Abstract
Background
Musculoskeletal US is a noninvasive imaging method for diagnosing and monitoring inflammatory rheumatic diseases.
Objectives
To develop age- and gender-related arthrosonographic reference intervals for the hip joint of healthy children and adolescents.
Materials and methods
In a cross-sectional US study, we examined both hip joints of 445 children and adolescents with an age range of 1 year to 18 years. We measured the distance between the bone surface and the outer margin of the joint capsule to define the bone-capsule distance, the joint capsule and cartilage thickness, and the capsule layer thickness. Reference values were calculated. The shape of the joint capsule and bone-capsule junction zone were analyzed qualitatively. An intraobserver analysis was performed.
Results
Bone-capsule distance, capsule thickness and the anterior capsule layer increase with age. In contrast, joint cartilage decreases. The posterior capsule layer exhibited constant thickness across all age groups. The difference between both body sides and gender was collectively less than 0.5 mm. The intraobserver variations were within the calculated reference intervals. The insertion of the capsule to the bone was mostly a peaked one. The capsule shape had a convex or straight configuration in a neutral position and a concave position during outward rotation. The intraobserver analysis revealed good to very good concordance.
Conclusion
We propose age- and gender-related reference intervals for the bone-capsule distance, joint capsule and cartilage thickness of the hip.
Similar content being viewed by others
References
Ramos PC, Ceccarelli F, Jousse-Joulin S (2012) Role of ultrasound in the assessment of juvenile idiopathic arthritis. Rheumatology (Oxford) 51:vii10–vii12
Spannow AH, Stenboeg E, Pfeiffer-Jensen M et al (2011) Ultrasound and MRI measurements of joint cartilage in healthy children: a validation study. Ultraschall Med 32:S110–S116
Colebatch-Bourn AN, Edwards CJ, Collado P et al (2015) EULAR-PReS points to consider for the use of imaging in the diagnosis and management of juvenile idiopathic arthritis in clinical practice. Ann Rheum Dis 74:1946–1957
Eich GF, Halle F, Hodler J et al (1994) Juvenile chronic arthritis: imaging of the knees and hips before and after intraarticular steroid injection. Pediatr Radiol 24:558–563
Frosch M, Foell D, Ganser G, Roth J (2003) Arthrosonography of hip and knee joints in the follow up of juvenile rheumatoid arthritis. Ann Rheum Dis 62:242–244
Friedman S, Gruber MA (2002) Ultrasonography of the hip in the evaluation of children with seronegative juvenile rheumatoid arthritis. J Rheumatol 29:629–632
Silva VB, Faquin G, Nicacio A et al (2013) Association between the ultrasonographic and clinical findings in the hips of patients with juvenile idiopathic arthritis. Rev Bras Reumatol 53:322–327
Collado P, Jousse-Joulin S, Alcalde M et al (2012) Is ultrasound a validated imaging tool for the diagnosis and management of synovitis in juvenile idiopathic arthritis? A systematic literature review. Arthritis Care Res (Hoboken) 64:1011–1019
Haslam KE, McCann LJ, Wyatt S, Wakefield RJ (2010) The detection of subclinical synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis: a pilot study. Rheumatology (Oxford) 49:123–127
Backhaus M, Burmester G-R, Gerber T et al (2001) Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 60:641–649
Magni-Manzoni S, Collado P, Jousse-Joulin S et al (2014) Current state of musculoskeletal ultrasound in paediatric rheumatology: results of an international survey. Rheumatology (Oxford) 53:491–496
Schmidt WA, Schmidt H, Schicke B, Gromnica-Ihle E (2004) Standard reference values for musculoskeletal ultrasonography. Ann Rheum Dis 63:988–994
Roth J, Jousse-Joulin S, Magni-Manzoni S et al (2015) Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken) 67:136–142
Kemperdick H (1996) Skelettentwicklung (Wachstum, Reifung des Skeletts, Knochenalter- und Endgrößenbestimmung. In: Kinderradiologie, vol 2. Springer Berlin Heidelberg, Berlin Heidelberg, pp 79–99
Laurell L, Hochbergs P, Rydholm U, Wingstrand H (2002) Capsular distance in the hip of the healthy child - normal values with sonography and MR imaging. Acta Radiol 43:213–216
Terjesen T, Osthus P (1991) Ultrasound in the diagnosis and follow-up of transient synovitis of the hip. J Pediatr Orthop 11:608–613
Reed AH, Henry RJ, Mason WB (1971) Influence of statistical method used on the resulting estimate of normal range. Clin Chem 17:275–284
Clinical and Laboratory Standards Institute (2008) Defining, establishing and verifying reference intervals in the clinical laboratory; approved guideline - third edition. CLSI document C28-A3. Clinical and Laboratory Standards Institute, Wayne, PA
Robben SG, Lequin MH, Diepstraten AF et al (1999) Anterior joint capsule of the normal hip and in children with transient synovitis: US study with anatomic and histologic correlation. Radiology 210:499–507
Egund N, Wingstrand H, Forsberg L et al (1986) Computed tomography and ultrasonography for diagnosis of hip joint effusion in children. Acta Orthop 57:211–215
Collado P, Naredo E, Calvo C, Crespo M (2007) Assessment of the joint recesses and tendon sheaths in healthy children by high-resolution B-mode and power Doppler sonography. Clin Exp Rheumatol 25:915–921
Rohrschneider WK, Fuchs G, Tröger J (1996) Ultrasonographic evaluation of the anterior recess in the normal hip: a prospective study on 166 asymptomatic children. Pediatr Radiol 26:629–634
Acknowledgements
We thank the children and adolescents and their parents who took part in the study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
This study was supported by a grant from Pfizer Pharma. The funder had no involvement in the study design, in the collection, analysis and interpretation of the data, in the writing of the report or in the decision to submit the paper for publication. The authors declare that they have no conflicts of interest.
Rights and permissions
About this article
Cite this article
Trauzeddel, R.F., Lehmann, H., Windschall, D. et al. Age-dependent arthrosonographic reference values of the hip joint in healthy children and adolescents – a cross-sectional multicenter ultrasound study. Pediatr Radiol 47, 1329–1336 (2017). https://doi.org/10.1007/s00247-017-3862-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-017-3862-5