Musculoskeletal Task Force
Imaging growing bone is challenging, as bone structure, shape and size changes continuously until skeletal maturity. The numerous normal variants of growth which may mimic pathology have been accurately described radiographically, but little is known on the appearances on magnetic resonance imaging (MRI), for example. Thus, techniques and protocols designed for adults should not be applied in children without being properly audited and adjusted. As paediatric radiologists we have important work to do!
to present recommendations on ”best practice” for paediatric MSK imaging, based on own research and on the available literature
Karen Rosendahl (NO) and Paolo Toma (IT) (chairs), Catherine Treguier (FR), Catherine Adamsbaum (FR), Ignasi Barber (ES), Lil-Sofie Ording Müller (NO), Paul Humphries (UK), Laura Tanturri De Horatio (IT), Paolo Simoni (BE), Susie Shelmerdine (UK), Amaka Offiah (UK), Christian Ormeno (ES)
Charlotte Nusman (NL), Robert Hemke (NL), Derk Avenarius (NO)
1) Ultrasound screening for developmental dysplasia of the hip (DDH). Literature update.
2) Nor-JIA; a multicentre project including >220 children (and controls) with juvenile idiopathic arthritis (JIA), focusing on involvement of the temporomandibular joints. Validation of MRI, ultrasound CB-CT and radiography for detection and grading of active and chronic change (Tromsø, Trondheim, Bergen).
3) Establishing ultrasound techniques for paediatric MSK imaging. Work in progress- in collaboration with the ESSR and the OMERACT ultrasound group (Rome, Amsterdam, Sakiai, Warsaw, Bergen)
4) Establishing imaging (XR and MRI) scoring systems for hip JIA (Rome, Genova, London, Bergen)
5) Publish a “Statement” on the use of bone age for assessment of chronological age (all group).
6) Multicenter project on CNO (Rome, Oslo, Bergen, Tromsø, Bristol).
Publications and recommendations
1. Ultrasound screening for Developmental dysplasia of the hip (DDH)
- 1. Florens Q. M. P. van Douveren, Hans E. H. Pruijs, Ralph J. B. Sakkers, Rutger A. J. Nievelstein, Frederik J. A. Beek. Ultrasound in the management of the position of the femoral head during treatment in a spica cast after reduction of hip dislocation in developmental dysplasia of the hip. J Bone Joint Surg [Br] 2003;85-B:117-20.
- Rosendahl K, Toma P. Ultrasound in the diagnosis of developmental dysplasia of the hip. The European approach. Methods, accuracy and clinical validity. Eur Radiol. 2007 Aug;17(8):1960-7. Includes the results of a short questionnaire performed among the taskforce group members during 2006 – 2007
- Dezateux C, Rosendahl K. Developmental dysplasia of the hip . Lancet. 2007 May 5;369(9572):1541-52
- Rosendahl K, Dezateux C, Fosse K, Aukland SM, Aase H, Reigstad H, Moster D, Lie RT, AlsakerT, Markestad T. Immediate Treatment Versus Sonographic Surveillance for Mild Hip Dysplasia in Newborns. Pediatrics. 2010 Jan;125(1):e9-1
- Frederik J. A. Beek, Rutger-Jan Nievelstein, Hans E. Pruijs, Pim A. de Jong, Ralph J. B. Sakkers. Transinguinal sonographic determination of the position of the femoral head after reposition and follow-up in a spica cast. Pediatr Radiol (2010) 40:1794–1799.
- Brurås KR, Aukland SM, Markestad T, Sera F, Dezateux C, Rosendahl K. Newborns With Sonographically Dysplastic and Potentially Unstable Hips: 6-Year Follow-up of an RCT . Pediatrics 2011 February 14.
- Tréguier C, Chapuis M, Branger B, Bruneau B, Grellier A, Chouklati K, Proisy M, Darnault P, Violas P, Pladys P, Gandon Y. Pubo-femoral distance: an easy sonographic screening test to avoid late diagnosis of DDH. Eur Radiol. 2013 Mar;23(3):836-44.
- Laborie LB, Engesæter IØ, Lehmann TG, Eastwood DM, Engesæter LB, Rosendahl K. Screening Strategies for Hip Dysplasia: Long-term Outcome of a Randomized Controlled Trial. 2013 Sep;132(3):492-501
- Selective ultrasound screening for developmental hip dysplasia: effect on management and late detected cases. A prospective survey during 1991-2006. Laborie LB, Markestad TJ, Davidsen H, Brurås KR, Aukland SM, Bjørlykke JA, Reigstad H, Indrekvam K, Lehmann TG, Engesæter IO, Engesæter LB, Rosendahl K. Pediatr Radiol. 2013 Dec 13. [Epub ahead of print]
- Diederichs C, Heath A, Hareendranathan AR, Zonoobi D, Kuntze G, Dulai S, Mabee MG, Ronsky JL, Jaremko JL. Cross-Modality Validation of Acetabular Surface Models Using 3-D Ultrasound Versus Magnetic Resonance Imaging in Normal and Dysplastic Infant Hips. Ultrasound Med Biol. 2016 Sep;42(9):2308-14.
- Olsen SF, Blom HC, Rosendahl K. Introducing universal ultrasound screening for developmental dysplasia of the hip doubled the treatment rate. Acta Paediatr. 2017 Sep 4.
