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Nguyen JC, Caine D. Youth soccer players: patterns of injury involving the primary growth plates of epiphyses. Skeletal Radiol 2024:10.1007/s00256-023-04541-y. [PMID: 38175258 DOI: 10.1007/s00256-023-04541-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/08/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
Youth soccer (football) is immensely popular internationally. Earlier participation, sport sub-specialization, and year-around practice have led to an increased incidence of injury from both acute trauma and repetitive overuse. The growth plates (physes) of the immature skeleton are particularly vulnerable to injury and delayed diagnosis can lead to future growth disturbance and long-term morbidity. Familiarity with the various components of the growth plate complex necessary for ensuring normal endochondral ossification is fundamental in understanding the various patterns of imaging findings following injury. This review discusses the zonal columnar arrangement of the growth plate proper and the contrasting function of the vasculature within the subjacent epiphysis and metaphysis. This is followed by an evidence-based discussion of the common patterns of injury involving the epiphyseal primary growth plate observed among youth soccer players: subcategorized into physeal fractures (direct injury) and physeal stress injuries (indirect insult to subjacent metaphysis). In this section, the role of imaging and characteristic imaging features will be discussed. While the normal physiologic and pathophysiologic mechanisms can be applied to other growth plates, such as primary growth plates underlying the apophyses and secondary growth plates surrounding the secondary ossificiation centers, which also undergo endochondral ossification, the current review is focused on injuries involving the primary growth plates underlying epiphyses.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Section of MSK, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dennis Caine
- Kinesiology and Public Health Education, Division of Education, Health and Behavior Studies, University of North Dakota, Grand Forks, ND, 58202-8235, USA
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Mushtaq N, Osmani H, Patel J, Alwan S, Sarraf K, Ahmed N. Evaluation of paediatric hip pain. Br J Hosp Med (Lond) 2023; 84:1-10. [PMID: 37490445 DOI: 10.12968/hmed.2023.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Hip pain in a child can pose a diagnostic conundrum. In most cases, the cause of a painful hip is often attributed to trauma, but a number of these cases will be atraumatic. The main entities to consider are inflammatory, infective and neoplastic causes. Pathologies such as avascular necrosis and slipped upper femoral epiphysis can also present in a similar manner. A detailed history and clinical examination are crucial in narrowing down the differential diagnosis. In addition, understanding the most appropriate imaging modalities and the characteristic radiological findings is key in ensuring timely treatment and management. This article reviews the various disease processes in children who present with hip pain and outlines the most appropriate assessment and imaging modalities that will aid diagnosis.
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Affiliation(s)
- Nida Mushtaq
- Department of Imaging, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Humza Osmani
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Jugal Patel
- Department of Imaging, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Samir Alwan
- Department of Imaging, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Khaled Sarraf
- Department of Trauma and Orthopaedics, St Mary's Hospital, Imperial College Healthcare Trust, London, UK
| | - Naeem Ahmed
- Department of Imaging, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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3
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Muacevic A, Adler JR, Young SM, Ray J, Shah A, Conklin MJ. A Review of Pediatric Heel Pain. Cureus 2023; 15:e34228. [PMID: 36852370 PMCID: PMC9960861 DOI: 10.7759/cureus.34228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
The objective of this review article is to provide orthopaedic surgeons and general practitioners a reference and guidance for the evaluation and workup of heel pain in pediatric patients. The authors performed a comprehensive literature search to review the etiologies and management of heel pain in patients <18 years of age. Relevant studies in Medline/PubMed and EMBASE were searched from inception to March 3, 2022 using medical subject headings and text words without limitations on language or study type. The initial search utilized the following Boolean operators: (children) AND (heel pain); (pediatric) AND (heel pain). Heel pain in the pediatric population is usually a benign condition. Sever's apophysitis is the most common etiology of heel pain in pediatric patients. Most causes of heel pain in the pediatric population do not require imaging or extensive workup. However, providers must maintain a high index of suspicion for symptoms that could indicate a more severe pathology.
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Affiliation(s)
- Alexander Muacevic
- Orthopaedic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - John R Adler
- Orthopaedic Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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4
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Emmet D, Roberts J, Yao KV. Update on Preventing Overuse Injuries in Youth Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Augusto ACDL, Goes PCK, Flores DV, Costa MAF, Takahashi MS, Rodrigues ACO, Padula LC, Gasparetto TD, Nogueira-Barbosa MH, Aihara AY. Imaging Review of Normal and Abnormal Skeletal Maturation. Radiographics 2022; 42:861-879. [PMID: 35213260 DOI: 10.1148/rg.210088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The growing skeleton undergoes well-described and predictable normal developmental changes, which may be misinterpreted a as pathologic condition at imaging. Primary and secondary ossification centers (SOCs), which form the diaphysis and the epiphysis of long bones, respectively, are formed by endochondral and intramembranous ossification processes. During skeletal maturation, the SOCs may appear irregular and fragmented, which should not be confused with fractures, osteochondritis dissecans, and osteochondrosis. These normal irregularities are generally symmetric with a smooth, round, and sclerotic appearance, which are aspects that help in the differentiation. The metaphysis, epiphysis, and growth plates or physes are common sites of injuries and normal variants in the pediatric skeleton. The metaphysis contains the newly formed bone from endochondral ossification and is highly vascularized. It is predisposed to easy spread of infections and bone tumors. The physis is the weakest structure of the immature skeleton. Injuries to this location may disrupt endochondral ossification and lead to growth disturbances. Pathologic conditions of the epiphyses may extend into the articular surface and lead to articular damage. At MRI, small and localized foci of bone marrow changes within the epiphysis and metaphysis are also a common finding. These can be related to residual red marrow (especially in the metaphysis of long bones and hindfoot), focal periphyseal edema (associated with the process of physeal closure), and ultimately to a normal ossification process. The authors review the imaging appearance of normal skeletal maturation and discuss common maturation disorders on the basis of developmental stage and location. ©RSNA, 2022.
