Age-Related Vascularization and Ossification of Joints in Children: An International Pilot Study to Test Multiobserver Ultrasound Reliability

Maria Antonietta D'Agostino, Daniel Windschall, Paz Collado, Jelena Vojinovic, Silvia Magni-Manzoni, Peter Balint, George A. W. Bruyn, Cristina Hernandez-Diaz, Juan Carlos Nieto, Viviana Ravagnani, Nikolay Tzaribachev, Annamaria Iagnocco, Esperanza Naredo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

10 Citazioni (Scopus)


Objective: To determine the intra- and interobserver reliability of ultrasound (US)-detected age-related joint vascularization and ossification grading in healthy children. Methods: Following standardized image acquisition and machine setting protocols, 10 international US experts examined 4 joints (wrist, second metacarpophalangeal joint, knee, and ankle) in 12 healthy children (divided into 4 age groups: 2–4, 5–8, 9–12, and 13–16 years). Gray-scale was used to detect the ossification grade, and power Doppler ultrasound (PDUS) was used to detect physiologic vascularization. Ossification was graded from 0 (no ossification) to 3 (complete ossification). A positive PDUS signal was defined as any PDUS signal inside the joint. Kappa statistics were applied for intra- and interobserver reliability. Results: According to the specific joint and age, up to 4 solitary PDUS signals (mean 1.5) were detected within each joint area with predominant localization of the physiologic vascularization in specific anatomic positions: fat pad, epiphysis, physis, and short bone cartilage. The kappa values for ossification grading were 0.87 (range 0.85–0.91) and 0.58 for intra- and interobserver reliability, respectively. The bias-adjusted kappa values for intra- and interobserver reliability were 0.71 (range 0.44–1.00) and 0.69, respectively. Conclusion: Detection of normal findings (i.e., grading of physiologic ossification during skeletal maturation and identification of physiologic vessels) can be highly reliable by using clear definitions and a standardized acquisition protocol. These data will permit development of a reliable and standardized US approach for evaluating pediatric joint pathologies.
Lingua originaleEnglish
pagine (da-a)498-506
Numero di pagine9
Stato di pubblicazionePubblicato - 2020


  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Joints
  • Male
  • Neovascularization, Physiologic
  • Osteogenesis
  • Pilot Projects
  • Reference Values
  • Reproducibility of Results
  • Synovial Membrane
  • Ultrasonography, Doppler


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