Development and validation of a pediatric internationally agreed ultrasound knee synovitis protocol (PIUS-knee) by the Pediatric Rheumatology european Society (PReS) imaging working party
An erratum to this article was published (Pediatr Rheumatol Online J, 29 Oct 2024 ↗)
Authors' conclusion
BM and PD positivity reliably correlated with the identification of pathological findings in knees of patients with JIA. From an internationally agreed protocol of eight images, a combination of five showed the greatest sensitivity for synovitis. This protocol, termed 'PIUS-Knee' performed well when compared to existing protocols.
Study context
- Population
- Consecutive juvenile idiopathic arthritis (JIA) patients with confirmed knee arthritis after clinical examination
- Participants
- 114 patients
- Comparison
- Musculoskeletal ultrasound (MSUS) knee views and published MSUS protocols for detection of knee synovitis
- Outcome
- Detection of knee arthritis (BM and PD synovitis) by MSUS views/protocol
Methodological detailsprotocol development and validation, consecutive patients, comparison with published protocols, Pediatric OMERACT scoring (B-Mode (BM) and PD grading 0 to 3); eight views agreed by PReS Imaging Working Party
- Protocol development and validation
- Consecutive patients
- Comparison with published protocols
- Pediatric OMERACT scoring (BM and PD grading 0 to 3); eight views agreed by PReS Imaging Working Party
Performance
As reported in the abstract
Intrasynovial PD positivity (grading ≥ 1)
| Test or model | Value | Sensitivity | Specificity | Sensitivity of positive PD findings | Sensitivity of positive PD findings (range) |
|---|---|---|---|---|---|
| Lateral parapatellar | 69% | 0.68 | 0.98 | ||
| Medial parapatellar | 67% | 0.67 | 1.0 | ||
| Longitudinal lateral | 68% | 0.67 | 0.98 | ||
| Suprapatellar transverse in 30° | 64% | 0.64 | 1.0 | ||
| PIUS-knee (5 views) | 91% | ||||
| Published protocols | 53-83% |
Value
Lateral parapatellar69%
Medial parapatellar67%
Longitudinal lateral68%
Suprapatellar transverse in 30°64%
PIUS-knee (5 views)— not stated in the abstract
Published protocols— not stated in the abstract
Sensitivity
Lateral parapatellar0.68
Medial parapatellar0.67
Longitudinal lateral0.67
Suprapatellar transverse in 30°0.64
PIUS-knee (5 views)— not stated in the abstract
Published protocols— not stated in the abstract
Specificity
Lateral parapatellar0.98
Medial parapatellar1.0
Longitudinal lateral0.98
Suprapatellar transverse in 30°1.0
PIUS-knee (5 views)— not stated in the abstract
Published protocols— not stated in the abstract
Sensitivity of positive PD findings
Lateral parapatellar— not stated in the abstract
Medial parapatellar— not stated in the abstract
Longitudinal lateral— not stated in the abstract
Suprapatellar transverse in 30°— not stated in the abstract
PIUS-knee (5 views)91%
Published protocols— not stated in the abstract
Sensitivity of positive PD findings (range)
Lateral parapatellar— not stated in the abstract
Medial parapatellar— not stated in the abstract
Longitudinal lateral— not stated in the abstract
Suprapatellar transverse in 30°— not stated in the abstract
PIUS-knee (5 views)— not stated in the abstract
Published protocols53-83%
Further findings
BM positivity (grading ≥ 1), suprapatellar longitudinal in 30° or neutral
- Frequency, suprapatellar longitudinal in 30° or neutral respectively
- 97-99%
- PD positivity higher in 30° flexion than neutral
Suprapatellar recess size, knees with vs without arthritis
- Recess wider in knees with arthritis than without, for each age and gender group
- P < 0.001
Interobserver reliability of BM and PD positivity
- Agreement
- 85%
- Kappa (very good)
- 0.74
Original publication
Development and validation of a pediatric internationally agreed ultrasound knee synovitis protocol (PIUS-knee) by the PReS imaging working party. Pediatr Rheumatol Online J. Published 21 October 2024. doi:10.
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