• Usage of radiological and radioisotope methods for juvenile arthritis diagnosis (analytical review)

Usage of radiological and radioisotope methods for juvenile arthritis diagnosis (analytical review)

SOVREMENNAYA PEDIATRIYA.2018.2(90):71-80; doi 10.15574/SP.2018.90.71

Berezhniy V. V.,  Bondarets Yu. I.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Juvenile rheumatoid arthritis is one of the most frequent disabling rheumatic diseases in children, for diagnosis of which various radiological methods are used: X-ray imaging, ultrasound, magnetic resonance. Each of these methods has both positive properties and drawbacks. Often there is a need to use several radiological methods at the same time for early, timely diagnosis and administration of appropriate basic treatment. One of the most affordable diagnostic tools of articular syndrome is X&ray imaging that allows in most cases identifying erosion, osteoporosis, cysts, dislocations, incomplete dislocation in joints, however, for the detection of soft tissue lesions this method yields little information. At the present time, ultrasound of joints has become widespread that makes it possible to detect lesions of the synovial membrane, cartilage, erosion detection at an early stage of the disease, tendovaginitis and synovitis. However, evaluating the visualization of joints with ultrasound also has drawbacks: subjectivism of physician and absence of standard protocols. A more accurate diagnostic method for the diagnosis of juvenile rheumatoid arthritis is magnetic resonance imaging. However, high cost, limitations for young children do not allow using it widely in the doctor's practice.
Key words: juvenile rheumatoid arthritis, radiological diagnostic methods, radioisotope diagnostic methods.


1. Alekseeva OG, Severinova MV, Smirnov AV et al. (2016). Interrelation of ultrasound signs of inflammation and radiologic progression in patients with rheumatoid arthritis. Scientific and Practical Rheumatologists. 3 (54): 304–311.

2. Vasiliev AY, Blinov NN, Egorova EA. (2012). Possibilities of cone-beam computed tomography in assessing the condition of bones and joints of the hand. Radiology – Practice. 6: 54–61.

3. Kilina OY. (2009). Radionuclide diagnosis of inflammatory diseases of the musculoskeletal system. Tomsk. SibGMU: 35.

4. Kovalenko VA, Bortkevich OP, Terzov KA. (2006). Defeat of small joints in patients with rheumatoid arthritis at an early stage of the disease according to ultrasound data. Problems of osteology. 9: 55-56.

5. Kurzantseva OM, Murashkovskiy AL, Trofimov AF et al. (2005). Differential diagnosis of deforming osteoarthritis and rheumatoid arthritis in knee joint injury using ultrasound. Sono Ace International. 13: 78–81.

6. Levshakova AV. (2011). Radiation diagnosis of sacroiliitis. Radiology – practice. 3: 33–41.

7. Obramenko IE. (2014). Method of magnetic resonance imaging in patients with reactive arthritis. Radiology – practice. 4: 50-62.

8. Pohozheva EU. (2009). The value of magnetic resonance imaging for assessing the activity of early rheumatoid arthritis. Scientific and practical rheumatology. 1: 24-29.

9. Prokhorova EH, Zhiliaev EV. (2008). A quantitative scintigraphy of joints as a method for assessing the severity of inflammation. Medical News of the Ministry of Internal Affairs. 37(6): 39-44.

10. Rekalov DH, Bortkevich OP. (2011). Early instrumental markers of rheumatoid arthritis as predictors of disease progression. Ukrainian medical journal. 4(84): 104-107.

11. Senatorova AS, Gonchar MA, Pugacheva EA. (2016). Informativeness of X-ray and ultrasound research methods in the diagnosis of reactive arthritis in children. Child's health. 3(71): 45-48.

12. Smirnov AV. (2009). Atlas of X-ray diagnosis of rheumatoid arthritis. Moscow: IMA-Press.

13. Traudt AK, Zavadovskaya VD, Kailina AN. (2015). Evaluation of the activity of juvenile idiopathic arthritis according to magnetic resonance imaging of knee joints. Radiology – practice. 5(53): 61-72.

14. Shuba NM, Bortkevich OP, Mazurenko OB. (2003). Optimization of monitoring of rheumatoid arthritis on the basis of ultrasound imaging and magnetic resonance imaging. Ukrainian medical chapel. 5(37): 61-64.

