1. To discuss MRI protocols for MSK-imaging in children.
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 of development of the skeleton are well documented when it comes to radiographs; with the introduction of MRI there are many more features to consider that are often less known. Normal variations are common and these can simulate disease. It is important for radiologist to be aware of this and an overview of cases will be presented. Protocols for MRI imaging in paediatric MSK imaging will be discussed.
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 cut-offs 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.
Musculoskeletal injuries are common in children. They account for 15-20% of admissions to the ED. Children have an immature skeleton with unique biomechanical features and a stronger, thicker and richly vascularized periosteum. Paediatric fractures may present with unique patterns including plastic deformation, buckled fractures, and greenstick fractures. Fractures in children include the ones involving the physis (epiphysiolysis) and we will review their classification and prognosis after treatment. We will review these injuries making special remarks on the imaging techniques used for their correct diagnosis and treatment planning.