An audit of magnetic resonance imaging in the paediatric orthopaedic setting.
OBJECTIVE
To determine when magnetic resonance imaging (MRI) is helpful in the management of a selected group of paediatric orthopaedic patients.


METHODS
A retrospective analysis of 131 MRI scans was undertaken with allocation into seven categories based on clinical presentation.


RESULTS
MRIs performed for spinal, congenital and intra-articular pathology, as well as for growth plate assessment correlated well with subsequent clinical and/or surgical findings. Three of ten MRIs (30%) incorrectly assessed whether a foreign body was present with a sensitivity of 0.60 and specificity of 0.80. Three of 20 MRIs (15%) could not accurately distinguish between oedema/effusion and frank infection. Here sensitivity was 1.00 and specificity was 0.73. MRIs performed for assessment of tumours were accurate with respect to margins and extent. Assessment of pathology with MRI was never the indication for MRI, thus it was not surprising that in four of 27 soft tissue tumours (sensitivity of 0.88 and specificity of 0.63) MRI did not correlate with subsequent histological findings.


CONCLUSIONS
MRI plays an important role in the assessment of a wide range of musculo-skeletal pathology. MRI does not, and could not be expected to, replace the need for incisional biopsy for tumour diagnosis. It must be used with caution where tissues have been previously explored for foreign bodies. Interpretation of MRI in musculoskeletal infection must consider its timing in the evolution of the patient's infection.
Walker
M L
ML
Department of Paediatric Orthopaedics, Starship Children's Hospital, Auckland.
Nicol
R O
RO
D000293:Adolescent; D001847:Bone Diseases / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005188:False Negative Reactions; D005189:False Positive Reactions; D005547:Foreign Bodies / Q000175:diagnosis*; D006132:Growth Plate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008485:Medical Audit; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012983:Soft Tissue Neoplasms / Q000175:diagnosis*; D013131:Spine