From the Guidelines
If a radiologist and pediatric orthopedic specialist interpret a child's ankle MRI differently, you should seek a consensus opinion through a multidisciplinary discussion between the two specialists. This difference in interpretation is not uncommon as radiologists are experts in reading imaging studies while orthopedic specialists bring clinical expertise and experience with musculoskeletal conditions in children 1. Request that your child's primary doctor facilitate a conversation between these specialists to reconcile their different interpretations. Some key points to consider in this discussion include:
- The importance of MRI in assessing ligamentous injury and stability, particularly in athletes 1
- The potential for ligament and tendon injuries to occur without fracture on radiography, and the role of MRI in detecting these injuries 1
- The challenges of interpreting pediatric ankle MRIs due to the developing bones and growth plates, which can sometimes resemble abnormalities 1 If significant disagreement persists, consider obtaining a third opinion from another radiologist or orthopedist, preferably one with specific expertise in pediatric ankle conditions. You can also request a case review at a pediatric hospital's tumor board or clinical conference where multiple specialists can examine the case together. Some additional considerations for imaging in pediatric ankle trauma include:
- The use of radiography as the initial imaging study, with sensitivity for detecting ankle fracture ranging from 92% to 99% 1
- The importance of weight-bearing radiographs in assessing fracture stability, and the use of special views such as the axial Harris-Beath view and Broden view in certain scenarios 1
From the Research
Interpreting Child's Ankle MRI
- When a radiologist and a pediatric orthopedic specialist interpret a child's ankle MRI differently, it can be due to various factors, including the unique challenges of MR imaging in children, such as age-related changes and technical issues 2.
- The excellent soft tissue contrast of MR imaging can be helpful in delineating cartilage-related abnormalities, but it may also lead to varying interpretations 2.
- A study found that many pre-referral foot or ankle MRI scans obtained before evaluation by a foot and ankle specialist are not necessary, and radiographic interpretations may be considered immaterial or inconsistent with the specialist's interpretations 3.
- Another study described the normal MRI appearance of pediatric syndesmotic ligaments and compared MRI patterns of high ankle sprains in children versus adults, finding that tibial periosteal stripping is significantly more common among pediatric high ankle sprains 4.
- Understanding the normal MR imaging appearance associated with the dynamic skeletal maturation process is essential to prevent overdiagnosis and unnecessary treatment in pediatric patients 5.
- MRI is the preferred exam for further characterization of the majority of pediatric foot and ankle conditions, with high sensitivity and specificity, and its findings often dictate patient referral and further management 6.
Factors Influencing Interpretation
- Technical issues and age-related changes can affect the interpretation of MR imaging in children 2.
- The experience and expertise of the radiologist and pediatric orthopedic specialist can also influence their interpretations 3, 4.
- The specific conditions being evaluated, such as osteochondritis dissecans or tarsal coalition, can require specialized knowledge and expertise for accurate interpretation 2, 6.
Importance of Collaboration
- Collaboration between radiologists and pediatric orthopedic specialists is crucial to ensure accurate interpretation and effective management of pediatric foot and ankle conditions 3, 4.
- Open communication and discussion of differing interpretations can help to resolve discrepancies and provide the best possible care for the patient 3, 6.