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Detection of pediatric musculoskeletal pathology using the fluid-sensitive sequence
Jie C Nguyen1, Paul H Yi2, Kaitlin M Woo3
1Department of Radiology, 3NW39, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA. jiec29@gmail.com.
Pediatric Radiology
|September 21, 2018
Summary
A fluid-sensitive magnetic resonance (MR) sequence can effectively screen children for musculoskeletal conditions, potentially reducing the need for contrast-enhanced MR studies and sedation. This triage approach shows high agreement with full studies, improving diagnostic efficiency.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Diagnostic Accuracy
Background:
- Musculoskeletal complaints are frequent in children.
- Magnetic resonance (MR) imaging is a key tool for assessment.
- A validated triage protocol could minimize unnecessary contrast-enhanced MR studies and sedation.
Purpose of the Study:
- To compare diagnostic accuracy between fluid-sensitive sequences and contrast-enhanced MR studies.
- To evaluate the detection of musculoskeletal pathology in children's pelvis and appendicular skeleton.
- To assess the utility of a triage protocol for pediatric MR studies.
Main Methods:
- Retrospective review of 99 MR studies from 96 pediatric patients (excluding specific conditions).
- Two radiologists independently reviewed studies twice: first with fluid-sensitive sequences (triage), then with contrast-enhanced sequences.
- Agreement assessed using Cohen's kappa and percentage agreement.
Main Results:
- High inter-reader agreement for contrast-enhanced studies (κ=0.91-1) versus triage studies (κ=0.49-1).
- Excellent percentage agreement (97-100%) between triage and full studies for pathology detection.
- Contrast-enhanced studies slightly improved confidence (5/99) and accuracy (2/99) but did not change management.
Conclusions:
- Fluid-sensitive MR sequences demonstrate near-perfect agreement with contrast-enhanced studies for detecting pediatric musculoskeletal pathology.
- This fluid-sensitive sequence can serve as an effective screening tool.
- Implementing this triage protocol may reduce the need for contrast-enhanced MR studies in children.
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