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Kalça Ağrısı Nedeniyle Tetkik Edilen Çocuklarda Manyetik Rezonans Görüntülemenin Yeri

Year 2021, Volume: 15 Issue: 6, 513 - 517, 26.11.2021
https://doi.org/10.12956/tchd.1001859

Abstract

Amaç: Çocuklarda kalça ağrısı nadir olmayıp tanısal zorluk yaratabilmektedir. Akış şemalarında direk grafiler önceliği alsa da erişebilirliğin olduğu merkezlerde Manyetik Rezonans İnceleme (MRİ) klinisyenler tarafından ilk basamakta tercih edilebilmektedir. Bu çalışmada kalça ağrısı ile başvuran çocuklarda MR bulgularının dağılımı ve MRI’nin tanı değeri araştırıldı. Direk grafisi bulunan alt gruptaki konvansiyonel bulgularla karşılaştırıldı. Kalçada ağrı ile başvuran çocuklar için protokol önerileri oluşturuldu.


Gereç ve Yöntem:
Ocak 2019 ile Mart 2020 tarihleri arasında hastanemize kalça ağrısı nedeniyle başvuran ve kalça MR tetkiki yapılan 52 hasta (24 K /28 E; ortalama yaş: 9.4) çalışmaya dahil edildi. MR bulguları retrospektif olarak değerlendirilerek kaydedildi. Hasta tanıları klinik ve laboratuar, bulgularının bir kombinasyonu kullanılarak doğrulandı. MRİ’nin özgüllük, duyarlılık ve doğruluğu hesaplandı. Direk grafileri de bulunan subgruptaki patolojik konvansiyonel bulgular incelendi.


Bulgular:
MRI 52 hastadan 18’inde normal; 34 hastada patolojik olarak değerlendirildi. Klinik ve laboratuar bulgulara dayanarak 6 hasta yalancı negatif kabul edildi. Yaşları 7 ile 17 arasında değişen 7 hastada sakroileit bulguları saptandı. MRI’nin sensitivitesi %85, spesifitesi %100, doğruluk oranı ise %88 olarak hesaplandı. Kontrast uygulanan 22 hastanın 8’inde (%36) tanıya ek katkı gözlendi. Hastaların üçte birinden (%33) direk grafi istenmemişti. Direkt grafi çekilen 35 hastanın da yalnızca 6’sında (%17’si) patoloji tespit edilmiş olup kemiğe aitti.


Sonuç:
MRI kalça ağrısı araştırırken yüksek duyarlılığı nedeni ile erişimin kolay olduğu merkezlerde ilk basamak tetkik olarak kullanılmalıdır. Direk grafi istemleri belli kemik patolojilerle sınırlandırılmalıdır. Seçilmiş olgularda kontrast madde kullanımı ek bilgi sağlamaktadır. 7 yaşından büyük çocuklarda rutin kalça ağrısı protokolüne sakroiliak eklemlere yönelik sekansların eklenmesi önerilir.

