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MRI evaluation of pediatric tibial eminence fractures: comparison between conventional and “CT-like” ultrashort echo time (UTE) images

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Abstract

Objective

UTE MRI offers a radiation-free alternative to CT for bone depiction, but data on children is lacking. The purpose of this study was to determine whether UTE images improve detection and characterization of pediatric tibial eminence fractures.

Methods

Fifteen MRIs with UTE from 12 children (10 boys, 2 girls; mean age: 12.6 ± 3.3 years) with tibial eminence fractures (2018–2020) and 15 age-matched MRIs without fractures were included. After randomization, 5 readers reviewed images without and with UTE, at least 1 month apart, and recorded the presence of fracture and preferred images. If fracture is present, radiologists also recorded fragment size, number, and displacement; surgeons assigned Meyers-McKeever grade and management. Disagreements on management were resolved through consensus review. Kappa and intra-class correlation (ICC), sensitivity, and specificity were used to compare agreement between readers and fracture detection between images without and with UTE.

Results

For fracture detection, inter-reader agreement was almost perfect (κ-range: 0.91–0.93); sensitivity and specificity were equivalent between images without and with UTE (range: 95–100%). For fracture characterization, UTE improved agreement on size (ICC = 0.88 to 0.93), number (ICC = 0.52 to 0.94), displacement (ICC = 0.74 to 0.86), and grade (ICC = 0.92 to 0.93) but reduced agreement on management (κ = 0.68 to 0.61), leading to a change in consensus management in 20% (3/15). Radiologists were more likely to prefer UTE for fracture and conventional images for non-fracture cases (77% and 77%, respectively, p < 0.001).

Conclusion

While UTE did not improve diagnosis, it improved agreement on characterization of pediatric tibial eminence fractures, ultimately changing the preferred treatment in 20%.

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Acknowledgements

The authors would like to thank Peter Kollasch and Robert Sellers from Siemens Medical Solutions USA, Inc., for their help in optimizing the UTE pulse sequence for pediatric imaging and our inhouse MRI technologists, Robert H Carson, BS R.T. and Patricia Mecca, BS R.T. and our departmental MRI physicist, Suraj Serai, Ph.D., for their support in implementing the UTE sequence.

Funding

No funding was used to conduct the current study, but one of the co-authors, TPV, received a scholarship from the University of Pennsylvania Undergraduate Research and Fellowships Grant that provided partial salary support during the research period.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Jie C. Nguyen, Andressa Guariento, Tanvi P. Venkatesh & Raymond W. Sze

  2. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Jie C. Nguyen, Brendan A. Williams, J. Todd R. Lawrence, Theodore J. Ganley & Raymond W. Sze

  3. Division of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Brendan A. Williams, J. Todd R. Lawrence & Theodore J. Ganley

  4. University of Pennsylvania Undergraduate Program, Philadelphia, PA, USA

    Tanvi P. Venkatesh

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  1. Jie C. Nguyen
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Correspondence to Jie C. Nguyen.

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Nguyen, J.C., Guariento, A., Williams, B.A. et al. MRI evaluation of pediatric tibial eminence fractures: comparison between conventional and “CT-like” ultrashort echo time (UTE) images. Skeletal Radiol 51, 1603–1610 (2022). https://doi.org/10.1007/s00256-022-04000-0

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  • DOI: https://doi.org/10.1007/s00256-022-04000-0

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