Semin Musculoskelet Radiol 2021; 25(01): 068-081
DOI: 10.1055/s-0041-1726014
Review Article

Conventional Radiography and Ultrasound Imaging of Rheumatic Diseases Affecting the Pediatric Population

Grzegorz Pracoń
1   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
,
Maria Pilar Aparisi Gómez
2   Department of Radiology, Auckland City Hospital, Auckland, New Zealand
3   Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
,
Paolo Simoni
4   “Reine Fabiola” Children's University Hospital, Paediatric Imaging Department, Bruxelles, Belgium
,
Piotr Gietka
5   Clinics of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
,
Iwona Sudoł-Szopińska
1   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
› Author Affiliations

Abstract

Juvenile idiopathic arthritis is the most frequent rheumatic disease in the pediatric population, followed by systemic lupus erythematosus, juvenile scleroderma syndromes, juvenile dermatomyositis, chronic recurrent multifocal osteomyelitis, and juvenile vasculopathies. The imaging approach to inflammatory connective tissue diseases in childhood has not changed dramatically over the last decade, with radiographs still the leading method for bony pathology assessment, disease monitoring, and evaluation of growth disturbances. Ultrasonography is commonly used for early detection of alterations within the intra- and periarticular soft tissues, assessing their advancement and also disease monitoring. It offers several advantages in young patients including nonionizing radiation exposure, short examination time, and high resolution, allowing a detailed evaluation of the musculoskeletal system for the features of arthritis, tenosynovitis, enthesitis, bursitis, myositis, as well as pathologies of the skin, subdermis, vessels, and fasciae. In this pictorial essay we discuss radiographic and ultrasound inflammatory features of autoimmune pediatric inflammatory arthropathies: juvenile idiopathic arthritis, lupus erythematosus, juvenile scleroderma, juvenile dermatomyositis and polymyositis.



