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Amaç: Çocuklarda kalça ağrısı nadir olmayıp tanısal zorluk yaratabilmektedir. Akış şemalarında direk grafiler önceliği alsa da erişebilirliğin olduğu merkezlerde Manyetik Rezonans İnceleme (MRİ) klinisyenler tarafından ilk basamakta tercih edilebilmektedir. Bu çalışmada kalça ağrısı ile başvuran çocuklarda MR bulgularının dağılımı ve MRI’nin tanı değeri araştırıldı. Direk grafisi bulunan alt gruptaki konvansiyonel bulgularla karşılaştırıldı. Kalçada ağrı ile başvuran çocuklar için protokol önerileri oluşturuldu. Gereç ve Yöntem: Ocak 2019 ile Mart 2020 tarihleri arasında hastanemize kalça ağrısı nedeniyle başvuran ve kalça MR tetkiki yapılan 52 hasta (24 K /28 E; ortalama yaş: 9.4) çalışmaya dahil edildi. MR bulguları retrospektif olarak değerlendirilerek kaydedildi. Hasta tanıları klinik ve laboratuar, bulgularının bir kombinasyonu kullanılarak doğrulandı. MRİ’nin özgüllük, duyarlılık ve doğruluğu hesaplandı. Direk grafileri de bulunan subgruptaki patolojik konvansiyonel bulgular incelendi. Bulgular: MRI 52 hastadan 18’inde normal; 34 hastada patolojik olarak değerlendirildi. Klinik ve laboratuar bulgulara dayanarak 6 hasta yalancı negatif kabul edildi. Yaşları 7 ile 17 arasında değişen 7 hastada sakroileit bulguları saptandı. MRI’nin sensitivitesi %85, spesifitesi %100, doğruluk oranı ise %88 olarak hesaplandı. Kontrast uygulanan 22 hastanın 8’inde (%36) tanıya ek katkı gözlendi. Hastaların üçte birinden (%33) direk grafi istenmemişti. Direkt grafi çekilen 35 hastanın da yalnızca 6’sında (%17’si) patoloji tespit edilmiş olup kemiğe aitti. Sonuç: MRI kalça ağrısı araştırırken yüksek duyarlılığı nedeni ile erişimin kolay olduğu merkezlerde ilk basamak tetkik olarak kullanılmalıdır. Direk grafi istemleri belli kemik patolojilerle sınırlandırılmalıdır. Seçilmiş olgularda kontrast madde kullanımı ek bilgi sağlamaktadır. 7 yaşından büyük çocuklarda rutin kalça ağrısı protokolüne sakroiliak eklemlere yönelik sekansların eklenmesi önerilir.
Purpose: In children, neck pain is not rare and can cause diagnosis difficulties. While direct graphics are prioritized in flow schemes, magnetic resonance examination (MRI) clinics can be preferred in the first stage in the centers where accessibility is available. This study examined the distribution of MR findings in children with back pain and the diagnostic value of MRI. The direct graph was compared with the conventional findings in the subgroup. Protocol recommendations for children with back pain were created. Tools and Methods: From January 2019 to March 2020, 52 patients who were applied to our hospital due to back pain and back MR examination (24 K/28 E; average age: 9.4) were included in the study. The results of the MR were evaluated retrospectively. Patient diagnoses were confirmed by clinical and laboratory use of a combination of findings. MRI’s personality, sensitivity and accuracy were calculated. Conventional pathological findings in the subgroup found in direct graphs were also studied. Results: MRI was normal in 18 of 52 patients; patologically assessed in 34 patients. Based on clinical and laboratory findings, 6 patients were considered false negative. Seven patients between the ages of 7 and 17 were diagnosed with sacrolitis. The MRI sensitivity was estimated at 85%, the specificity at 100%, and the accuracy rate at 88%. In 8 of 22 patients applied contrast (36 percent) an additional contribution to the diagnosis was observed. One-third of patients (33%) did not receive a direct graph. Only 6 of the 35 patients with a direct chart (17%) were diagnosed with pathology and belonged to the bone. The result: MRI should be used as a first-stage inspection in the centers where access is easy due to high sensitivity while researching back pain. Direct graph requests should be limited to certain bone pathologies. In the selected circumstances, the use of contrast material provides additional information. In children over 7 years of age, it is recommended to add sections to the joints by sacring to the routine back pain protocol.
Objective: Hip pain, which poses a diagnostic challenge, is common in children. In this study we aim to evaluate the diagnostic value of MRI in children with hip pain. Results are compared with radiographic findings. Imaging protocol suggestions are established. Material and Methods: 52 children (24F/28 M; mean age: 9.4 years) who underwent an MR exam for hip pain were included. MR findings were retrospectively reavaluated and diagnosis were verified by using a combination of clinical and laboratory findings. Specificity, sensitivity and accuracy of MRI were calculated. Radiographic findings of the subgroup with X-rays were detected. Results: MRI revealed normal findings in 18 and pathological findings in 34 patients. 6 cases were accepted as ‘false negative’ depending on clinical and laboratory findings. 7 sacroileitis were detected in patients with an age range of 7 to 17 years. The sensitivity, specificity and accuracy of MRI were calculated as 85%, 100% and 88% respectively. Contrast administration added diagnostic value in 8 of the 22 cases (36%) with enhanced imaging. In 35 patients who underwent X-ray examination, only 6 patients (17%) - all with bony lesions - had pathological findings. Conclusion: MRI can be used as the first line imaging modality for hip pain in children in centers where it is easily accessable. X-rays shoud be limited to certain bony pathologies. IV contast administration adds value to MRI in selected cases. We suggest to add sacroiliac joint specific sequences to the MRI protocol for hip pain in children over 7 years.
Alan : Sağlık Bilimleri
Dergi Türü : Uluslararası
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