Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
ASST Mantova, C. Poma Hospital, Mantova, Italy.
Arthritis Care Res (Hoboken). 2017 Aug;69(8):1217-1223. doi: 10.1002/acr.23130.
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.
肌肉骨骼超声（US）有可能成为评估儿童关节炎疾病活动的重要工具。为了评估病理学，首先需要为滑膜炎制定明确的定义。本研究旨在通过国际共识过程来制定和验证这些定义。
在共识过程中，31 名 US 专家决定使用哪些 US 技术以及定义中包含的组件，以及最终措辞。使用 1-5 的李克特量表（其中 1 表示完全不同意，5 表示完全同意）。需要至少 80%的专家评分 4 或 5 才能最终批准。然后，在显示不同年龄不同程度滑膜炎的 120 个腕关节、掌指关节和跗骨间关节的标准化 US 图像上验证了这些定义。
B 模式和多普勒应用于评估儿童滑膜炎。制定了滑膜炎的各种成分（即滑膜肥厚、积液和滑膜内的多普勒信号）的 US 定义。该定义在静态图像上进行了验证，中位数为 89%的参与者（范围为 80-100）对其进行了评分，李克特量表上的评分均为 4 或 5。
通过 Delphi 过程成功制定了涵盖整个儿科年龄范围的滑膜炎及其基本成分的 US 定义，并在基于网络的静态图像练习中进行了验证。这些结果为临床实践和研究中滑膜炎的标准化 US 评估提供了基础。