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Affiliation(s)
- Ana Carolina de Lima Augusto
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Paola Cecy Kuenzer Goes
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Dyan V Flores
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Maria Alice F Costa
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Marcelo Straus Takahashi
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - André C O Rodrigues
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Luiz C Padula
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Taisa Davaus Gasparetto
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - Marcello H Nogueira-Barbosa
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
| | - André Yui Aihara
- From the Divisions of Musculoskeletal Radiology (A.C.d.L.A., P.C.K.G., M.A.F.C., A.C.O.R., L.C.P., A.Y.A.) and Pediatric Radiology (M.S.T., T.D.G.), Laboratório Delboni Auriemo, DASA, São Paulo, Brazil; Department of Diagnostic Imaging, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil (A.C.d.L.A., A.Y.A.); Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (D.V.F.); Department of Medical Imaging, Hematology and Clinical Oncology Ribeirão Preto Medical School, USP Ribeirão Preto, Brazil (M.H.N.B.); and Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, Mo (M.H.N.B.)
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Whole body magnetic resonance imaging in healthy children and adolescents.Bone marrow appearances of the appendicular skeleton. Eur J Radiol 2022; 153:110365. [DOI: 10.1016/j.ejrad.2022.110365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 11/22/2022]
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Full-body MR imaging: a retrospective study on a novel diagnostic approach for children sustaining high-energy trauma. Eur J Trauma Emerg Surg 2021; 48:2165-2172. [PMID: 34279669 PMCID: PMC9192453 DOI: 10.1007/s00068-021-01736-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/23/2021] [Indexed: 11/04/2022]
Abstract
Purpose Severe accidents are the leading cause of long-term impairment and death in children. A common diagnostic procedure for children exposed to high-injury trauma is full-body contrast-enhanced CT (fbCT). However, the number of fbCT without detected injuries is relevant. In 2007, full-body MRI (fbMRI) was implemented as a diagnostic approach for children sustaining high-energy trauma. The aim of this cross-sectional retrospective study was to analyze fbMRI as a diagnostic tool for children after high-energy trauma focusing on feasibility, radiological findings, and limitations. Methods Diagnostics using fbMRI (from apex of the head to the pelvis) was performed if a child was stable and suffered a high-energy trauma in a Level I Trauma Center in Germany. 105 fbMRIs in patients exposed to high-energy trauma aged ≤ 16 years were performed between January 2007 and December 2018. Four fbMRIs were excluded as conducted for reasons other than trauma. Time between arrival in the emergency department and fbMRI, additional diagnostic procedures, injuries, and non-trauma related pathologies were analyzed. Results Mean time between arrival in the emergency department and fbMRI was 71 min (± SD 132 min). Two scans were discontinued and changed to a faster diagnostic procedure. 45% of children had additional X-rays and 11% CT scans. The MRIs showed intracranial abnormalities in 27%, extremities injuries in 26%, spinal injuries in 18%, pelvic, and thoracic injuries in 7% of the cases. Conclusion Overall fbMRI is a diagnostic alternative for hemodynamically stable, conscious children after high-energy trauma with the advantages of a radiation-free technique. However, MRI diagnostics take longer than CT scans. Prospective studies will be needed to identify the limiting factors of fbMRIs as primary diagnostic procedure compared to CT scans. Trial registration German Clinical Trials Register (DRKS; DRKS00017015). Level of evidence Case series, level of evidence V.
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Person A, Janitz E, Thapa M. Pediatric Bone Marrow: Normal and Abnormal MRI Appearance. Semin Roentgenol 2021; 56:325-337. [PMID: 34281683 DOI: 10.1053/j.ro.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Abstract
Atraumatic fractures of femur, although not as common as traumatic fractures, are frequently encountered in the clinical practice. They present with non-specific symptoms and can be occult on initial imaging making their diagnosis difficult, sometimes resulting in complications. Overlapping terminologies used to describe these fractures may hamper effective communication between the radiologist and the clinician. In this article, we review various atraumatic fractures of femur, terminologies used to describe them, their imaging findings and differential diagnosis. The article also describes the aetiology, pathophysiology and relevant biomechanics behind these fractures. An approach to atraumatic femoral fractures has been outlined.
