title: MRI of suspected lower extremity musculoskeletal infection in the pediatric patient: how useful is bilateral imaging?
abstract: OBJECTIVE
  The purpose of this study was to determine the frequency of bilateral abnormalities in children with suspected lower extremity musculoskeletal infection and the impact of detection of contralateral abnormalities by MRI on patient management.
  
  
  METHODS
  A retrospective review of 165 consecutive bilateral lower extremity MRI examinations performed for suspected musculoskeletal infection in pediatric patients (64% boys and 36% girls; mean age, 7.5 years; age range, 0-18 years) in 2010 at a children's hospital was performed. Imaging findings were compared with the final clinical diagnosis and management.
  
  
  RESULTS
  The MRI examination was normal in 2% (4/165). Osteomyelitis was diagnosed in 33% (54/165) of the MRI examinations; among these examinations 20% (11/54) had both ipsilateral septic arthritis and osteomyelitis, 2% (1/54) had bilateral osteomyelitis, and 67% (111/165) of the examinations were negative for osteomyelitis. Bilateral abnormalities were detected in 20% (22/111) of patients without osteomyelitis, with 18% (4/22) presenting with bilateral signs or symptoms. Abnormalities in the contralateral extremity included myositis (18%, 4/22), stress reaction (18%, 4/22), subcutaneous edema (18%, 4/22), leukemia (14%, 3/22), reactive joint effusion (14%, 3/22), Baker cyst (5%, 1/22), and osteonecrosis (5%, 1/22). Identification of clinically unsuspected abnormalities of the contralateral extremity by MRI was not associated with alterations in medical or surgical management in children with or without osteomyelitis.
  
  
  CONCLUSIONS
  Clinically unsuspected abnormalities of the asymptomatic contralateral lower extremity are common in children referred for MRI of suspected musculoskeletal infection. However, detection of these abnormalities is not associated with alterations in patient management.
authors.affiliation: Department of Radiology, Baylor College of Medicine, One Baylor Plaza, MS-360, Houston, TX 77030, USA. metwalli@bcm.edu
authors.forename: Zeyad A
authors.initials: ZA
authors.lastname: Metwalli
authors.forename: J Herman
authors.initials: JH
authors.lastname: Kan
authors.forename: Karuna A
authors.initials: KA
authors.lastname: Munjal
authors.forename: Robert C
authors.initials: RC
authors.lastname: Orth
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: R Paul
authors.initials: RP
authors.lastname: Guillerman
mesh_terms: D000293:Adolescent; D001850:Bone Diseases, Infectious / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D007223:Infant; D035002:Lower Extremity; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA