Purpose or Case Report: To validate the necessity of an MRI when there is high clinical concern of epiphyseal injury with normal radiographic findings
Methods & Materials: A five-year retrospective Picture Archiving and Communication System (PACS) query was conducted between January 2014 and December 2018 at a local institution for patients with suspected physeal injury who had MRI and radiographs within 2 weeks. The search yielded 41 patients. Imaging review of MRI and radiographs were performed by two radiologists and characterized by descriptive factors.
Results: Of the 41 fractures confirmed by MRI only 15 radiographs showed a fracture or suspected fracture, yielding a sensitivity of 36%. In the subgroup where physeal widening was seen on MRI, only 63% were called on radiographs with a sensitivity of 38% and a positive predictive value of 66%. The sensitivity of the radiographs would even be lower in the context of isolated physeal edema, marrow edema or periosteal hematoma
Conclusions: MRI remains the most accurate modality for the diagnosis of Salter-Harris I fractures. For patients with persistent pain or loss of function with normal initial radiograph findings, MRI should be the next step in diagnostic care.