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Affiliation(s)
- Ganesh Hedge
- Department of Radiology, Royal Lancaster Infirmary, Lancaster, UK
| | - Siddharth Thaker
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Richard Fawcett
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
| | - Harun Gupta
- Department of Musculoskeletal Radiology, Leeds Teaching Hospitals, Leeds, UK
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Vidoni A, Pressney I, Saifuddin A. Paediatric bone lesions: diagnostic accuracy of imaging correlation and CT-guided needle biopsy for differentiating benign from malignant lesions. Br J Radiol 2021; 94:20201234. [PMID: 33565896 DOI: 10.1259/bjr.20201234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the sensitivity, specificity and accuracy of CT-guided needle biopsy (CT-NB) for distinguishing benign and malignant lesions in children with suspected primary bone tumours, and to assess the correlation between imaging diagnosis and final diagnosis. METHODS Retrospective review of children who underwent CT-NB of a suspected primary bone tumour between October 2016 and October 2019. Data collected included anatomical location, imaging diagnosis, type of needle, type of biopsy sample, CT-NB diagnosis, final diagnosis and post-procedural complications. The final diagnosis was established based on surgical histology or clinical/imaging follow-up. RESULTS 125 patients met the inclusion criteria (68M, 57F: mean age 11 years; range 10 months-18 years). Biopsy was performed using a 10 cm Jamshidi needle (10G n = 96; 13 G n = 8); 14G Tru-Cut needle (n = 18); 14G Temno needle (n = 3). The commonest anatomical locations were the femur (n = 40), tibia (n = 25) and humerus (n = 16), while the commonest diagnoses were osteosarcoma (n = 35), CRMO (n = 15) and LCH (n = 14). A benign tumour was correctly identified on imaging in 100% of cases, and a malignant tumour in 95.8%. Sensitivity, specificity and diagnostic accuracy of CT-NB for distinguishing malignant from benign lesions were 98%, 100 and 99%. Of 24 indeterminate biopsy results, all that had a non-aggressive radiological appearance were benign. No immediate complications were recorded. CONCLUSION CT-NB represents a safe and very effective tool for differentiating benign and malignant lesions in children presenting with a suspected primary bone tumour. Suspected radiological diagnosis plays a pivotal role in the management of indeterminate biopsy results. ADVANCES IN KNOWLEDGE Paediatric bone tumours pose a significant diagnostic and therapeutic challenge. The interpretation of the imaging findings is essential for the successful management of indeterminate histological results.
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Affiliation(s)
- Alessandro Vidoni
- Musculoskeletal Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Ian Pressney
- Musculoskeletal Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Musculoskeletal Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
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Laor T, Cornwall R. Describing pediatric fractures in the era of ICD-10. Pediatr Radiol 2020; 50:761-775. [PMID: 31915858 DOI: 10.1007/s00247-019-04591-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
Childhood fractures are extremely common. The recent trend is to direct certain fracture care from orthopedic specialists to primary care clinicians. However, to confirm an appropriate level of treatment, the initial diagnosis must be accurate, the description precise, and the communication between those caring for the child consistent. This review illustrates descriptors used at one institution that are based on terminology consensually created between radiologists and orthopedic surgeons for common pediatric fracture types and their displacement, and that satisfy the expanded and detailed International Statistical Classification of Diseases and Related Health Problems (ICD)-10 requirements for successful coding.
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Affiliation(s)
- Tal Laor
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Roger Cornwall
- Division of Pediatric Orthopaedics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abstract
STUDY DESIGN Literature review. OBJECTIVE To conduct a literature review of studies reporting the incidence of pars interarticularis defects in athletes of specific sports, in order to allow more targeted prevention and treatment strategies to be implemented for the groups at highest risk. METHODS Electronic searches were performed using PubMed, Ovid Medline, EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and Cochrane Database of Controlled Trials from their dates of inception to September 2017, with the following keywords: "spondylolysis," "sports," "low back pain," and "pars defects." RESULTS A total of 509 total articles were retrieved, of which 114 were used in the final review. The incidence of pars interarticularis defects was found to be highest in diving (35.38%), cricket (31.97%), baseball/softball (26.91%), rugby (22.22%), weightlifting (19.49%), sailing (17.18%), table tennis (15.63%), and wrestling (14.74%). Only 5 studies reported the management instituted for their participants, and these were all case reports. Of 74 players with spondylolysis in these studies, 70 (94.59%) underwent conservative treatment and 4 (5.41%) underwent surgical treatment. 61 (82.43%) returned to their previous level of play, 6 (8.11%) retired, and the disposition of the final 7 was not reported. CONCLUSION The current medical literature provides good evidence that the incidence of pars interarticularis defects is higher in the athletic population, with the highest incidence in diving. There remains no gold standard protocol for the management of pars interarticularis defects. Further research is required to compare conservative therapy to surgical therapy and to compare the various surgical techniques to each other.
