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Ultrasound and MRI of the foot in children and adolescents newly diagnosed with juvenile idiopathic arthritis

Magdalena Posadzy
Magdalena Posadzy
, 
Monika Ostrowska
Monika Ostrowska
, 
Emil Michalski
Emil Michalski
, 
Piotr Gietka
Piotr Gietka
, 
Małgorzata Mańczak
Małgorzata Mańczak
, 
Michał Lanckoroński
Michał Lanckoroński
, 
Marek Leszkiewicz
Marek Leszkiewicz
 et 
Iwona Sudoł-Szopińska
Iwona Sudoł-Szopińska
   | 11 sept. 2023
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Article Category: Research paper
Publié en ligne: 11 sept. 2023
Pages: e106 - e113
Reçu: 21 mars 2023
Accepté: 14 juin 2023
DOI: https://doi.org/10.15557/jou.2023.0019
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© 2023 Magdalena Posadzy et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1.

US of the MTP1 joint in longitudinal view in a patient diagnosed with JIA, presenting with thickened synovium with hyperemia on color Doppler in grade 2 (arrow)
US of the MTP1 joint in longitudinal view in a patient diagnosed with JIA, presenting with thickened synovium with hyperemia on color Doppler in grade 2 (arrow)

Fig. 2.

US of the Chopart joint in a patient with JIA. A. Effusion and hypertrophied synovium in gray scale is shown dorsally in the talonavicular part of the Chopart joint. Note that both effusion and hypertrophied synovium may have hypoechoic appearance, and the ultrasound probe pressure maneuver may be helpful in discriminating both entities as fluid will be displaceable and compressible. B. Grade 2 vascularization is seen in microflow option in the talonavicular part medially
US of the Chopart joint in a patient with JIA. A. Effusion and hypertrophied synovium in gray scale is shown dorsally in the talonavicular part of the Chopart joint. Note that both effusion and hypertrophied synovium may have hypoechoic appearance, and the ultrasound probe pressure maneuver may be helpful in discriminating both entities as fluid will be displaceable and compressible. B. Grade 2 vascularization is seen in microflow option in the talonavicular part medially

Fig. 3.

US of the interphalangeal joint of the big toe (IP) in longitudinal view in a patient diagnosed with JIA, presenting with thickened synovium with grade 2 hyperemia on color Doppler (arrow)
US of the interphalangeal joint of the big toe (IP) in longitudinal view in a patient diagnosed with JIA, presenting with thickened synovium with grade 2 hyperemia on color Doppler (arrow)

Fig. 4.

Short axis US of the flexor tendon at the level of the third toe in a patient diagnosed with JIA presenting with tendinopathy of the flexor tendon. On color Doppler, there is severe vascularization within the thickened tendon sheath (arrow) and inside the flexor tendon (curved arrow)
Short axis US of the flexor tendon at the level of the third toe in a patient diagnosed with JIA presenting with tendinopathy of the flexor tendon. On color Doppler, there is severe vascularization within the thickened tendon sheath (arrow) and inside the flexor tendon (curved arrow)

Fig. 5.

Proton density fat saturated MRI image of the foot in a patient diagnosed with JIA, A. sagittal view showing bone marrow edema in the calcaneus, navicular, and talus (arrows) and a small amount of effusion in the tibiotalar joint (star); B. on axial view bone marrow edema is detected in the calcaneus and cuboid (arrows)
Proton density fat saturated MRI image of the foot in a patient diagnosed with JIA, A. sagittal view showing bone marrow edema in the calcaneus, navicular, and talus (arrows) and a small amount of effusion in the tibiotalar joint (star); B. on axial view bone marrow edema is detected in the calcaneus and cuboid (arrows)

Fig. 6.

Tenosynovitis of the tibias posterior, flexor hallucis longus, and flexor digitorum longus in patient with JIA. A. Gray-scale US in axial view at the level of the tibiotalar joint presenting with thickened tendon sheaths (arrows); B. vascularization is detected in the microflow SMI mode (right image) with only subtle hyperemia seen on power Doppler (left image); C. US of the peroneus longus tendon of the same patient in longitudinal view showing markedly thickened synovium within the tendon sheath with no hyperemia on power Doppler (left image) and detected vascularization in the microflow mode on the same level (right image)
Tenosynovitis of the tibias posterior, flexor hallucis longus, and flexor digitorum longus in patient with JIA. A. Gray-scale US in axial view at the level of the tibiotalar joint presenting with thickened tendon sheaths (arrows); B. vascularization is detected in the microflow SMI mode (right image) with only subtle hyperemia seen on power Doppler (left image); C. US of the peroneus longus tendon of the same patient in longitudinal view showing markedly thickened synovium within the tendon sheath with no hyperemia on power Doppler (left image) and detected vascularization in the microflow mode on the same level (right image)

