Purpose or Case Report: To present the results and evaluate the added value of applying CT-like sequences in the MRI examinations of the musculoskeletal system in children and adolescents with clinical suspicion of overuse stress injury.
Methods & Materials: During the past 12 months, CT-like (Zero TE, UTE and PETRA) sequences with image reconstruction were added to the protocol of musculoskeletal imaging in children and adolescents examined in our department with the indication of low – impact or repetitive overuse injury, usually in the grounds of elite athletic training. A total of 32 children were examined, of which 25 had a follow-up MRI scan and 7 an additional CT scan.
Results: MRI was ideal to reveal areas of bone edema and identify the focus area to be examined with CT-like sequences. Different anatomical sites included the lower extremities and tibial stress injuries in the majority of the children, but also femoral, pelvic and spinal stress injuries and one case with humeral injury in elite tennis player. CT-like reconstructions revealed in all cases fine cortical stress fracture lines and in most of the cases haziness of the adjacent trabecular bone. Follow up imaging confirmed the diagnosis with improvement or resolution of the findings.
Conclusions: Imaging of the pediatric bones with CT-like MRI sequences provides a unique anatomical imaging of the bones with identification of minor anomalies not discernable by the usual protocol. It offers an alternative and detailed imaging method to traditional CT, without any exposure to ionizing radiation and with additional benefit of confirming the presence of fine cortical stress fracture lines. Thus, it clarifies the clinical hypothesis and rules out our other causes of pain in the growing skeleton.