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Affiliation(s)
- Samuel Tawfik
- University of New South Wales, Sydney, New South Wales, Australia,St George Hospital, Sydney, New South Wales, Australia,Samuel Tawfik, St George Hospital, Sydney, New South Wales, Australia 2217.
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia,Neurospine Surgery Research Group, Sydney, New South Wales, Australia
| | - Ralph J. Mobbs
- Neurospine Surgery Research Group, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Prashanth J. Rao
- Neurospine Surgery Research Group, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia,Westmead Hospital, Sydney, New South Wales, Australia
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13
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Abstract
Fractures are common in children, although accurate diagnosis is confounded by mimics of fractures some of which are unique to the pediatric population. Such fracture mimics include developmental variations of the growth plates, normal anatomic structures that simulate fracture lines, and/or metabolic disorders that alter the pattern of ossification. Although subtle clues on plain radiographs may help to discriminate between a true fracture or injury and a fracture mimic, MR imaging may be helpful to eliminate uncertainty or expedite diagnosis.
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Affiliation(s)
- Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Main 2, 300 Longwood Avenue, Boston, MA 02115, USA.
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Abstract
OBJECTIVE. The purpose of this article is to summarize the nomenclature of nonneoplastic conditions affecting subchondral bone through a review of the medical literature and expert opinion of the Society of Skeletal Radiology Subchondral Bone Nomenclature Committee. CONCLUSION. This consensus statement summarizes current understanding of the pathophysiologic characteristics and imaging findings of subchondral nonneoplastic bone lesions and proposes nomenclature to improve effective communication across clinical specialties and help avoid diagnostic errors that could affect patient care.
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Kraan RBJ, Kox LS, Mens MA, Kuijer PPFM, Maas M. Damage of the distal radial physis in young gymnasts: can three-dimensional assessment of physeal volume on MRI serve as a biomarker? Eur Radiol 2019; 29:6364-6371. [PMID: 31115619 PMCID: PMC6795914 DOI: 10.1007/s00330-019-06247-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 11/23/2022]
Abstract
Objective To explore the use of quantitative volume assessment to identify the presence and extent of stress-related changes of the distal radial physis in gymnasts with suspected physeal injury, asymptomatic gymnasts, and non-gymnasts. Methods Symptomatic gymnasts with clinically suspected distal radial physeal injury, asymptomatic gymnasts, and non-gymnasts (n = 69) were included and matched on skeletal age and sex. Volume measurements were performed on coronal water selective cartilage MRI images by creating three-dimensional physeal reconstructions semi-automatically using active-contour segmentation based on image-intensity thresholding. Inter- and intra-rater reliability of the measurements were assessed using intra-class correlation coefficients (ICC) for absolute agreement. Results Twenty-seven symptomatic-, 18 asymptomatic-, and 24 non-gymnasts were included with a median age of 13.9 years (interquartile range (IQR) 13.0–15.0 years). Median physeal volume was significantly increased (p < 0.05) in symptomatic- (971 mm3, IQR 787–1237 mm3) and asymptomatic gymnasts (951 mm3, IQR 871–1004 mm3) compared with non-gymnasts (646 mm3, IQR 538–795 mm3). Inter-rater (ICC 0.96, 95% CI 0.92–0.98) and intra-rater (ICC 0.93, 95% CI 0.85–0.97) reliability of volume measurements were excellent. Of the 10 participants with the highest physeal volumes, nine were symptomatic gymnasts. Conclusion Increased volume of the distal radial physis can reliably be assessed and is a sign of physeal stress that can be present in both symptomatic- and asymptomatic gymnasts, but gymnasts with suspected physeal injury showed larger volume increases. Future studies should explore if volume assessment can be used to (early) identify athletes with or at risk for physeal stress injuries of the wrist. Key Points • The volume of the distal radial physis can be reliably assessed by creating three-dimensional physeal reconstructions. • Stress-related volume increase of the distal radial physis is present in symptomatic and asymptomatic gymnasts. • Gymnasts with clinically suspected physeal injury showed larger volume increases compared with asymptomatic gymnasts and may therefore be a valuable addition in the (early) diagnostic workup of physeal stress injuries.
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Affiliation(s)
- Rik B J Kraan
- Amsterdam University Medical Center, Department of Radiology & Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands. .,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, The Netherlands.
| | - Laura S Kox
- Amsterdam University Medical Center, Department of Radiology & Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, The Netherlands
| | - Marieke A Mens
- Amsterdam University Medical Center, Department of Radiology & Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - P Paul F M Kuijer
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Amsterdam University Medical Center, Department of Radiology & Nuclear Medicine, Amsterdam Movement Sciences, University of Amsterdam, G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc, Amsterdam, The Netherlands
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16
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George MP, Bixby S. Frequently Missed Fractures in Pediatric Trauma: A Pictorial Review of Plain Film Radiography. Radiol Clin North Am 2019; 57:843-855. [PMID: 31076036 DOI: 10.1016/j.rcl.2019.02.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Missed fractures are common in pediatric trauma patients. Pediatric bone differs from adult bone in its composition and response to injury, leading to fracture patterns that may be subtle, radiographically unfamiliar, and challenging to distinguish from normal variation. Familiarity with the unique fracture types of the pediatric skeleton and site-specific injury patterns is critical, because prompt diagnosis can significantly alter clinical management and outcome. This article examines the unique features of pediatric bone contributing to missed fractures, the incidence of missed fractures, common injury types of the pediatric skeleton, and frequently missed site-specific fracture patterns, highlighting problem-solving techniques for challenging cases.