15. Abramowicz S, Cheon JE, Kim S, Bacic J, Lee EY. (2011). Magnetic resonance imaging of temporomandibular joints in children with arthritis. J Oral Maxillofac Surg. 69(9): 2321—2328. https://doi.org/10.1016/j.joms.2010.12.058; PMid:21514711

16. Al-Eissa YA, Kambal AM, Alrabeeah AA et al. (1990). Osteoarticular brucellosis in children. Ann Rheum Dis. 896—900. https://doi.org/10.1136/ard.49.11.896; PMid:2256735 PMCid:PMC1004258

17. Ansell BM, Kent PA. (1977). Radiological change in juvenile chronic polyarthritis. Skeletal Radiol. 1: 129—144. https://doi.org/10.1007/BF00347138

18. Argyropoulou MI, Margariti PN, Karali A et al. (2009). Temporomandibular joint involvement in juvenile idiopathic arthritis: clinical predictors of magnetic resonance imaging signs. Eur Radiol. 19(3): 693—700. https://doi.org/10.1007/s00330-008-1196-2; PMid:18958475

19. Bache C. (1964). Mandibular growth and dental occlusion in juvenile rheumatoid arthritis. Acta Rheumatol Scand. 10: 142—153. https://doi.org/10.3109/03009746409165228; https://doi.org/10.3109/rhe1.1964.10.issue-1-4.14; PMid:14166435

20. Backhaus M, Kamradt Т, Golybig S et al. (1999). Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum, 42(6): 1232—45.

21. Berghs H, Remans J, Drieskens L et al. (1978). Diagnostic value of sacroiliac joint scintigraphy with 99m Tc technetium pyrophosphate in sacroiliitis. Ann Rheum Dis. 37: 190—194. https://doi.org/10.1136/ard.37.2.190; PMid:646471 PMCid:PMC1001189

22. Bloom BJ, Tucker LB, Miller LC. (1995). Bicipital synovial cysts in juvenile rheumatoid arthritis: clinical description and sonographic correlation. J Rheumatol. 22: 1953—1955. PMid:8991997

23. Boini S, Guillemin F. (2001). Radiographic scoring methods as outcome measures in rheumatoid arthritis: properties and advantages. Ann Rheum Dis. 60: 817—827. PMid:11502606 PMCid:PMC1753828

24. Bollow M, Biedermann T, Kannenberg J et al. (1998). Use of dynamic magnetic resonance imaging to detect sacroiliitis in HLA-B 27 positive and negative children with juvenile arthritides. J Reumatol. 25: 556—564. PMid:9517781

25. Bollow M, Braun J, Biedermann T et al. (1998). Use of contrast-enhanced MR imaging to detect sacroiliitis in children. Skeletal Radiol. 27: 606—616. https://doi.org/10.1007/s002560050446; PMid:9867178

26. Bollow M, Braun J, Hamm B et al. (1995). Early sacroiliitis in patients with spondyloarthropathy: evaluation with dynamic gadolinium-enhanced MR imaging. Radiology. 194 (2): 529—536. https://doi.org/10.1148/radiology.194.2.7824736; PMid:7824736

27. Cellerini M, Salti S, Trapani S et al. (1999). Correlation between clinical and ultrasound assessment of the knee in children with mono-articular or pauciarticular juvenile rheumatoid arthritis. Pediatr Radiol. 29: 117—123. https://doi.org/10.1007/s002470050554; PMid:9933332

28. Chamlers IM, Chamlers IM, Lentle BC, Percy JS et al. (1979). Sacroiliitis detected by bone scintiscanning a clinical, radiological, and scintigraphic follow3up stady. Ann Rheum Dis. 38: 112—117. https://doi.org/10.1136/ard.38.2.112

29. Damassio MB, Malattia C, Martini A, Toma P. (2010). Synovial and inflammatory disease in childhood: role of new imaging modalities in the assessment of patients with juvenile idiopathic arthritis. Pediatr Radiol. 40(6): 985—998. https://doi.org/10.1007/s00247-010-1612-z; PMid:20432018

30. Doria AS, CC de Castro, Kiss MH et al. (2003). Inter- and intrareader variability in the interpretation of two radiographic classification systems for juvenile rheumatoid arthritis. Pediatr Radiol. 33(10): 673—681. https://doi.org/10.1007/s00247-003-0912-y; PMid:12904917

31. Duer–Jensen A, Vestergaard A, Dohn UM et al. (2008). Detection of rheumatoid arthritis bone erosions by 2 different dedicated extremity MRI units and conventional radiography. Ann Rheum Dis. 67(7): 998—1003. https://doi.org/10.1136/ard.2007.076026; PMid:17984195

32. Dunn NA, Manida BH, Merrick MV et al. (1984). Quantitative sacroiliac scintiscanning as a sensitive and objective method for assessing efficacy of nonsteroidal anti3inflammatory drugs in patients with sacroiliitis. Ann Rheum Dis. 43: 157—159. https://doi.org/10.1136/ard.43.2.157; PMid:6231893 PMCid:PMC1001456

33. Espada G, Babini JC, Maldonado–Cocco JA, Garcia–Morteo O. (1988). Radiologic review: the cervical spine in juvenile rheumatoid arthritis. J Rheumatolog. 17(3): 185—195. https://doi.org/10.1016/0049-0172(88)90019-4

34. Geasimou G, Muralidis E, Papanastasiou E. (2011). Radionuclide imaging with human polyclonal immunoglobulin 99mTc-HIG) and bone scan in patients with rheumatoid arthritis and serum-negative polyarthritis. Hippokratia. 15(1): 37—42.

