European Radiology

, Volume 25, Issue 7, pp 2143–2152 | Cite as

Normal sonoanatomy of the paediatric entheses including echostructure and vascularisation changes during growth

  • Sandrine Jousse-Joulin
  • Claire Cangemi
  • Stéphanie Gerard
  • Simon Gestin
  • Luc Bressollette
  • Loic de Parscau
  • Valérie Devauchelle-Pensec
  • Alain SarauxEmail author



To describe the sonoanatomy of paediatric lower-limb entheses according to age and gender. We studied sites that most commonly involved entheses in spondyloarthritis.


We studied 41 consecutive healthy children (20 girls, 21 boys; age 2–15 years) divided into four age groups: 2–4 years (n = 9), 5–7 years (n = 11), 8–12 years (n = 12) and 13–15 years (n = 9). Ultrasound was used to obtain both transverse and longitudinal views of each enthesis. We assessed the echostructural components of the lower limb entheses and the vascularisation of the entheses and cartilage according to the different anatomical sites and age and gender.


At all sites on B-mode, cartilage and tendon thicknesses showed positive or negative correlations with age (P < 0.0001). Side-to-side correlations were good (P < 0.0001 overall) and stronger for cartilage (r, 0.77–0.97) than for tendon thickness (r, 0.58–0.63). Agreement between the two sides for discrete data was very good to excellent (kappa, 0.77–1). Cartilage thickness at the various sites was significantly greater in boys than in girls (P ≤ 0.05). Tendon thickness was not significantly influenced by gender. Blood vessels were seen within the cartilage with differences across age groups.


This study provides the first data on normal entheseal sonoanatomy and vascularisation in children.

Key Points

The tendons of children exhibit the same fibrillar structure as adults

Tendon thickness at enthesis insertion in children is not influenced by gender

Cartilage thickness in children decreases with advancing age and varies with gender


Ultrasound Healthy children Entheses Juvenile idiopathic arthritis Spondyloarthritis 



The scientific guarantor of this publication is A. Saraux. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from the parents of the subjects in this study. Methodology: prospective, cross-sectional study, performed at one institution.

This study has received funding by CHU Brest.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Sandrine Jousse-Joulin
    • 1
    • 5
  • Claire Cangemi
    • 2
  • Stéphanie Gerard
    • 2
  • Simon Gestin
    • 3
  • Luc Bressollette
    • 3
  • Loic de Parscau
    • 4
  • Valérie Devauchelle-Pensec
    • 1
    • 5
  • Alain Saraux
    • 1
    • 5
    • 6
    Email author
  1. 1.Department of RheumatologyCHU de la Cavale BlancheBrestFrance
  2. 2.Department of RadiologyCHU de la Cavale BlancheBrestFrance
  3. 3.Department of vascular medicineCHU de la Cavale BlancheBrestFrance
  4. 4.Department of paediatryCHU MorvanBrestFrance
  5. 5.EA 2216, INSERM ESPRI, ERI29 Université Bretagne OccidentaleBrestFrance
  6. 6.Rheumatology Unit, Hôpital de la Cavale BlancheBrest cedexFrance

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