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Affiliation(s)
- Michael P George
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA.
| | - Sarah Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston MA 02115, USA
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17
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Moraux A, Balbi V, Cockenpot E, Vandenbussche L, Miletic B, Letartre R, Khalil C. Sonographic Overview of Usual and Unusual Disorders of the Rectus Femoris Tendon Origins. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1543-1553. [PMID: 28857221 DOI: 10.1002/jum.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023]
Abstract
Rectus femoris muscle proximal injuries are not rare conditions. The proximal rectus femoris tendinous anatomy is complex and may be affected by traumatic, microtraumatic, or nontraumatic disorders. A good knowledge of the proximal rectus femoris anatomy allows a better understanding of injury and disorder patterns. A new sonographic lateral approach was recently described to assess the indirect head of the proximal rectus femoris, hence allowing for a complete sonographic assessment of the proximal rectus femoris tendons. This article will review sonographic features of direct, indirect, and conjoined rectus femoris tendon disorders.
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Affiliation(s)
- Antoine Moraux
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Vincent Balbi
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Eric Cockenpot
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Laurent Vandenbussche
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Bruno Miletic
- Nord Genou, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Romain Letartre
- Nord Genou, Lille, France
- Hôpital Privé la Louvière, Lille, France
| | - Chadi Khalil
- Imagerie Médicale Jacquemars Giélée, Lille, France
- Hôpital Privé la Louvière, Lille, France
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18
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Kox LS, Kraan RBJ, van Dijke KF, Hemke R, Jens S, de Jonge MC, Oei EHG, Smithuis FF, Terra MP, Maas M. Systematic assessment of the growth plates of the wrist in young gymnasts: development and validation of the Amsterdam MRI assessment of the Physis (AMPHYS) protocol. BMJ Open Sport Exerc Med 2018; 4:e000352. [PMID: 29682313 PMCID: PMC5905740 DOI: 10.1136/bmjsem-2018-000352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/22/2018] [Indexed: 12/11/2022] Open
Abstract
Objectives To develop and validate a protocol for MRI assessment of the distal radial and ulnar periphyseal area in gymnasts and non-gymnasts. Methods Twenty-four gymnasts with wrist pain, 18 asymptomatic gymnasts and 24 non-gymnastic controls (33 girls) underwent MRI of the wrist on a 3T scanner. Sequences included coronal proton density-weighted images with and without fat saturation, and three-dimensional water-selective cartilage scan and T2 Dixon series. Skeletal age was determined using hand radiographs. Three experienced musculoskeletal radiologists established a checklist of possible (peri)physeal abnormalities based on literature and clinical experience. Five other musculoskeletal radiologists and residents evaluated 30 MRI scans (10 from each group) using this checklist and reliability was determined using the intraclass correlation coefficient (ICC) and Fleiss' kappa. A final evaluation protocol was established containing only items with fair to excellent reliability. Results Twenty-seven items were assessed for reliability. Intra-rater and inter-rater agreement was good to excellent (respective ICCs 0.60-0.91 and 0.60-0.78) for four epiphyseal bone marrow oedema-related items, physeal signal intensity, metaphyseal junction and depth of metaphyseal intrusions. For physeal thickness, thickness compared with proximal physis of first metacarpal, metaphyseal intrusions, physeal connection of intrusions and metaphyseal bone marrow signal intensity, intra-rater agreement was fair to excellent (ICC/kappa 0.55-0.85) and inter-rater agreement was fair (ICC/kappa 0.41-0.59). Twelve items were included in the final protocol. Conclusion The Amsterdam MRI assessment of the Physis protocol facilitates patient-friendly and reliable assessment of the (peri)physeal area in the radius and ulna.
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Affiliation(s)
- Laura S Kox
- Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES) Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc Amsterdam, The Netherlands
| | - Rik B J Kraan
- Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES) Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc Amsterdam, The Netherlands
| | - Kees F van Dijke
- Department of Radiology and Nuclear Medicine, Noordwest Hospital Group Alkmaar, The Netherlands
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands
| | - Sjoerd Jens
- Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital Utrecht, The Netherlands
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC Rotterdam, The Netherlands
| | - Frank F Smithuis
- Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands
| | - Maaike P Terra
- Department of Radiology, Amphia Hospital Breda, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Academic Medical Center Amsterdam, The Netherlands.,Academic Center for Evidence-based Sports medicine (ACES) Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center AMC/VUmc Amsterdam, The Netherlands
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19
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O'Dell MC, Jaramillo D, Bancroft L, Varich L, Logsdon G, Servaes S. Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients. Radiographics 2017; 36:1807-1827. [PMID: 27726754 DOI: 10.1148/rg.2016160009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. ©RSNA, 2016.
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Affiliation(s)
- M Cody O'Dell
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Diego Jaramillo
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Laura Bancroft
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Laura Varich
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Gregory Logsdon
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
| | - Sabah Servaes
- From the Department of Radiology, Florida Hospital, University of Central Florida College of Medicine, 601 E Rollins St, Orlando, FL 32803 (M.C.O., L.B., L.V., G.L.); Department of Radiology, VA Palo Alto Health Care System, Stanford University Medical Center, Palo Alto, Calif (D.J.); and Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa (S.S.)
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20
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Mandell JC, Khurana B, Smith SE. Stress fractures of the foot and ankle, part 2: site-specific etiology, imaging, and treatment, and differential diagnosis. Skeletal Radiol 2017; 46:1165-1186. [PMID: 28343329 DOI: 10.1007/s00256-017-2632-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/22/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023]
Abstract
Stress fractures of the foot and ankle are a commonly encountered problem among athletes and individuals participating in a wide range of activities. This illustrated review, the second of two parts, discusses site-specific etiological factors, imaging appearances, treatment options, and differential considerations of stress fractures of the foot and ankle. The imaging and clinical management of stress fractures of the foot and ankle are highly dependent on the specific location of the fracture, mechanical forces acting upon the injured site, vascular supply of the injured bone, and the proportion of trabecular to cortical bone at the site of injury. The most common stress fractures of the foot and ankle are low risk and include the posteromedial tibia, the calcaneus, and the second and third metatarsals. The distal fibula is a less common location, and stress fractures of the cuboid and cuneiforms are very rare, but are also considered low risk. In contrast, high-risk stress fractures are more prone to delayed union or nonunion and include the anterior tibial cortex, medial malleolus, navicular, base of the second metatarsal, proximal fifth metatarsal, hallux sesamoids, and the talus. Of these high-risk types, stress fractures of the anterior tibial cortex, the navicular, and the proximal tibial cortex may be predisposed to poor healing because of the watershed blood supply in these locations. The radiographic differential diagnosis of stress fracture includes osteoid osteoma, malignancy, and chronic osteomyelitis.
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Affiliation(s)
- Jacob C Mandell
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Bharti Khurana
- Division of Emergency Radiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
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21
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Nguyen JC, Sheehan SE, Davis KW, Gill KG. Sports and the Growing Musculoskeletal System: Sports Imaging Series. Radiology 2017. [DOI: 10.1148/radiol.2017161175] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jie C. Nguyen
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E1/313, Madison, WI 53792-3252
| | - Scott E. Sheehan
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E1/313, Madison, WI 53792-3252
| | - Kirkland W. Davis
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E1/313, Madison, WI 53792-3252
| | - Kara G. Gill
- From the Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E1/313, Madison, WI 53792-3252
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22
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Abstract
A 19-year-old male military recruit presented with 3 weeks of persistent left hip and groin pain after abnormally twisting his hip during a hike. Initial radiographs were interpreted as negative. He subsequently underwent a bone scan which revealed linear left sacral uptake along or paralleling the sacroiliac joint. Differential diagnostic considerations included unilateral sacroiliitis and sacral fracture. SPECT/CT was performed which confirmed left sacral fatigue stress fracture. Transitional lumbosacral anatomy was evident on radiographs with pseudoarticulation of the transitional left S1 transverse process with the sacrum. We postulate this predisposed the recruit to sacral fracture.
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23
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Herregods N, Dehoorne J, Van den Bosch F, Jaremko JL, Van Vlaenderen J, Joos R, Baraliakos X, Varkas G, Verstraete K, Elewaut D, Jans L. ASAS definition for sacroiliitis on MRI in SpA: applicable to children? Pediatr Rheumatol Online J 2017; 15:24. [PMID: 28399875 PMCID: PMC5387253 DOI: 10.1186/s12969-017-0159-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/04/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The Assessment of Spondyloarthritis International Society (ASAS) definition for a 'positive' Magnetic Resonance Imaging (MRI) for sacroiliitis is well studied and validated in adults, but studies about the value of this definition in children are lacking. The aim of this study is to evaluate whether the adult ASAS definition of a positive MRI of the sacroiliac joints can be applied to children with a clinical suspicion of Juvenile Spondyloarthritis (JSpA). METHODS Two pediatric musculoskeletal radiologists blinded to clinical data independently retrospectively reviewed sacroiliac (SI) joint MRI in 109 children suspected of sacroiliitis. They recorded global impression (sacroiliitis yes/no) and whether the adult ASAS definition for sacroiliitis was met at each joint. This was compared to gold-standard clinical diagnosis of JSpA. Additionally, MRI were scored according to'adapted' ASAS definitions including other features of sacroiliitis on MRI. RESULTS JSpA was diagnosed clinically in 47/109 (43%) patients. On MRI, sacroiliitis was diagnosed by global assessment in 30/109 patients, of whom 14 also fulfilled ASAS criteria. No patients with negative global assessment for sacroiliitis fulfilled ASAS criteria. Sensitivity (SN) for JSpA was higher for global assessment (SN = 49%) than for ASAS definition (SN = 26%), but the ASAS definition was more specific (SP = 97% vs. 89%). Modifying adult ASAS criteria to allow bone marrow edema (BME) lesions seen on only one slice, synovitis or capsulitis, increased SN to 36%, 32% and 32% respectively, only slightly lowering SP. Including structural lesions increased SN to 28%, but lowered specificity to 95%. CONCLUSION The adult ASAS definition for sacroiliitis has low sensitivity in children. A pediatric-specific definition of MRI-positive sacroiliitis including BME lesions visible on one slice only, synovitis and/or capsulitis may improve diagnostic utility, and increase relevance of MRI in pediatric rheumatology practice.