35. Gylys-Morin VM. (1998). MR imaging of pediatric muskuloskeletas inflammatory and infectious disorders. Magn Reson Imaging Clin. 6: 537—559.

36. Hemke R, Lavini С, Nusman СМ et al. (2014). Pixel-by-pixel analysis of DCE3MRI curve shape patterns in knees of active and inactive juvenile idiopathic arthritis patients. Eur Radiol: 686—1693.

37. Hensinger R, DeVito PD, Ragsdale CG. (1986). Changes in the cervical spine in juvenile rheumatoid arthritis. J Bone Joint Surg Am. 68(2): 189—198. https://doi.org/10.2106/00004623-198668020-00003 ;PMid:3944157

38. Hu YS, Schneiderman ED, Harper RP. (1996). The temporomandibular joint in juvenile rheumatoid arthritis. II. Relationship between computed tomographic and clinical findings. Pediatr Dent. 18(4): 312—319. PMid:8857660

39. Iversen JK, Nelleman H, Buss A et al. (1996). Synovial cysts of the hips in seronegative arthritis. Skeletal Radiol. 25: 396—399. https://doi.org/10.1007/s002560050103; PMid:8738009

40. Johnson K. (2006). Imaging of juvenile idiopathic arthritis. Pediatric radiology. 8. 743—758. https://doi.org/10.1007/s00247-006-0199-x

41. Jonson K. (2002). Childhood arthritis: classification and radiology. Clin Radiol. 57: 47—58. https://doi.org/10.1002/art.10585; https://doi.org/10.1002/art.10641

42. Kim JY, Cho S-K, Han M et al. (2010). The role of bone scintigraphy in the diagnosis of rheumatoid arthritis to the 2010 ACR/EULAR classification criteria. J Korean Med Sci. 29: 204—209. https://doi.org/10.3346/jkms.2014.29.2.204; PMid:24550646 PMCid:PMC3923998

43. Kim J-Y, Kim Y-K, Kim S-G et al. (2012). Effectiveness of bone scan in the diagnosis of osteoarthritis of the temporomandibular joint. Dentomaxillaofacial Radiology. 41: 224—229. https://doi.org/10.1259/dmfr/83814366; PMid:22116124 PMCid:PMC3520285

44. Klarlund M, Ostergaard M, Jensen KE et al. (2000). Magnetic resonance imaging, radiography and scintigraphy of the finger joins: one year follow up of patients with early arthritis. Ann Rheum Dis. 59: 521—528. https://doi.org/10.1136/ard.59.7.521; PMid:10873961 PMCid:PMC1753194

45. Kuseler A, Pedersen TK, Herlin T, Gelineck J. (1998). Contrast enhanced magnetic resonance imaging as a method to diagnose early inflammatory changes in the temporomandibular joint in children with juvenile chronic arthritis. J Rheumatol. 25(7): 1406—1412. PMid:9676776

46. Laiho K, Hannula S, Savolainen A, Kautiainen H, Kauppi M. (2001). Cervical spine in patients with juvenile chronic arthritis and amyloidosis. Clin Exp Rheumatol. 19(3): 345—348. PMid:11407093

47. Lamer S, Sebag GH. (2000). MRI and ultrasound in children with juvenile chronic arthritis. Eur J Radiol. 33: 85—93. https://doi.org/10.1016/S0720-048X(99)00158-8

48. Lang IM, Hughes D, Williamson JB et al. (1997). MRI of popliteal cysts in childhood. Pediatr Radiol. 22(1): 130—132. https://doi.org/10.1007/s002470050083; PMid:9028844

49. Lopes F, de Azevedo M, Marchiori E et al. (2010). Use of 99mNc-anti-CD3 scintigraphy in the differential diagnosis of rheumatic diseases. Rheumatology. 49: 933—939. https://doi.org/10.1093/rheumatology/kep471; PMid:20129997

50. Martini G, Bacciliero U, Tregnaghi A, Montesco MC, Zulian F. (2001). Isolated temporomandibular synovitis as unique presentation of juvenile idiopathic arthritis. J Rheumatol. 28(7): 1689—1692. PMid:11469480

