Advertisement

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
Ultrasound

Abstract

Objectives

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

Methods

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.

Results

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.

Conclusions

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

Keywords

Ultrasound Healthy children Entheses Juvenile idiopathic arthritis Spondyloarthritis 

Notes

Acknowledgments

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.

References

  1. 1.
    Jousse-Joulin S, Breton S, Cangemi C, Fenoll B, Bressolette L, de Parscau L et al (2011) Ultrasonography for detecting enthesitis in juvenile idiopathic arthritis. Arthritis Care Res 63:849–855CrossRefGoogle Scholar
  2. 2.
    D’Agostino M-A, Said-Nahal R, Hacquard-Bouder C, Brasseur J-L, Dougados M, Breban M (2003) Assessment of peripheral enthesitis in the spondylarthropathies by ultrasonography combined with power Doppler. Arthritis Rheum 48:523–533PubMedCrossRefGoogle Scholar
  3. 3.
    Cellerini M, Salti S, Trapani S, D’Elia G, Falcini F, Villari N (1999) Correlation between clinical and ultrasound assessment of the knee in children with monoarticular or pauci-articular juvenile rheumatoid arthritis. Pediatr Radiol 29:117–123PubMedCrossRefGoogle Scholar
  4. 4.
    Eich G, Halle F, Hodler J, Seger R, Willi UV (1994) Juvenile chronic arthritis: imaging of the knees and hips before and after intraarticular steroid injection. Pediatr Radiol 24:558–563PubMedCrossRefGoogle Scholar
  5. 5.
    Rydholm U, Wingstrand H, Egund N et al (1986) Sonography, arthroscopy, and intracapsular pressure in juvenile chronic arthritis of the hip. Acta Orthop Scand 57:295–298PubMedCrossRefGoogle Scholar
  6. 6.
    Ruhoy K, Tuckmer L, Mc Cauley R (1996) Hypertrophic bursopathy of the subacromial-subdeltoid bursa in juvenile rheumatoid arthritis: sonographic appearance. Pediatr Radiol 20:353–355CrossRefGoogle Scholar
  7. 7.
    Weiss PF, Chauvin NA, Klink AJ, Localio R, Feudtner C, Jaramillo D et al (2014) Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography. Arthritis Rheumatol 66:218–227PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Roth J, Jousse-Joulin S, Magni-Manzoni S, Rodriguez A, Tzaribachev N, Iagnocco A et al (2015) Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken). 67:136–42Google Scholar
  9. 9.
    Grechening W, Mayr JM, Peicha G, Hammerl R, Schatz B, Grechenig S (2004) Sonoanatomy of the Achilles tendon insertion in children. J Clin Ultrasound 32:338–343CrossRefGoogle Scholar
  10. 10.
    Morel M, Boutry N, Demondion X, Legroux-Gerot I, Cotten H, Cotten A (2005) Normal anatomy of the heel entheses: anatomical and ultrasonographic study of their blood supply. Surg Radiol Anat 27:176–183PubMedCrossRefGoogle Scholar
  11. 11.
    Schweitzer M, Mitchell DG, Ehrlich SM (1993) The patellar tendon: thickening, internal signal buckling, and other MR variants. Skelet Radiol 22:411–416CrossRefGoogle Scholar
  12. 12.
    Koivunen-Niemelä T, Parkkola K (1995) Anatomy of the Achille tendon (tendo calcaneus) with respect to tendon thickness measurements. Surg Radiol Anat 17:263–268PubMedCrossRefGoogle Scholar
  13. 13.
    Huerta J, Alarcon Garcia JM (2007) Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects. Eur J Radiol 62:449–453CrossRefGoogle Scholar
  14. 14.
    Snow S, Bohne WHO, DiCarlo E, Chang VK (1995) Anatomy of the Achilles tendon and plantar fascia in relation to the calcaneus in various age groups. Foot Ankle Int 16:418–421PubMedCrossRefGoogle Scholar
  15. 15.
    Khan M, Bonar F, Desmond PM, Cook JL, Young DA, Visentini PJ et al (1996) Patellar tendinosis (jumper’s knee): findings at histopathologic examination, US, and MR imaging. Radiology 200:821–827PubMedCrossRefGoogle Scholar
  16. 16.
    Carr J, Hanly S, Griffin J, Gibney R (2001) Sonography of the patellar tendon and adjacent structures in pediatric and adult patients. Am J Roentgenol 176:1535–1539CrossRefGoogle Scholar
  17. 17.
    Spannow A, Stenboeg E, Pfeiffer-Jensen M, Herlin T (2007) Ultrasound measurement of joint cartilage thickness in large and small joints in healthy children: a clinical pilot study assessing observer variability. Pediatr Rheumatol 5:3CrossRefGoogle Scholar
  18. 18.
    Ehrenborg G, Lagergren C (1961) Roentgenologic changes in the Osgood-Schlatter lesions. Acta Chir Scand 121:315–327PubMedGoogle Scholar
  19. 19.
    Volpon J, De Carvalho Filho G (2002) Calcaneal apophysitis: a quantitative radiographic evaluation of the secondary ossification center. Arch Orthop Trauma Surg 122:338–341PubMedGoogle Scholar
  20. 20.
    Weskott H (1997) Slow blood flow detection tested with a flow phantom. Radiology 202:125–130PubMedCrossRefGoogle Scholar
  21. 21.
    Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J et al (2004) International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 31:390–392PubMedGoogle Scholar
  22. 22.
    Burgos-Vargas R, Pacheco-Tena C, Vazquez-Mellado J (2002) A short-term follow-up of enthesitis and arthritis in the active phase of juvenile onset spondyloarthropathies. Clin Exp Rheumatol 20:727–731PubMedGoogle Scholar
  23. 23.
    Balint P, Kane D, Wilson H, McInnes IB, Sturrock RD (2002) The majority of lower limb enthesiopathy in seronegative spondylarthropathy is underestimated by clinical examination: an ultrasonography study. Ann Rheum Dis 61:905–910PubMedCentralPubMedCrossRefGoogle Scholar

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

Personalised recommendations