Windschall Daniel, Trauzeddel Ralf, Magni-Manzoni Silvia, Adiguzel-Dundar Hatice, Hardt Sven, Krumrey-Langkammerer Manuela, Fotis Lampros, Berendes Rainer, Schua Sebastian, Haller Maria, Demir Ferhat, Sözeri Betul, Gohar Faekah
Clinic for Paediatric and Adolescent Rheumatology, St.-Josef-Stift Sendenhorst, Sendenhorst, Germany.
Medical Faculty, University of Halle-Wittenberg, Halle, Germany.
Pediatr Rheumatol Online J. 2025 Aug 13;23(1):87. doi: 10.1186/s12969-025-01134-y.
Whilst musculoskeletal ultrasound (MSUS) normal values for examination of the hip joint have been established for healthy children, equivalent values for patients with juvenile idiopathic arthritis (JIA), as well as internationally validated MSUS protocols for the optimal evaluation of synovitis are lacking. This study aimed to develop and validate the most sensitive MSUS protocol for the detection of hip synovitis in JIA.
In consecutive JIA patients with ≥ 1 clinically affected hip joint, affected and unaffected hips underwent MSUS. Disease, demographic and clinical findings were recorded. Synovitis was graded using the pediatric OMERACT score for B-Mode (BM) and power-Doppler Mode (PD) in the longitudinal and transverse scans and the sensitivity and specificity was analyzed. Additionally anterior recess size (bone to capsula distance), capsula thickness and femoral head cartilage thickness (transverse view) were measured. Published data provided further control data for anterior recess size (children without JIA). Interobserver reliability of BM and PD was tested using Fleiss-Kappa.
60 patients were enrolled who had 76 hips with and 32 without clinical arthritis. BM was positive (grade ≥ 1) in 74/76 of hips with clinical arthritis (97%, sensitivity 0.97 (0.93-1.0), specificity 0.85 (0.74-0.97) versus 2/32 (6%) in hips without arthritis. PD positivity frequency was 6 (8%) in hips with arthritis versus 0 in hips without. Anterior recess size (mean ± SD) was significantly wider in patients with clinical arthritis (9.9 ± 2.5 vs 5.5 ± 1.3, p-value 0.001). Use of the cut-off of ≥ 7.2 mm resulted in an area under the curve of at least 95%, with a sensitivity of 86% and specificity of 94%. Articular capsula and femoral head cartilage thickness did not differ between patients with and without arthritis. Recess size was comparable in the internal and external control groups (n = 449). Interobserver reliability of BM and PD positivity showed excellent agreement (kappa = 0.85).
The Pediatric internationally agreed UltraSound hip synovitis protocol (PIUS-hip) could be limited to one longitudinal scan including B-Mode scoring plus measurement of anterior recess size for maximal sensitivity and specificity for synovitis.
虽然已确定了健康儿童髋关节检查的肌肉骨骼超声（MSUS）正常值，但缺乏青少年特发性关节炎（JIA）患者的相应值，以及国际上验证的用于滑膜炎最佳评估的MSUS方案。本研究旨在开发和验证检测JIA患者髋关节滑膜炎最敏感的MSUS方案。
对连续的JIA患者中临床受累髋关节≥1个的患者，对受累和未受累的髋关节进行MSUS检查。记录疾病、人口统计学和临床发现。在纵向和横向扫描中使用儿科OMERACT B模式（BM）和能量多普勒模式（PD）对滑膜炎进行分级，并分析敏感性和特异性。此外，测量前隐窝大小（骨到关节囊的距离）、关节囊厚度和股骨头软骨厚度（横向视图）。已发表的数据提供了前隐窝大小的进一步对照数据（无JIA的儿童）。使用Fleiss-Kappa检验BM和PD的观察者间可靠性。
纳入60例患者，其中76个髋关节有临床关节炎，32个髋关节无临床关节炎。在有临床关节炎的76个髋关节中，74个（97%）BM呈阳性（分级≥1）（敏感性0.97（0.93 - 1.0），特异性0.85（0.74 - 0.97）），而在无关节炎的32个髋关节中为2个（6%）呈阳性。有临床关节炎的髋关节中PD阳性频率为6个（8%），无关节炎的髋关节中为0个。临床关节炎患者的前隐窝大小（平均值±标准差）明显更宽（9.9±2.5对5.5±1.3，p值0.001）。使用≥7.2 mm的截断值导致曲线下面积至少为95%，敏感性为86%，特异性为94%。有关节炎和无关节炎患者的关节囊和股骨头软骨厚度无差异。内部和外部对照组（n = 449）的隐窝大小相当。BM和PD阳性的观察者间可靠性显示出极好的一致性（kappa = 0.85）。
国际认可的儿科超声髋关节滑膜炎方案（PIUS-hip）可限于一次纵向扫描，包括B模式评分加前隐窝大小测量，以获得滑膜炎的最大敏感性和特异性。