51. Mayne JG, Hatch GS. (1969). Arthritis of the temporomandibular joint. J Am Dent Assoc, 79(1): 125—130. https://doi.org/10.14219/jada.archive.1969.0225; PMid:5254541

52. Muller L, Kellenberger CJ, Cannizzaro E et al. (2009). Early diagnosis of temporomandibular joint involvement in juvenile idiopathic arthritis: a pilot study comparing clinical examination and ultrasound to magnetic resonance imaging. Rheumatology (Oxford). 48(6): 680—685. https://doi.org/10.1093/rheumatology/kep068; PMid:19386819 PMCid:PMC2681286

53. Olsen N, Halberg P, Halskov O et al. (1988). Scintimetric assessment of synjvitis activity during treatment with disease modifying antirheumatic drugs. Ann Rheum Dis. 47: 995—1000. https://doi.org/10.1136/ard.47.12.995; PMid:3061369 PMCid:PMC1003653

54. Ostergaard M, Hansen M, Stoltenberg M, Lorenzen I. (1996). Quantitative assessment of the synovial membrane in the rheumatoid wrist: an easily obtained MRI score reflects the synovial volume. Br J Rheumatol. 3: 965—971. https://doi.org/10.1093/rheumatology/35.10.965

55. Pagnini I, Savelli S, Matussi-Cerinic M et al. (2010). Early predictors of juvenile sacroiliitis in enthesitis3related arthritis J. Reumatol. 37 (11): 2395—2401.

56. Pedersen TK, Kuseler A, Gelineck J, Herlin T. (2008). A prospective study of magnetic resonance and radiographic imaging in relation to symptoms and clinical findings of the temporomandibular joint in children with juvenile idiopathic arthritis. J. Rheumatol. 35(8): 1668—1675. PMid:18634141

57. Ravelli A, Martini A. (2007). Juvenile idiopathic arthritis. Lancer. 369 (9563): 676—778. https://doi.org/10.1016/S0140-6736(07)60363-8

58. Rebollo-Polo M, Koujok K, Weisser C, Jurencak R, Broun A. (2011). Ultrasound findings in patients with juvenile idiopatic arthritis in clinical remission. J Roth — Arthritis Care Res (Hoboken). 63(7): 1013—1019. https://doi.org/10.1002/acr.20478; PMid:21485021

59. Roimicher L, Lopes FPPL, de Souza SAL et al. (2011). 99m Tc-anti-TNF-α scintigraphy in RA: a comparison pilot study with MRI. Rheumatology. 50: 2044—2050. https://doi.org/10.1093/rheumatology/ker234; PMid:21873267

60. Ronchezel MV, Hilario MO, Goldenberg J et al. (1995). Temporomandibular joint and mandibular growth alterations in patients with juvenile rheumatoid arthritis. J Rheumatol. 22(10): 1956—1961. PMid:8991998

61. Rossi F, Fiorella D, Galipo O et al. (2006). Use of the Sharp and Larsen Scoring Methods in the Assessment of Radiographic Progression in Juvenile Idiopathic Arthritis. Arthritis and Reumatology. 5(55): 717—723. https://doi.org/10.1002/art.22246; PMid:17013855

62. Scott C, Meiorin S, Filocamo G et al. (2010). A reappraisal of intra-articular corticosteroid therapy in juvenile idiopathic arthritis. Clin Exp Rheumatol. 28(5): 774—781. PMid:20863449

63. Sheybani EF, Khanna G, White AJ, Demertzis JL. (2013). Imaging of Juvenile Idiopathic Arthritis: A Multimodality Approach. RadioGraphics. 33: 1253—1273. https://doi.org/10.1148/rg.335125178; PMid:24025923

64. Spasovski D. (2015). Comparation Aspect of Scoring Indexes betweens Osteoarticular Scores, Sharps Radiographic Indexes in Patients with Rheumathoid Arthritis Patients. International J of Inflammation, Cancer and Integrative Therapy.

65. Svensson B, Adell R, Kopp S. (2000). Temporomandibular disorders in juvenile chronic arthritis patients: a clinical study. Swed Dent J. 24(3): 83—92. PMid:11061206

66. Wakefield RJ, Balint PV, Szkudlarek M et al. (2005). Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol. 32(12): 2485—2487. PMid:16331793

67. Wilkinson RH, Weissman BN. (1988). Arthritis in children. Radiol Clin North Am. 26: 1247—1265. PMid:3051095

68. Yasser M, Ilham H, Hisham M et al. (2001). Ultrasound versus MRI in the evaluation of juvenile idiopathic arthritis of the knee. 3(68): 222—230.