Publication History

Article published online:
21 May 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Jurik AG, Klicman RF, Simoni P, Robinson P, Teh J. SAPHO and CRMO: the value of imaging. Semin Musculoskelet Radiol 2018; 22 (02) 207-224
  • 2 Sudoł-Szopińska I, Jacques T, Gietka P, Cotten A. Imaging in dermatomyositis in adults and children. J Ultrason 2020; 20 (80) e36-e42
  • 3 Znajdek M, Gazda A, Gietka P, Wysmołek M, Sudoł-Szopińska I. Juvenile spondyloarthritis and chronic recurrent multifocal osteomyelitis overlap syndrome in a 16-year-old adolescent. A case report and literature review. J Ultrason 2019; 19 (77) 152-157
  • 4 Sudoł-Szopińska I, Jans L, Jurik AG, Hemke R, Eshed I, Boutry N. Imaging features of the juvenile inflammatory arthropathies. Semin Musculoskelet Radiol 2018; 22 (02) 147-165
  • 5 Basra HAS, Humphries PD. Juvenile idiopathic arthritis: what is the utility of ultrasound?. Br J Radiol 2017; 90 (1073): 20160920
  • 6 Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet 2007; 369 (9563): 767-778
  • 7 Dalvi SR, Moser DW, Samuels J. Ultrasound and treatment algorithms of RA and JIA. Rheum Dis Clin North Am 2013; 39 (03) 669-688
  • 8 Avenarius DFM, Nusman C, Malattia C. et al. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48 (06) 801-810
  • 9 Barbuto L, Di Serafino M, Della Vecchia N. et al. Pediatric musculoskeletal ultrasound: a pictorial essay. J Ultrasound 2019; 22 (04) 491-502
  • 10 Ravelli A, Ioseliani M, Norambuena X. et al. Adapted versions of the Sharp/van der Heijde score are reliable and valid for assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 2007; 56 (09) 3087-3095
  • 11 Cellerini M, Salti S, Trapani S, D'Elia G, Falcini F, Villari N. Correlation between clinical and ultrasound assessment of the knee in children with mono-articular or pauci-articular juvenile rheumatoid arthritis. Pediatr Radiol 1999; 29 (02) 117-123
  • 12 Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics 2013; 33 (05) 1253-1273
  • 13 Magni-Manzoni S, Rossi F, Pistorio A. et al. Prognostic factors for radiographic progression, radiographic damage, and disability in juvenile idiopathic arthritis. Arthritis Rheum 2003; 48 (12) 3509-3517
  • 14 Hemke R, Nusman CM, van der Heijde DM. et al. Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: implications for MR imaging as outcome measure. Rheumatol Int 2015; 35 (02) 351-357
  • 15 Kröger L, Piippo-Savolainen E, Tyrväinen E, Penttilä P, Kröger H. Osteochondral lesions in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013; 11 (01) 18
  • 16 Lang BA, Schneider R, Reilly BJ, Silverman ED, Laxer RM. Radiologic features of systemic onset juvenile rheumatoid arthritis. J Rheumatol 1995; 22 (01) 168-173
  • 17 Rossi F, Di Dia F, Galipò O. et al. Use of the Sharp and Larsen scoring methods in the assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 2006; 55 (05) 717-723
  • 18 Ravelli A. The time has come to include assessment of radiographic progression in juvenile idiopathic arthritis clinical trials. J Rheumatol 2008; 35 (04) 553-557
  • 19 Burnham JM, Shults J, Weinstein R, Lewis JD, Leonard MB. Childhood onset arthritis is associated with an increased risk of fracture: a population based study using the General Practice Research Database. Ann Rheum Dis 2006; 65 (08) 1074-1079
  • 20 Vicente G, Osman R. eds. Hand Bone Age: A Digital Atlas of Skeletal Maturity. Berlin, Germany: Springer; 2005
  • 21 Saurenmann RK, Rose JB, Tyrrell P. et al. Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor. Arthritis Rheum 2007; 56 (06) 1974-1984
  • 22 Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2018; 14 (08) 681-694
  • 23 Ostrowska M, Maśliński W, Prochorec-Sobieszek M, Nieciecki M, Sudoł-Szopińska I. Cartilage and bone damage in rheumatoid arthritis. Reumatologia 2018; 56 (02) 111-120
  • 24 Sudoł-Szopińska I, Grochowska E, Gietka P. et al. Imaging of juvenile idiopathic arthritis. Part II: Ultrasonography and MRI. J Ultrason 2016; 16 (66) 237-251
  • 25 Bruyn GA, Iagnocco A, Naredo E. et al; OMERACT Ultrasound Working Group. OMERACT definitions for ultrasonographic pathologies and elementary lesions of rheumatic disorders 15 years on. J Rheumatol 2019; 46 (10) 1388-1393
  • 26 Smith MD. The normal synovium. Open Rheumatol J 2011; 5: 100-106
  • 27 Brunner E, Ting T, Vega-Fernandez P. Musculoskeletal ultrasound in children: current state and future directions. Eur J Rheumatol 2020; 7 (Suppl. 01) S28-S37
  • 28 Sudoł-Szopińska I, Kwiatkowska B, Prochorec-Sobieszek M, Maśliński W. Enthesopathies and enthesitis. Part 1. Etiopathogenesis. J Ultrason 2015; 15 (60) 72-84
  • 29 Sudoł-Szopińska I, Kwiatkowska B, Prochorec-Sobieszek M, Pracoń G, Walentowska-Janowicz M, Maśliński W. Enthesopathies and enthesitis. Part 2: Imaging studies. J Ultrason 2015; 15 (61) 196-207
  • 30 Sudoł-Szopińska I, Kontny E, Zaniewicz-Kaniewska K, Prohorec-Sobieszek M, Saied F, Maśliński W. Role of inflammatory factors and adipose tissue in pathogenesis of rheumatoid arthritis and osteoarthritis. Part I: Rheumatoid adipose tissue. J Ultrason 2013; 13 (53) 192-201