Recommendations on DDH, and ongoing discussions
- Recommendations on hip screening (issued post-IPR May 2011)
- Riccabona M, Schweintzger G, Grill F, Graf R. Screening for DDH – clinically or sonographically? Comments to the current discussion and proposals. Pediatr Radiol. 2013 Mar;43(5):637-40
- Rosendahl K, Toma P. Reply to Riccabona et al. Regarding screening for developmental dysplasia of the hip. Pediatr Radiol. 2013 Mar;43(5):641-2.
2. Juvenile Idiopathic Arthritis (JIA) – research performed by group-members from 2012 onwards:
- Boavida P. Hargunani R, Owens C, Rosendahl K . Magnetic Resonance Imaging and Radiographic Assessment of Carpal Depressions in Children with Juvenile Idiopathic Arthritis: Normal Variants or Erosion? J Rheumatol. 2012 Mar;39(3):645-50
- Tanturri de Horatio L, Damasio MB, Barbuti D, Bracaglia C, Lambot-Juhan K, Boavida P, Ording Müller LS, Malattia C, Ravà L, Rosendahl K, Tomà P. MRI assessment of bone marrow in children with juvenile idiopathic arthritis: intra- and inter-observer variability. Pediatr Radiol. 2012 Jun;42(6):714-20.
- Damasio MB, Malattia C, Tanturri de Horatio L, Mattiuz C, Pistorio A, Bracaglia C, Barbuti D, Boavida P, Juhan KL, Ording LS, Rosendahl K, Martini A, Magnano G, Tomà P. MRI of the wrist in juvenile idiopathic arthritis: proposal of a paediatric synovitis score by a consensus of an international working group. Results of a multicentre reliability study . Pediatr Radiol. 2012 Sep;42(9):1047-55. Epub 2012 Jul 26.
- Avenarius DM, Ording Müller LS, Eldevik P, Owens CM, Rosendahl K. The paediatric wrist revisited-findings of bony depressions in healthy children on radiographs compared to MRI. Pediatr Radiol. 2012 Jul;42(7):791-8.
- Ording Muller LS, Boavida P, Avenarius D, Damasio B, Eldevik OP, Malattia C, Lambot-Juhan K, Tanturri L, Owens CM, Rosendahl K. MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study. Pediatr Radiol. 2013;43(7):785-95.
- Damasio MB, de Horatio LT, Boavida P, Lambot-Juhan K, Rosendahl K, Tom P, Ording L. Imaging in juvenile idiopathic arthritis (JIA): an update with particular emphasis on MRI. Acta Radiol. 2013 Nov;54(9):1015-23.
- Nusman CM, Ording Muller LS, Hemke R, Doria AS, Avenarius D, Tzaribachev N, Malattia C, van Rossum MA, Maas M, Rosendahl K. Current Status of Efforts on Standardizing Magnetic Resonance Imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child.J Rheumatol. 2015 May 15. pii: jrheum.141276. [Epub ahead of print].
- Ording Muller LS, Humphries P, Rosendahl K.The joints in juvenile idiopathic arthritis. Insights Imaging. 2015 Jun;6(3):275-84.
- Boavida P, Lambot-Juhan K, Müller LO, Damasio B, de Horatio LT, Malattia C, Owens CM, Rosendahl K.Carpal erosions in children with juvenile idiopathic arthritis: repeatability of a newly devised MR-scoring system. Pediatr Radiol. 2015 Dec;45(13):1972-80.
- Avenarius DF, Ording Müller LS, Rosendahl K. Erosion or normal variant? 4-year MRI follow-up of the wrists in healthy children. Pediatr Radiol. 2015 Dec 4. [Epub ahead of print]
- Rieter JF, de Horatio LT, Nusman CM, Müller LO, Hemke R, Avenarius DF, van Rossum MA, Malattia C, Maas M, Rosendahl K. The many shades of enhancement: timing of post-gadolinium images strongly influences the scoring of juvenile idiopathic arthritis wrist involvement on MRI. Pediatr Radiol. 2016 Jul 12. [Epub ahead of print].
- Nusman CM, Ording Muller LS, Hemke R, Doria AS, Avenarius D, Tzaribachev N, Malattia C, van Rossum MA, Maas M, Rosendahl K. Current Status of Efforts on Standardizing Magnetic Resonance Imaging of Juvenile Idiopathic Arthritis: Report from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol. 2016 Jan;43(1):239-44.
- Nusman CM, Rosendahl K, Maas M. MRI Protocol for the Assessment of Juvenile Idiopathic Arthritis of the Wrist: Recommendations from the OMERACT MRI in JIA Working Group and Health-e-Child. J Rheumatol. 2016 Jun;43(6):1257-8.
- Avenarius DF, Ording Müller LS, Rosendahl K.Joint Fluid, Bone Marrow Edemalike Changes, and Ganglion Cysts in the Pediatric Wrist: Features That May Mimic Pathologic Abnormalities-Follow-Up of a Healthy Cohort. AJR Am J Roentgenol. 2017 Mar 23:1-6.
3. Establishing ultrasound techniques for paediatric MSK imaging:
Ongoing discussions on standard views for joint examinations. Presented at ESPR 2015. 2nd draft in process – in collaboration with the OMERACT (Outcome Measures in RA Clinical Trials) ultrasound group.
4. Publish a “Statement” on the use of bone age for assessment of chronological age.
The issue will be discussed during a session at the ECR 2017, and a statement on behalf of the task force will be published.
5. Planned: Multicenter project on CRMO. A multicenter study led by Dr Laura Tanturri at the Ospedale Pediatrico Bambino Gesu, Rome.
ECR Vienna, Austria, March 2018
JIA working group meeting, Rome, January 15-17th 2018.
ESPR Berlin June 2018