From the Guidelines
Radiologists and pediatric orthopedic surgeons interpret ankle MRIs differently regarding growth plates due to their distinct training backgrounds and clinical focuses, with surgeons prioritizing the impact on bone development and future growth. Radiologists are imaging specialists who excel at identifying abnormalities in the MRI itself, including subtle signal changes, bone marrow edema, and soft tissue pathologies, as noted in general radiology practice 1. They provide comprehensive reports on all visible structures, which is crucial for initial assessments. Pediatric orthopedic surgeons, however, interpret these images through the lens of their surgical experience and clinical context of the patient's symptoms, physical examination findings, and developmental stage, particularly focusing on how growth plate abnormalities might affect bone development and future growth.
The differences in interpretation are also influenced by the specialized training of pediatric orthopedic surgeons, who have completed an additional Accreditation Council for Graduate Medical Education–approved 1-year fellowship in pediatric orthopedics, equipping them with in-depth knowledge of growth plate vulnerabilities and healing potentials 1. Growth plates (physes) are especially challenging to interpret in children because they normally have high signal intensity on T2-weighted images that can resemble pathology, and their appearance changes throughout development. The clinical implications of growth plate injuries are significant, as damage can lead to growth arrest, angular deformities, or limb length discrepancies, making the orthopedic surgeon's interpretation critical for treatment decisions.
Key factors influencing the different interpretations include:
- The radiologist's focus on accurate description of imaging findings
- The pediatric orthopedic surgeon's consideration of the clinical context and potential impact on bone development
- The specialized training of pediatric orthopedic surgeons in managing growth plate abnormalities and their complications
- The importance of growth plate interpretation in preventing long-term sequelae such as growth arrest or limb deformities, as would be considered in the management of conditions like those described for referral to pediatric surgical specialists 1.
From the Research
Differences in Interpretation
The differences in interpretation of ankle MRIs between radiologists and pediatric orthopedic surgeons can be attributed to several factors, including:
- Variability in understanding of normal skeletal maturation process 2
- Limited familiarity with the appearance of growth plates on MRI 3, 4, 5
- Difficulty in differentiating between normal developmental findings and pathologic conditions 4, 5
Growth Plate Considerations
When interpreting ankle MRIs, it is essential to consider the growth plate, as it can be a source of confusion. The growth plate, also known as the physis, is a cartilaginous structure that allows for bone growth and development. On MRI, the growth plate can appear as a high-signal intensity structure, which can be misinterpreted as a pathologic condition 3, 6.
- MRI can provide useful information on the appearance of the growth plate and changes in the metaphysis, which can affect the prognosis and results of surgical procedures 3
- The merging shape of the arrest line with calcification of the provisional zone of the metaphysis on MRI can indicate poor viability of the physis 3
Diagnostic Challenges
Diagnostic errors can occur due to the complexity of the pediatric foot and ankle anatomy, which includes multiple bones, ossification centers, apophyses, and physes 4, 5, 6.
- The lack of ionizing radiation and increased demand for MRI examinations in children have led to a higher demand for accurate interpretation of pediatric foot and ankle MRIs 4, 5
- It is crucial to differentiate between normal developmental findings and anatomic variants from pathologic conditions, whether mechanical, inflammatory, infectious, or neoplastic 4, 5, 6