Fast MRI in the diagnosis of painful hip in children

Hip complaints are infrequently encountered in children and while usually no
underlying pathologic process can be found and the complaints will eventually
subside, sometimes hip complaints may indicate underlying disease. In addition
to relatively benign conditions such as transient synovitis, more severe causes
(Perthes disease, osteomyelitis, septic arthritis) which acquire immediate
medical attention can be found. For effective treatment and to prevent advanced
disease and possible complications, early diagnosis is desirable
In our clinic in case of hip complaints conventional radiographs (AP and Frog
Lateral) are taken, often followed by ultrasound. Only if these will fail to be
diagnostic and in case of high clinical suspicion of underlying pathology,
imaging will include CT or MRI.
CT is effective in showing bone pathology, but has limited value in assessing
intra-articular processes and early inflammatory disease.
It is our hypothesis that MRI has a higher diagnostic yield compared to
conventional radiography and ultrasound in cases of hip pain in the pediatric
population. MRI is known to be a safe procedure, but is frequently omitted due
to difficulty in accessibility, and the assumed distress it may cause. By
running three short MRI sequences the total duration of the MRI can be limited
to fifteen minutes and can be performed in an emergency setting. Also,
according to Westra et al distress has been overestimated and MRI in children
is only accompanied by minimal discomfort in the majority of cases.

This study investigates the use of MRI during diagnostic workup for children
presenting with hip pain and compares the usefulness of MRI to conventional
radiography and ultrasound.

for a more detailed description; see study protocol.

Children aged 4-16 years old presenting at the radiology department for
diagnostic imaging in case of suspected hip pathology are asked to enter the
study. In case of consent, MRI of the hip will be performed (coronal T1,
sagital T2 PD, coronal T2 SPIR). MR imaging should take place within 72 hours
of radiography and ultrasound.
Xrays and MR images will be assessed by two independent radiologists.
Ultrasound imaging will be performed by the radiologist on duty.
When all imaging has taken place, the diagnostic value of the xrays and
ultrasound will be compared to the diagnotic value of MRI by use of statistic
tests.

Burden: See above. A study by Westra et al (Eur J Pediatr 2010) has shown that
most children only experience minimal discomfort by entering the MRI scanner.
In case of serious discomfort imaging will be cancelled. Patients are free to
withdraw at any time.

Risks: To date there are no risks from magnetic resonance imaging.