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Affiliation(s)
- Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Joke Dehoorne
- Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Filip Van den Bosch
- Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Jacob Lester Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street, Edmonton, T6G 2B7, AB, Canada
| | - Joke Van Vlaenderen
- Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Rik Joos
- Department of Pediatric Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr-University Bochum, Claudiusstr. 45, 44649, Herne, Germany
| | - Gaëlle Varkas
- Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Koenraad Verstraete
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology and VIB Inflammation Research Center, Unit for Molecular Immunology and Inflammation, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
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24
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Raissaki M, Demetriou S, Spanakis K, Skiadas C, Katzilakis N, Velivassakis EG, Stiakaki E, Karantanas AH. Multifocal bone and bone marrow lesions in children - MRI findings. Pediatr Radiol 2017; 47:342-360. [PMID: 28004130 DOI: 10.1007/s00247-016-3737-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/13/2016] [Accepted: 10/18/2016] [Indexed: 12/20/2022]
Abstract
Polyostotic bone and bone marrow lesions in children may be due to various disorders. Radiographically, lytic lesions may become apparent after loss of more than 50% of the bone mineral content. Scintigraphy requires osteoblastic activity and is not specific. MRI may significantly contribute to the correct diagnosis and management. Accurate interpretation of MRI examinations requires understanding of the normal conversion pattern of bone marrow in childhood and of the appearances of red marrow rests and hyperplasia. Differential diagnosis is wide: Malignancies include metastases, multifocal primary sarcomas and hematological diseases. Benign entities include benign tumors and tumor-like lesions, histiocytosis, infectious and inflammatory diseases, multiple stress fractures/reactions and bone infarcts/ischemia.
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Affiliation(s)
- Maria Raissaki
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece.
| | - Stelios Demetriou
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Konstantinos Spanakis
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Christos Skiadas
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Nikolaos Katzilakis
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | | | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Radiology, University Hospital of Heraklion, University of Crete, Faculty of Medicine, Heraklion, Crete, Greece
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25
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Belair JA, Hegazi TM, Roedl JB, Zoga AC, Omar IM. Core Injuries Remote from the Pubic Symphysis. Radiol Clin North Am 2016; 54:893-911. [PMID: 27545427 DOI: 10.1016/j.rcl.2016.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The core, or central musculoskeletal system of the torso, is essential for participating in sports and other physical activities. Core injuries are commonly encountered in athletes and active individuals. The importance of the midline pubic plate and rectus abdominis-adductor aponeurosis for core stability and function is discussed in the literature. This review article examines other important core injuries remote from the pubic symphysis, relevant clinical features, and preferred approaches to imaging. Several specific syndromes encountered in the core are reviewed. By protocoling imaging studies and identifying pathology, radiologists can add value to the clinical decision-making process and help guide therapeutic options.
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Affiliation(s)
- Jeffrey A Belair
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA.
| | - Tarek M Hegazi
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA; Department of Radiology, University of Dammam, PO Box 2114, Dammam 31451, Saudi Arabia
| | - Johannes B Roedl
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Adam C Zoga
- Division of Musculoskeletal Imaging and Interventions, Department of Radiology, Jefferson Medical College, Thomas Jefferson University Hospital, Thomas Jefferson University, 132 South 10th Street, Suite 1096, 1087 Main Building, Philadelphia, PA 19107, USA
| | - Imran M Omar
- Department of Radiology, Northwestern Memorial Hospital, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
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Imagen musculoesquelética en la urgencia pediátrica. Lo esencial a través de tres escenarios clínicos. RADIOLOGIA 2016; 58 Suppl 2:104-18. [DOI: 10.1016/j.rx.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 03/04/2016] [Accepted: 03/13/2016] [Indexed: 12/12/2022]
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Rosendahl K, Strouse PJ. Sports injury of the pediatric musculoskeletal system. Radiol Med 2016; 121:431-41. [DOI: 10.1007/s11547-015-0615-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
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Abstract
There has been a substantial increase in the number of children participating in organized competitive sports, which has led to a surge in the number of both acute and overuse injuries. To prevent further complications such as limb deformity and disability, radiologists must be familiar with typical overuse injury patterns in children. Traction apophysitis, chronic physeal injury, and stress fractures are the principal overuse injuries. This article reviews overuse injuries in children with an emphasis on the role of magnetic resonance imaging in diagnosis, prognosis, and treatment.
