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Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain
P M White1, J Boyd, T F Beattie
1Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Magnetic resonance imaging (MRI) is a practical and accurate tool for diagnosing acute non-traumatic hip pain in children. This advanced imaging correctly identified serious underlying disorders missed by standard methods, guiding necessary treatment.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Diagnostic Accuracy
Background:
- Acute non-traumatic hip pain is a common presentation in pediatric emergency departments.
- Conventional imaging modalities like arthrosonography and hip radiographs have limitations in diagnosing the underlying cause.
- Accurate and timely diagnosis is crucial for appropriate management and preventing long-term sequelae.
Purpose of the Study:
- To prospectively evaluate the role and diagnostic accuracy of magnetic resonance imaging (MRI) in children with acute non-traumatic hip pain.
- To compare the effectiveness of MRI with standard imaging investigations.
- To identify imaging features associated with serious underlying hip disorders.
Main Methods:
- Prospective evaluation of 50 children with acute non-traumatic hip pain.
- Standard investigations (arthrosonography +/- hip radiographs) followed by open 0.23T MRI (gradient echo T1, fast spin echo T2, IRSE axial sequences).
- Assessment of diagnostic quality, interobserver agreement, sensitivity, specificity, accuracy, PPV, and NPV for both MRI and standard imaging.
Main Results:
- Diagnostic quality MRI was achieved in 94% of children; the inversion recovery spin echo (IRSE) sequence was most reliable (p<0.002).
- MRI demonstrated higher sensitivity (0.79 vs. 0.70), specificity (1.00 vs. 0.57), and accuracy (0.81 vs. 0.72) compared to standard imaging.
- MRI correctly identified all 7 children with serious underlying disorders, while standard imaging identified only 2. Pelvic musculoskeletal infection was linked to adjacent tissue signal alteration and elevated erythrocyte sedimentation rate (>20 mm/hr; p<0.0001).
Conclusions:
- MRI is a practical, well-accepted, and accurate non-invasive imaging technique for pediatric acute non-traumatic hip pain.
- Combined with inflammatory markers, MRI helps identify children requiring aggressive management.
- MRI is the imaging modality of choice for this condition where available.
Abstract:
The role of magnetic resonance imaging (MRI) in children presenting with acute non-traumatic hip pain was evaluated prospectively. Hip MRI was performed in addition to standard investigations (arthrosonography +/- hip radiographs) in 50 children presenting to the accident and emergency department of a paediatric hospital. MRI was performed on an open 0.23T system and comprised gradient echo T1 weighted coronal, fast spin echo T2 weighted coronal and inversion recovery spin echo (IRSE) axial sequences. Diagnostic quality MRI examinations were obtained in 94% of children. The IRSE sequence was the most reliable at determining underlying disorder (p<0.002). Interobserver agreement on the MRI examinations was very good with unweighted kappa value of 0.89, 95% confidence intervals 0.79, 0.99. Sensitivity of MRI was 0.79 (0.68, 0.90, specificity 1.00 (0.89, 1.00), accuracy 0.81 (0.70, 0.92), PPV 1.00 (0.89, 1), NPV 0.36 (0.25, 0.47). Sensitivity of standard imaging was 0.70 (0.54-0.86), specificity 0.57 (0.41, 0.73), accuracy 0.72 (0.56, 0.88), PPV 0.91 (0.75, 1.00), NPV 0.24 (0.08, 0.40). MRI correctly identified all seven children with serious underlying disorder whereas conventional imaging correctly diagnosed only two. Pelvic musculoskeletal infection was associated with the combination of marked alteration in signal in tissues adjacent to a symptomatic hip and an erythrocyte sedimentation rate of >20 mm 1st h (p<0.0001). In conclusion, MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain. Combined with inflammatory markers MRI can be used to determine those children who require aggressive management. Where it is available, MRI is the imaging modality of choice in this condition.
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