RC 512 - Paediatric musculoskeletal imaging
A. The occurrence of bone marrow oedema, joint fluid, ganglion cysts and erosion like features in the normal paediatric wrist
1. To discuss MRI protocols for the paediatric wrist.
2. To give an overview of normal development and variations in MR anatomy and signal patterns.
3. To provide an understanding of features indicative of pathology.
Normal variations in the amount of joint fluid, ganglion cysts, bone marrow oedema, and bony depressions that resemble erosions are frequent in the wrists of children. The results of a follow-up of a healthy cohort aged 6-17 will be presented. The cohort was examined twice with MR of the wrist, and the second time also with a cartilage sequence for better visualization of the bony depressions. Knowledge of these normal variations is important because they can resemble disease.
1. To discuss MRI protocols for imaging of the temporomandibular joints (TMJ).
2. To give an overview of MR imaging finding in arthritis of the TMJ.
3. To highlight the major differential diagnoses of TMJ arthritis and its MR imaging characteristics.
Arthritis of the temporomandibular joint (TMJ) is common in children and adolescents with juvenile idiopathic arthritis (JIA). Early treatment is warranted to prevent severe growth disturbances and joint deformities. As TMJ arthritis is often clinically silent, MRI with contrast-enhancement has been considered to be the most reliable method to assess signs of inflammation. To reliably guide therapeutic decisions and monitor outcomes it would be of utmost importance to clearly define the MR characteristics of a normal TMJ as a basis for the assessment of minor pathologies. However, similar to other small joints in children, we are just beginning to understand its developmental, physiological and anatomical characteristics as well as its reaction to inflammatory diseases and their treatment. Recent studies on normal TMJ in children have revealed age-dependent changes in shape and angulation of the mandibular condyle as well as typical time-intensity curves of contrast-enhancement in the soft joint tissue and the condyle. To date, the differentiation between normal synovial findings and mild signs of synovitis remains challenging. This lecture presents typical MR images of normal and inflamed TMJs in children and adolescents, including age-dependent anatomical variations. It discusses the available data on possible cutoffs between normality and pathology, the impact of the temporal dynamics of contrast enhancement, and presents findings that can mimic arthritis. It summarizes the minimum requirements of image quality and spatial resolution, the best image orientation, as well as the advantages of fat suppression and subtraction analysis in contrast-enhanced imaging.
1. To become familiar with the types of injuries seen in children.
2. To understand the basic mechanisms.
3. To learn about the diagnostic imaging approach.
Paediatric fracture patterns, mechanisms of Injury and complications are different to those in adults. Differences are related to the dynamic state of a growing skeleton and its decreased mechanical strength. Imaging skeletal trauma is based on orthogonal radiographs but we will also discuss the role of other imaging techniques such as US, CT and MR imaging. Differential diagnosis with normal developmental variant and tumours, and recognition of an underlying metabolic syndrome are also important in children. Finally, complications of paediatric fractures will also be reviewed including growth arrest, malunion, nonunion, synostosis and avascular necrosis. We will try to give a rationale for diagnostic imaging based on the clinical and surgical demand.