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Abstract
Context: As the intensity of youth participation in athletic activities continues to rise, the number of overuse injuries has also increased. A subset of overuse injuries involves the physis, which is extremely susceptible to injury. This paper aims to review the utility of the various imaging modalities in the diagnosis and management of physeal injuries in the skeletally immature population. Evidence Acquisition: A search for the keywords pediatric, physis, growth plate, x-ray, computed tomography, magnetic resonance imaging, and overuse injury was performed using the PubMed database. No limits were set for the years of publication. Articles were reviewed for relevance with an emphasis on the imaging of growth plate injuries. Study Design: Retrospective literature review. Level of Evidence: Level 4. Results: Three major imaging modalities (radiographs, computed tomography, and magnetic resonance imaging) complement each other in the evaluation of pediatric patients with overuse injuries. However, magnetic resonance imaging is the only modality that offers direct visualization of the physis, and it also offers the best soft tissue contrast for evaluating the other periarticular structures for concomitant injury. Conclusion: Imaging has an important role in the diagnosis of physeal injuries, and the information it provides has a tremendous impact on the subsequent management of these patients.
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Affiliation(s)
- Shari T Jawetz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Parina H Shah
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Hollis G Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
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Abstract
Pediatric overuse injury is a common complaint presenting to pediatricians. Overuse injury can affect the soft tissues or bone, and results from an imbalance between training and load to the tissues and recovery time. In the skeletally immature athlete, physeal and apophyseal tissue is particularly vulnerable to overuse resulting in different patterns of injury compared to adults. Awareness of age-dependent patterns of overuse is necessary for proper recognition, treatment, and prevention of injury. This article reviews the most common pediatric overuse injuries with emphasis on risk factors, diagnosis, and treatment. Guidelines for prevention are included, as this is the key component for successful management of overuse injury in pediatric athletes.
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Alkhawaldeh K, Ghuweri AA, Kawar J, Jaafreh A. Back Pain in Children and Diagnostic Value of (99m)Tc MDP Bone Scintigraphy. Acta Inform Med 2014; 22:297-301. [PMID: 25568576 PMCID: PMC4272846 DOI: 10.5455/aim.2014.22.297-301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/22/2014] [Indexed: 11/25/2022] Open
Abstract
Aim: The aim of our study is to assess the diagnostic value of Technituim-99m-Methyle diphosphonate (99mTc-MDP) Bone scintigraphy in the assessment of children with back pain. Methods: Included in this retrospective study were 68 child referred to us complaining of back pain (mean age of 13+ 2). There were 45 boys and 23 girls. All children have been investigated with conventional x-ray which revealed normal or inconclusive result. All underwent bone scintigraphy after the injection of 99mTc-MDP with calculated doses according to there body weights. Results: Bone scintigraphy revealed 17 (25%) abnormal scans in 11 boys and 6 girls. Scans findings were suggestive of spondylolysis (n=4); malignancy including primary tumors and metastases (n=3); infection including osteomyelitis and discitis (n=3); sacroiliitis (n=2); benign tumors (n=2); pseudo fractures in ribs (n=1); necrosis in femoral head epiphysis(n=1) and nonskeletal-renal retention due to hydronephrosis (n=1). Sensitivity, specificity and accuracy of bone scan in detecting gross skeletal abnormality as a cause for back pain were 94% and 100% and 99% respectively. Conclusion: Bone isotope scan is a sensitive imaging modality in the assessment of pediatric patients with back pain. It is a reliable modality to detect and role out most benign and aggressive serious etiologies.
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Affiliation(s)
- Khaled Alkhawaldeh
- Department. King Hussein Medical Center. Royal Medical Services. Amman, Jordan
| | - Ali Al Ghuweri
- Department. King Hussein Medical Center. Royal Medical Services. Amman, Jordan
| | - Jane Kawar
- Department. King Hussein Medical Center. Royal Medical Services. Amman, Jordan
| | - Amany Jaafreh
- Department. King Hussein Medical Center. Royal Medical Services. Amman, Jordan
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Jaimes C, Chauvin NA, Delgado J, Jaramillo D. MR Imaging of Normal Epiphyseal Development and Common Epiphyseal Disorders. Radiographics 2014; 34:449-71. [DOI: 10.1148/rg.342135070] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW To provide primary care physicians with strategies to evaluate and manage pediatric upper extremity stress injuries related to overuse with a focus on anatomic location, patient history, physical examination, and imaging. RECENT FINDINGS Children are susceptible to stress injuries due to their open physes. The physeal cartilage of epiphyses and apophyses is the weakest structure in the developing skeleton. The differential diagnosis for pediatric stress injuries includes injury to the bone, physis, epiphysis, and apophysis. Most stress injuries in children improve with rest. Missed or misdiagnosed stress injuries can lead to growth abnormalities and potential malalignment. SUMMARY Awareness of stress injuries is important for timely diagnosis and prevention of sequelae. A thorough history, focused physical examination, and proper imaging studies are crucial steps to identify upper extremity stress injuries in the pediatric population.
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