Supporting Institution

Yok

Project Number

Yok

Thanks

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References

  • Jain N, Sah M, Chakraverty J, Evans A, Kamath S. Radiological approach to a child with hip pain..Clin Radiol 2013 Nov;68:1167-78.
  • Bartoloni A, Aparisi Gómez MP, Cirillo M, Allen G, Battista G, et al. Imaging of the limping child. Eur J Radiol 2018;109:155-70.
  • Sarwar ZU, DeFlorio R, Catanzano TM. Imaging of nontraumatic acute hip pain in children: multimodality approach with attention to the reduction of medical radiation exposure. Semin Ultrasound CT MR 2014;35:394-408
  • White PM, Boyd J, Beattie TF, Hurst M, Hendry GM. Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain Hendry. Emerg Med J 2001;18:25-29.
  • Tal Laor. Hip and groin pain in adolescents. Pediatr Radiol 2010; 40:461-7.
  • Milla SS, Coley BD, Karmazyn B, Dempsey-Robertson ME, Dillman JR, Dory CE, et al. ACR Appropriateness Criteria® limping child--ages 0 to 5 years. J Am Coll Radiol 2012;9:545-53.
  • Forbes-Amrhein MM, Marine MB, Wanner MR, Roth TD, Davis JT, Ravi AK, et al. JOURNAL CLUB: Can Coronal STIR Be Used as Screening for Acute Nontraumatic Hip Pain in Children? AJR Am J Roentgenol 2017;209:676-83.
  • Khoury NJ, Birjawi GA, Chaaya M, Hourani MH. Use of limited MR protocol (coronal STIR) in the evaluation of patients with hip pain. Skeletal Radiol 2003;32:567-74.
  • Özen A, Sanal HT, Yıldız C. Legg-Calvé-Perthes hastalığında MR görüntüleme MR imaging in Legg-Calvé-Perthes disease. TOTBİD Dergisi 2017; 16:17–23.
  • Mixa PJ, Segreto FA, Luigi-Martinez H, Diebo BG, Naziri Q, Kolla S, et al. van Neck-Odelberg Disease: A 3.5-Year Follow-Up Case Report and Systematic Review Surg Technol Int 2017;31:365-73.
  • Peck D. Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician 2010; 82:258-62.
  • Mettler FA Jr, Huda W, yoshizumi TT, Mahesh M. Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog. Radiology 2008: 254-63.
  • Bomer J, Klerx-Melis F, Holscher HC. Painful paediatric hip: frog-leg lateral view only. Eur Radiol 2014;24:703-8.  
  • Mooney JF 3rd, Murphy RF. Septic arthritis of the peditric hip: update on diagnosis and treatment. Curr Opin Pediatr 2019;31:79-85.
  • Ekşioğlu AS, Uner Ç. Pediatricians’ awareness of diagnostic medical radiation effects and doses: are the latest efforts paying off? Diagn Interv Radiol 2012;18:78-86.
  • Şahin Onat Ş. Eklem Ağrılı Çocuklarda Tanısal Yaklaşım Diagnostic Aproach To Painful Joints With Children. Abant Med J2014;3: 201-9.

Value of Magnetic Resonance Imaging in Children with Hip Pain

Year 2021, Volume: 15 Issue: 6, 513 - 517, 26.11.2021
https://doi.org/10.12956/tchd.1001859

Abstract

Objective: Hip pain, which poses a diagnostic challenge, is common in children. In this study we aim to evaluate the diagnostic value of MRI in children with hip pain. Results are compared with radiographic findings. Imaging protocol suggestions are established.


Material and Methods
: 52 children (24F/28 M; mean age: 9.4 years) who underwent an MR exam for hip pain were included. MR findings were retrospectively reavaluated and diagnosis were verified by using a combination of clinical and laboratory findings. Specificity, sensitivity and accuracy of MRI were calculated. Radiographic findings of the subgroup with X-rays were detected.

Results: MRI revealed normal findings in 18 and pathological findings in 34 patients. 6 cases were accepted as ‘false negative’ depending on clinical and laboratory findings. 7 sacroileitis were detected in patients with an age range of 7 to 17 years. The sensitivity, specificity and accuracy of MRI were calculated as 85%, 100% and 88% respectively. Contrast administration added diagnostic value in 8 of the 22 cases (36%) with enhanced imaging. In 35 patients who underwent X-ray examination, only 6 patients (17%) - all with bony lesions - had pathological findings.

Conclusion: MRI can be used as the first line imaging modality for hip pain in children in centers where it is easily accessable. X-rays shoud be limited to certain bony pathologies. IV contast administration adds value to MRI in selected cases. We suggest to add sacroiliac joint specific sequences to the MRI protocol for hip pain in children over 7 years.