Pathologies reported on foot ultrasound examination in children diagnosed with JIA. According to three-grade scale of color Doppler hyperemia proposed by the EULAR-OMERACT consensus (no hyperemia = grade 0, minimal = grade 1: with up to three single Doppler spots or up to one confluent spot and two single spots or up to two confluent spots, moderate = grade 2: greater than grade 1 but <50% Doppler signals in total area and severe = grade 3: greater than grade 2 > 50% of the background grey scale)(17)

Location Effusion Synovial hypertrophy
Chopart /midtarsal joint 9/47 (19%) 11/47 (23%) (color Doppler hyperemia:grade 1: 1grade 2: 3grade 3: 3no hyperemia: 4)
First metatarsophalangeal joint (MTP1) 23/47 (49%) 23 /47 (49%) (color Doppler hyperemia:grade 1: 1grade 2: 3grade 3: 0no hyperemia: 19)
Metatarsophalangeal joints 2–5 (MTP2–5) 8/47 (17%) 10/47 (21%) (color Doppler hyperemia:grade 1: 3grade 2: 1grade 3: 0no hyperemia: 6)
Interphalangeal joint of the big toe (aIP) 11/47 (23%) 8/47 (17%) (no color Doppler hyperemia)
Proximal interphalangeal joints (aPiP) 4/47 (8.5%) 4/47 (8.5%) (no color Doppler hyperemia)
Tibiotalar joint 16/47 (34%) 11 /47 (23%) (color Doppler hyperemia:grade 1 : 1grade 2 : 3grade 3 : 1no hyperemia: 6)

MRI acquisitions for non-contrast foot MRI examination

Sequence Plane TR (ms) TE (ms) ST (mm) Gap (mm) FOV (mm) Matrix (mm)
Localizer All planes 6.9 2.99 3 6 300 205 × 256
T1w Cor 615 11 3 0.9 150 × 150 240 × 320
T1w FS Cor 654 11 3 0.9 150 × 150 192 × 256
T2w TIRM Cor 4690 35 3 0.9 150 × 150 256 × 256
T2w TIRM Tra 4430 30 3 0.6 290 × 290 154 × 320
PDw FS Tra 2800 30 3 0.6 280 × 280 224 × 448
PDw Tra 2800 30 3 0.6 280 × 280 224 × 448
T2w Tra 3900 83 3 0.6 280 × 280 304 × 512
T1w FS Tra 590 11 3 0.6 280 × 280 199 × 384
PDw Sag 2370 30 3 0.6 280 × 280 224 × 448
PDw FS Sag 3210 30 3 0.6 280 × 280 214 × 384
T1w FS Sag 654 10 3 0.6 280 × 280 126 × 256

Pathologies detected on non-contrast MRI of the foot in children diagnosed with JIA

Location Pathology Number
Subtalar joint effusion 10/22 (45%)
alP effusion 1/22 (4.5%)
Second metatarsophalangeal joint (aMTP2) effusion 1/22 (4.5%)
Chopart /midtarsal joint effusion 3/22 (14%)
Talus BME 9/22 (41%)
Calcaneus BME 10/22 (45%)
Navicular BME 9/22 (41%)
Cuboid BME 9/22 (41%)
Cuneiform intermediate BME 6/22 (27%)
Cuneiform lateral BME 7/22 (32%)
Cuneiform medial BME 6/22 (27%)
1. Metatarsal bone BME 3/22 (14%)
2. Metatarsal bone BME 1/22 (4.5%)
3. Metatarsal bone BME 1/22(4.5%)
4. Metatarsal bone BME 2/22 (9%)
5. Metatarsal bone BME 3/22 (14%)
  enthesitis 1/22 (4.5%)
tenosynovitis FHL 1/22 (4.5%)
sclerotization 1/22 (4.5%)
Kager’s fat pad 1/22 (4.5%)
bursitis, myositis, cyst, erosions, chondromalacia, JSN, ankylosis, osteophytes, developmental disorders 0/22
Tibiotalar joint effusion 14/22 (67%)
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