berlin, Germany.
authors.forename: Marina
authors.initials: M
authors.lastname: Backhaus
authors.affiliation: National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
authors.forename: Peter
authors.initials: P
authors.lastname: Balint
authors.affiliation: Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bruns
authors.affiliation: MC Groep Hospitals, Lelystad, The Netherlands.
authors.forename: George A
authors.initials: GA
authors.lastname: Bruyn
authors.affiliation: Hospital Universitario Severo Ochoa, Madrid, Spain.
authors.forename: Paz
authors.initials: P
authors.lastname: Collado
authors.affiliation: Hospital Universitario Universidad Autonoma de Nuevo Leon-Monterrey, Nuevo Leon, Mexico.
authors.forename: Lorenia
authors.initials: L
authors.lastname: De la Cruz
authors.affiliation: Bicetre University Hospital, Le Kremlin Bicetre, France.
authors.forename: Severine
authors.initials: S
authors.lastname: Guillaume-Czitrom
authors.affiliation: Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Troels
authors.initials: T
authors.lastname: Herlin
authors.affiliation: Instituto Nacional de Rehabilitacion, Mexico City, Mexico.
authors.forename: Cristina
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Università degli Studi di Torino, Turin, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.affiliation: Hôpital de la Cavale Blanche, Brest, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.affiliation: Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Lanni
authors.affiliation: Rikshospitalet University Hospital, Oslo, Norway.
authors.forename: Vibke
authors.initials: V
authors.lastname: Lilleby
authors.affiliation: Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Malattia
authors.affiliation: Ospedale Pediatrico Bambino Gesu, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Magni-Manzoni
authors.affiliation: Vall d'Hebron University Hospital, Barcelona, Spain.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Modesto
authors.affiliation: Hospital Universitario Ramon y Cajal, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodriguez
authors.affiliation: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Nieto
authors.affiliation: Charité University Hospital, Berlin, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ohrndorf
authors.affiliation: Bicetre University Hospital, Le Kremlin Bicetre, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Rossi-Semerano
authors.affiliation: Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Anne-Marit
authors.initials: AM
authors.lastname: Selvaag
authors.affiliation: Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
authors.forename: Nanno
authors.initials: N
authors.lastname: Swen
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Tracy V
authors.initials: TV
authors.lastname: Ting
authors.affiliation: Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany.
authors.forename: Nikolay
authors.initials: N
authors.lastname: Tzaribachev
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Vega-Fernandez
authors.affiliation: University Clinical Center, Nis, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Vojinovic
authors.affiliation: Asklepios Hospital Weissenfels, Weissenfels, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Windschall
authors.affiliation: Ambroise Paré Hospital, Boulogne-Billancourt and INSERM U1173, Laboratoire d'Excellence INFLAMEX, University Paris Ouest-Versailles St.-Quentin, Saint Quentin en Yvelines, 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: D002648:Child; D032921:Consensus; D006801:Humans; D013585:Synovitis / Q000145:classification* / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler / Q000145:classification* / Q000592:standards