A pilot study on magnetic resonance imaging of the distal radial growth plate: defining healthy and pathologic characteristics in a non-invasive manner

Chronic wrist pain is an overuse syndrome frequently affecting young gymnasts,
and often involving the radial growth plate. In the immature skeletal system,
growth plates are potential sites of injury due to chronic repetitive axial
loading of the wrist joint. Such injury can lead to growth abnormalities at a
later age. In the athlete with chronic wrist pain, imaging of the wrist is thus
essential for early diagnosis and to visualize possible degenerative changes of
the wrist. Early diagnosis leading to appropriate treatment can aid in
preventing worse outcome on the long term. At present, general consensus on
optimal magnetic resonance imaging (MRI) of the growth plate does not exist. We
hypothesize that MRI is useful for clear visualization of the growth plate and
for detecting early signs of growth plate injury.

1. The primary objective is to evaluate the characteristics of the distal
radial growth plate on MRI (including functional imaging techniques) and on
conventional radiographs in young gymnasts with wrist pain, compared to young
gymnasts without wrist pain and to young non-gymnasts.

2. The secondary objectives are:
- To evaluate the additional value of MRI over conventional radiography in the
evaluation of distal radial growth plate injuries;
- To evaluate the role of additional MRI applications (DWI MRI, 3D physeal
mapping) in quantifying and staging radial growth plate pathology;
- To correlate anthropomorphic and training characteristics as well as clinical
signs of wrist overuse injury with the characteristics of the distal radial
growth plate on imaging in young symptomatic and asymptomatic gymnasts and
non-gymnast controls;
- To compare bone age with characteristics of the distal radial growth plate on
MRI in gymnasts and non-gymnast controls;
- To develop an optimal MRI protocol (including functional imaging techniques)
for the diagnosis and staging of distal radial growth plate injuries, to be
used in clinical practice, in patients with suspected injury of the distal
radial growth plate.

Prospective observational study. We will obtain PA radiographs and MR images of
the wrist in a small group of young gymnasts with wrist pain, in a group of
young gymnasts without wrist pain, and in a control group of young
non-gymnasts. Wrist radiographs will be used for screening for distal radial
growth plate pathology and for assessment of bone age using automated software
(BoneXpert). MR images will be interpreted by an experienced musculoskeletal
radiologist and an experienced musculoskeletal radiology resident. All images
will be compared between gymnasts with wrist pain, gymnasts without wrist pain,
and non-gymnast volunteers to assess anatomic aspects and to identify signs of
distal radial growth plate injury.

Gymnasts with wrist pain, gymnasts without wrist pain and non-gymnasts are
asked to participate in this study.
1. All participants will have to travel to the AMC in order to undergo imaging;
2. Participants will be asked to fill out a short questionnaire on wrist pain
and gymnastics or other sports performance (additional examination time: 5
minutes);
3. Participants will undergo physical examination of the wrist (additional
examination time: + 5 minutes);
5. All participants will undergo MRI scanning of the wrist (scan time: 45
minutes).
6. All participants will undergo a single wrist radiograph (radiation exposure:
0.001 mSv).

Gymnasts with wrist pain may benefit when early signs of wrist overuse injury
are identified during this study and adequate treatment can be initiated at an
early stage. For the purpose of studying the active growth plate, inclusion of
a patient group younger than 18 years is unavoidable.