Imaging Methods and the Immature Joint: An Introduction

  • Sergio Lopes Viana
  • Maria Custódia Machado Ribeiro
  • Bruno Beber Machado


Unparalleled improvements in diagnostic imaging have occurred over the last several decades. Until the 1960s, radiographs were the only technique available in this field. In time, however, more sophisticated imaging methods were gradually added to the diagnostic arsenal, and even radiographs have entered into the digital arena. Each of these imaging methods has singularities to be considered in the assessment of immature joints, and both the radiologist and the requesting physician must be familiar with them. The requesting physician is supposed to have an open-minded and receptive attitude, consulting with the radiologist whenever a doubt arises (e.g., “which imaging method is the most appropriate for this patient in this specific clinical setting?”) and providing all the relevant information for each case. Accordingly, the radiologist must perform the requested imaging study and interpret the findings under the light of the clinical picture. Analyzing the images without taking the clinical background into account is dangerous and may lead to an erroneous – and potentially catastrophic – diagnosis. This chapter is a brief introduction to the most important imaging methods used in the investigation of the immature joint, emphasizing their peculiarities in pediatric patients. It is important to keep in mind these imaging methods are complementary instead of exclusive, acting synergistically when properly combined.


Imaging Joints Radiology Children Adolescents Pediatrics Radiographs X-rays Ultrasonography Computed tomography Magnetic resonance imaging Bone scintigraphy DEXA Dual energy X-ray absorptiometry 

Recommended Reading

  1. 1.
    Alizai H, Chang G, Regatte RR. MRI of the musculoskeletal system: advanced applications using high and ultrahigh field MRI. Semin Musculoskelet Radiol. 2015;19:363–74.CrossRefGoogle Scholar
  2. 2.
    Allen G, Wilson D, Graham R, Jacob D. Échographie pédiatrique ostéo-articulaire. J Radiol. 2005;86:1924–30.CrossRefGoogle Scholar
  3. 3.
    Babyn P, Doria AS. Radiologic investigation of rheumatic diseases. Rheum Dis Clin N Am. 2007;33:403–40.CrossRefGoogle Scholar
  4. 4.
    Boavida P, Muller LS, Rosendahl K. Magnetic resonance imaging of the immature skeleton. Acta Radiol. 2013;54:1007–14.CrossRefGoogle Scholar
  5. 5.
    Buchmann RF, Jaramillo D. Imaging of articular disorders in children. Radiol Clin N Am. 2004;42:151–68.CrossRefGoogle Scholar
  6. 6.
    Daftari Besheli L, Aran S, Shaqdan K, Kay J, Abujudeh H. Current status of nephrogenic systemic fibrosis. Clin Radiol. 2014;69:661–8.CrossRefGoogle Scholar
  7. 7.
    Daldrup-Link HE, Steinbach L. MR imaging of pediatric arthritis. Magn Reson Imaging Clin N Am. 2009;17:451–67.CrossRefGoogle Scholar
  8. 8.
    Damasio MB, Magnaguagno F, Stagnaro G. Whole-body MRI: non-oncological applications in paediatrics. Radiol Med. 2016;121:454–61.CrossRefGoogle Scholar
  9. 9.
    Damilakis J, Maris TG, Karantanas AH. An update on the assessment of osteoporosis using radiologic techniques. Eur Radiol. 2007;17:1591–602.CrossRefGoogle Scholar
  10. 10.
    Delle Sedie A, Riente L, Bombardieri S. Limits and perspectives of ultrasound in the diagnosis and management of rheumatic diseases. Mod Rheumatol. 2008;18:125–31.CrossRefGoogle Scholar
  11. 11.
    DiPietro MA, Leschied JR. Pediatric musculoskeletal ultrasound. Pediatr Radiol. 2017;47:1144–54.CrossRefGoogle Scholar
  12. 12.
    Fritzsche PJ. Communication: the key to improved patient care. Radiology. 2005;234:13–4.CrossRefGoogle Scholar
  13. 13.
    Hryhorczuk AL, Restrepo R, Lee EY. Pediatric musculoskeletal ultrasound: practical imaging approach. AJR Am J Roentgenol. 2016;206:W62–72.CrossRefGoogle Scholar
  14. 14.
    Hustinx R, Malaise MG. PET imaging of arthritis. PET Clin. 2006;1:131–9.CrossRefGoogle Scholar
  15. 15.
    Imhof H, Mang T. Advances in musculoskeletal radiology: multidetector computed tomography. Orthop Clin North Am. 2006;37:287–98.CrossRefGoogle Scholar
  16. 16.
    Jaramillo D, Laor T. Pediatric musculoskeletal MRI: basic principles to optimize success. Pediatr Radiol. 2008;38:379–91.CrossRefGoogle Scholar
  17. 17.
    Johnson K. Imaging of juvenile idiopathic arthritis. Pediatr Radiol. 2006;36:743–58.CrossRefGoogle Scholar
  18. 18.
    Kalkwarf HJ, Abrams SA, DiMeglio LA, Koo WW, Specker BL, Weiler H, et al. Bone densitometry in infants and young children: the 2013 ISCD Pediatric Official Positions. J Clin Densitom. 2014;17:243–57.CrossRefGoogle Scholar
  19. 19.
    Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S. Juvenile idiopathic arthritis – the role of imaging from a rheumatologist's perspective. Pediatr Radiol. 2018;48:785–91.CrossRefGoogle Scholar
  20. 20.
    Matuszewska G, Zaniewicz-Kaniewska K, Włodkowska-Korytkowska M, Smorawińska P, Saied F, Kunisz W, et al. Radiological imaging in pediatric rheumatic diseases. Pol J Radiol. 2014;79:51–8.CrossRefGoogle Scholar
  21. 21.
    Maurer K. Musculoskeletal ultrasound in childhood. Eur J Radiol. 2014;83:1529–37.CrossRefGoogle Scholar
  22. 22.
    Miller E, Uleryk E, Doria AS. Evidence-based outcomes of studies addressing diagnostic accuracy of MRI of juvenile idiopathic arthritis. AJR Am J Roentgenol. 2009;192:1209–18.CrossRefGoogle Scholar
  23. 23.
    Nadel HR, Stilwell ME. Nuclear medicine topics in pediatric musculoskeletal disease: techniques and applications. Radiol Clin North Am. 2001;39:619–51.CrossRefGoogle Scholar
  24. 24.
    Parisi MT, Iyer RS, Stanescu AL. Nuclear medicine applications in pediatric musculoskeletal diseases: the added value of hybrid imaging. Semin Musculoskelet Radiol. 2018;22:25–45.CrossRefGoogle Scholar
  25. 25.
    Patel AS, Soares B, Courtier J, Mackenzie JD. Radiation dose reduction in pediatric CT-guided musculoskeletal procedures. Pediatr Radiol. 2013;43:1303–8.CrossRefGoogle Scholar
  26. 26.
    Piccolo CL, Galluzzo M, Ianniello S, Trinci M, Russo A, Rossi E, et al. Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging. Musculoskelet Surg. 2017;101:85–102.CrossRefGoogle Scholar
  27. 27.
    Rodriguez-Lozano AL, Giancane G, Pignataro R, Viola S, Valle M, Gregorio S, et al. Agreement among musculoskeletal pediatric specialists in the assessment of radiographic joint damage in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken). 2014;66:34–9.CrossRefGoogle Scholar
  28. 28.
    Sheybani EF, Khanna G, White AJ, Demertzis JL. Imaging of juvenile idiopathic arthritis: a multimodality approach. Radiographics. 2013;33:1253–73.CrossRefGoogle Scholar
  29. 29.
    Windschall D. Möglichkeiten der Bildgebung in der Kinder- und Jugendrheumatologie. Z Rheumatol. 2016;75:973–86.CrossRefGoogle Scholar
  30. 30.
    Yamashita H, Kubota K, Mimori A. Clinical value of whole-body PET and/or CT in patients with active rheumatic diseases. Arthritis Res Ther. 2014;16:423.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sergio Lopes Viana
    • 1
  • Maria Custódia Machado Ribeiro
    • 2
  • Bruno Beber Machado
    • 3
  1. 1.Hospital da Criança de Brasília José Alencar, Hospital Ortopédico e Medicina Especializada (HOME) and Diagnóstico Clínica de Imagens MédicasBrasíliaBrazil
  2. 2.Hospital da Criança de Brasília José AlencarBrasíliaBrazil
  3. 3.Gastren Clínica Médica e Radiológica (Iúna-ES), Clínica Radiológica Med Imagem, Clínica Radiológica Radial, Santa Casa de Misericórdia and Unimed Sul CapixabaCachoeiro de ItapemirimBrazil

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