Novel MRI techniques in the diagnosis of musculoskeletal infection in children

Abstract

Abstract Introduction: Musculoskeletal infections in children are common and if not adequately treated can result in poor prognoses. Early diagnosis and rapid treatment are crucial. The clinical and laboratory results are often non-conclusive or misleading. Radiology has always played a part in the diagnosis of Paediatric musculoskeletal infections. MRI is the most sophisticated MSK imaging tool and advanced MRI protocols with tailored techniques can improve the diagnostic yield of MRI in Paediatric MSK infection. Methods: 99 children with acute MSK pain and signs of infection were prospectively recruited. Each patient had a MRI scan on the first day of admission. A tailored MRI protocol was utilised, consisting of structural and biodynamic (DWI & SCE) sequences. Two consultant MSK radiologists independently analysed the scans and completed evaluation forms consisting of qualitative and semi-quantitative questions. The quantitative data from DWI and SCE sequences were separately analysed.Results: 103 MRI scans were performed. 3 scans were excluded due to incomplete protocols. 5 quantitative DWI and 3 SCE analyses were excluded due to irregularities of the values. The most common clinical diagnosis was infection. The feasibility of the protocol was excellent. The accuracy of the MRI protocol was good-excellent. The most accurate sequence was SCE. The diagnostic accuracy of the readers was good compared to an agreed gold standard. The most valued sequence by the readers for the diagnostic process was SCE. There were no relevant statistical thresholds for ADC and most of permeability values except for one regarding MSK infection. Conclusion: The tailored MRI protocol of the study is a feasible diagnostic tool with high level of diagnostic accuracy for paediatric MSK infections. The advanced MRI techniques in this study are the strengths of the protocol, which have demonstrated high accuracy and subjective diagnostic confidence. The quantitative values of the biodynamic sequences are promising parameters which need further evaluation in future studies.