  • 31 Lanni S, Martini A, Malattia C. Heading toward a modern imaging approach in juvenile idiopathic arthritis. Curr Rheumatol Rep 2014; 16 (05) 416
  • 32 Müller LS, Avenarius D, Damasio B. et al. The paediatric wrist revisited: redefining MR findings in healthy children. Ann Rheum Dis 2011; 70 (04) 605-610
  • 33 Roth J, Jousse-Joulin S, Magni-Manzoni S. et al; Outcome Measures in Rheumatology Ultrasound Group. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken) 2015; 67 (01) 136-142
  • 34 Magni-Manzoni S, Epis O, Ravelli A. et al. Comparison of clinical versus ultrasound-determined synovitis in juvenile idiopathic arthritis. Arthritis Rheum 2009; 61 (11) 1497-1504
  • 35 Ćwikła JB, Żbikowski P, Kwiatkowska B, Buscombe JR, Sudoł-Szopińska I. Radiosynovectomy in rheumatic diseases. J Ultrason 2014; 14 (58) 241-251
  • 36 Laloo F, Herregods N, Jaremko JL, Verstraete K, Jans L. MRI of the sacroiliac joints in spondyloarthritis: the added value of intra-articular signal changes for a ‘positive MRI.’. Skeletal Radiol 2018; 47 (05) 683-693
  • 37 Tucker LB, Menon S, Schaller JG, Isenberg DA. Adult- and childhood-onset systemic lupus erythematosus: a comparison of onset, clinical features, serology, and outcome. Br J Rheumatol 1995; 34 (09) 866-872
  • 38 Levy DM, Kamphuis S. Systemic lupus erythematosus in children and adolescents. Pediatr Clin North Am 2012; 59 (02) 345-364
  • 39 Brunner HI, Gladman DD, Ibañez D, Urowitz MD, Silverman ED. Difference in disease features between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Rheum 2008; 58 (02) 556-562
  • 40 Hersh AO, von Scheven E, Yazdany J. et al. Differences in long-term disease activity and treatment of adult patients with childhood- and adult-onset systemic lupus erythematosus. Arthritis Rheum 2009; 61 (01) 13-20
  • 41 Hoffman IE, Lauwerys BR, De Keyser F. et al. Juvenile-onset systemic lupus erythematosus: different clinical and serological pattern than adult-onset systemic lupus erythematosus. Ann Rheum Dis 2009; 68 (03) 412-415
  • 42 das Chagas Medeiros MM, Bezerra MC, Braga FN. et al. Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adult-onset, and late-onset SLE. Lupus 2016; 25 (04) 355-363
  • 43 Lalani TA, Kanne JP, Hatfield GA, Chen P. Imaging findings in systemic lupus erythematosus. Radiographics 2004; 24 (04) 1069-1086
  • 44 Hemke R, Herregods N, Jaremko JL. et al. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30 (10) 5237-5249
  • 45 Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Juvenile scleroderma: a referral center experience. Arch Rheumatol 2018; 33 (03) 344-351
  • 46 Osminina MK, Geppe NA, Shpitonkova OV. Articular involvement in juvenile localized scleroderma. MOJ Orthop Rheumatol 2018; 10 (02) 104-108
  • 47 Lo CY, Shyur SD, Chu SH. et al. Juvenile scleroderma: experience in one institution. Asian Pac J Allergy Immunol 2010; 28 (04) 279-286
  • 48 Adrovic A, Sahin S, Barut K, Kasapcopur O. Juvenile scleroderma—what has changed in the meantime?. Curr Rheumatol Rev 2018; 14 (03) 219-225
  • 49 Zulian F, Culpo R, Sperotto F. et al. Consensus-based recommendations for the management of juvenile localised scleroderma. Ann Rheum Dis 2019; 78 (08) 1019-1024
  • 50 Chapin R, Hant FN. Imaging of scleroderma. Rheum Dis Clin North Am 2013; 39 (03) 515-546
  • 51 Marta I, Maria M, Emil M, Piotr G, Sudoł-Szopińska I. Ultrasonography, MRI and classic radiography of skin and MSK involvement in juvenile scleroderma. J Ultrason 2020; 20: e311-e317 DOI: 10.15557/JoU.2020.0054.
  • 52 Berko NS, Hay A, Sterba Y, Wahezi D, Levin TL. Efficacy of ultrasound elastography in detecting active myositis in children: can it replace MRI?. Pediatr Radiol 2015; 45 (10) 1522-1528
  • 53 Davis WR, Halls JE, Offiah AC, Pilkington C, Owens CM, Rosendahl K. Assessment of active inflammation in juvenile dermatomyositis: a novel magnetic resonance imaging-based scoring system. Rheumatology (Oxford) 2011; 50 (12) 2237-2244
  • 54 Leeuwenberg KE, Albayda J. Muscle ultrasound in inflammatory myopathies: a critical review. J Rheum Dis Treat 2019; 5: 69
  • 55 Bhansing KJ, Hoppenreijs EP, Janssen AJ. et al. Quantitative muscle ultrasound: a potential tool for assessment of disease activity in juvenile dermatomyositis. Scand J Rheumatol 2014; 43 (04) 339-341
  • 56 Habers GE, Van Brussel M, Bhansing KJ. et al. Quantitative muscle ultrasonography in the follow-up of juvenile dermatomyositis. Muscle Nerve 2015; 52 (04) 540-546
  • 57 Collison CH, Sinal SH, Jorizzo JL, Walker FO, Monu JU, Snyder J. Juvenile dermatomyositis and polymyositis: a follow-up study of long-term sequelae. South Med J 1998; 91 (01) 17-22
  • 58 Song Y, Lee S, Yoo DH, Jang KS, Bae J. Strain sonoelastography of inflammatory myopathies: comparison with clinical examination, magnetic resonance imaging and pathologic findings. Br J Radiol 2016; 89 (1065): 20160283
  • 59 Bachasson D, Dubois GJR, Allenbach Y, Benveniste O, Hogrel JY. Muscle shear wave elastography in inclusion body myositis: feasibility, reliability and relationships with muscle impairments. Ultrasound Med Biol 2018; 44 (07) 1423-1432
  • 60 Mlosek RK, Migda B, Migda M. High-frequency ultrasound in the 21st century. J Ultrason 2020; 20: e233-e241 DOI: 10.15557/JoU.2020.0042.