Project Number

Yok

References

  • Jain N, Sah M, Chakraverty J, Evans A, Kamath S. Radiological approach to a child with hip pain..Clin Radiol 2013 Nov;68:1167-78.
  • Bartoloni A, Aparisi Gómez MP, Cirillo M, Allen G, Battista G, et al. Imaging of the limping child. Eur J Radiol 2018;109:155-70.
  • Sarwar ZU, DeFlorio R, Catanzano TM. Imaging of nontraumatic acute hip pain in children: multimodality approach with attention to the reduction of medical radiation exposure. Semin Ultrasound CT MR 2014;35:394-408
  • White PM, Boyd J, Beattie TF, Hurst M, Hendry GM. Magnetic resonance imaging as the primary imaging modality in children presenting with acute non-traumatic hip pain Hendry. Emerg Med J 2001;18:25-29.
  • Tal Laor. Hip and groin pain in adolescents. Pediatr Radiol 2010; 40:461-7.
  • Milla SS, Coley BD, Karmazyn B, Dempsey-Robertson ME, Dillman JR, Dory CE, et al. ACR Appropriateness Criteria® limping child--ages 0 to 5 years. J Am Coll Radiol 2012;9:545-53.
  • Forbes-Amrhein MM, Marine MB, Wanner MR, Roth TD, Davis JT, Ravi AK, et al. JOURNAL CLUB: Can Coronal STIR Be Used as Screening for Acute Nontraumatic Hip Pain in Children? AJR Am J Roentgenol 2017;209:676-83.
  • Khoury NJ, Birjawi GA, Chaaya M, Hourani MH. Use of limited MR protocol (coronal STIR) in the evaluation of patients with hip pain. Skeletal Radiol 2003;32:567-74.
  • Özen A, Sanal HT, Yıldız C. Legg-Calvé-Perthes hastalığında MR görüntüleme MR imaging in Legg-Calvé-Perthes disease. TOTBİD Dergisi 2017; 16:17–23.
  • Mixa PJ, Segreto FA, Luigi-Martinez H, Diebo BG, Naziri Q, Kolla S, et al. van Neck-Odelberg Disease: A 3.5-Year Follow-Up Case Report and Systematic Review Surg Technol Int 2017;31:365-73.
  • Peck D. Slipped capital femoral epiphysis: diagnosis and management. Am Fam Physician 2010; 82:258-62.
  • Mettler FA Jr, Huda W, yoshizumi TT, Mahesh M. Effective Doses in Radiology and Diagnostic Nuclear Medicine: A Catalog. Radiology 2008: 254-63.
  • Bomer J, Klerx-Melis F, Holscher HC. Painful paediatric hip: frog-leg lateral view only. Eur Radiol 2014;24:703-8.  
  • Mooney JF 3rd, Murphy RF. Septic arthritis of the peditric hip: update on diagnosis and treatment. Curr Opin Pediatr 2019;31:79-85.
  • Ekşioğlu AS, Uner Ç. Pediatricians’ awareness of diagnostic medical radiation effects and doses: are the latest efforts paying off? Diagn Interv Radiol 2012;18:78-86.
  • Şahin Onat Ş. Eklem Ağrılı Çocuklarda Tanısal Yaklaşım Diagnostic Aproach To Painful Joints With Children. Abant Med J2014;3: 201-9.
There are 16 citations in total.

Details

Primary Language Turkish
Subjects ​Internal Diseases
Journal Section ORIGINAL ARTICLES
Authors

Ayse Secil Eksioglu 0000-0002-7044-5270

Seda Kaynak Şahap This is me 0000-0003-1283-9543

Project Number Yok
Publication Date November 26, 2021
Submission Date September 29, 2021
Published in Issue Year 2021 Volume: 15 Issue: 6

Cite

Vancouver Eksioglu AS, Kaynak Şahap S. Kalça Ağrısı Nedeniyle Tetkik Edilen Çocuklarda Manyetik Rezonans Görüntülemenin Yeri. Türkiye Çocuk Hast Derg. 2021;15(6):513-7.


The publication language of Turkish Journal of Pediatric Disease is English.


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