MR imaging spectrum of adolescent pubic symphyseal injuries/athletic pubalgia

BACKGROUND

Magnetic resonance imaging (MRI) findings associated with athletic pubalgia are well documented in the adult literature.

OBJECTIVE

To describe the spectrum of MRI findings in adolescents with pubic symphyseal injuries/athletic pubalgia.

MATERIALS AND METHODS

This is an institutional review board approved, retrospective study of all patients < 18 years who were referred for MRI, over the last 10 years. Two pediatric musculoskeletal radiologists evaluated the MRI in consensus for the following findings: Chronic Salter-Harris (SH)-I equivalent fracture or asymmetric parasymphyseal ossific fraying, non-retractile muscular tear or retraction, and edema of the aponeurosis and arcuate ligament. Radiographs were also reviewed for Risser stage.

RESULTS

Fifteen patients were identified (100% male, median age 17 years, IQR 16-17.6). Most patients (14/15, 93%) had either asymmetric parasymphyseal ossific fraying (4/15, 27%) or chronic SH-1 equivalent fracture (10/15, 67%) of the pubic symphysis, and all patients (15/15, 100%) had aponeurotic and arcuate ligament edema. Few patients had rectus abdominis muscular retraction (2/15, 13%), non-retractile muscular tear of the rectus abdominis (2/15, 13%), and/or adductor muscle (4/15, 27%). Risser stage was as follows: stages 0 (13%), 3 (7%), 4 (47%), and 5 (33%). The injuries in our limited data set were independent of skeletal maturity with no statistically significant association between any of the MRI findings and Risser stage.

CONCLUSION

The MR imaging spectrum of adolescent athletic pubalgia differs from the described findings in adults due to skeletal immaturity. The cleft sign described in adults manifests in adolescents as asymmetric parasymphyseal ossific fraying and chronic SH-1 equivalent fractures.

Improved Identification of Adolescent Hip Dysplasia Using a Screening Method Based on Lateral Center Edge Angle Measurements

BACKGROUND

In addition to the clinical exam, several quantitative measurement tools are performed on pelvic radiographs in the assessment of adolescent hip dysplasia at most dedicated pediatric hip preservation clinics, with the most commonly used measurement called the lateral center edge angle (LCEA). However, most pediatric radiologists do not use these quantitative measuring tools and instead make the diagnosis of adolescent hip dysplasia based on subjective review.

OBJECTIVE

The purpose of this study is to determine the additive value of a measurement-based diagnosis of adolescent hip dysplasia using LCEA versus subjective radiographic interpretation by pediatric radiologists.

METHODS

A review of pelvic radiographs for the binomial diagnosis of hip dysplasia was performed by four pediatric radiologists (two general, two musculoskeletal). The review included 97 pelvic AP radiographs (mean age 14.4 years [range 10-20 years], 81% female) for a total of 194 hips (58 cases of adolescent hip dysplasia and 136 normal) all of whom were evaluated in a tertiary care pediatric subspecialty hip preservation clinic. Subjective radiographic interpretation of each hip for a binomial diagnosis of hip dysplasia was performed. 2 weeks later and without knowledge of the subjective radiographic interpretation results, the same review was performed with LCEA measurement and a diagnosis of hip dysplasia made when LCEA angles were under 18 degrees. A comparison of sensitivity/specificity between methods per reader was conducted. A comparison of accuracy between methods for all readers combined was performed.

RESULTS

For all four reviewers, the sensitivity of subjective versus LCEA measurement-based diagnosis of hip dysplasia was 54-67% (average 58%) versus 64-72% (average 67%), respectively, and specificity was 87-95% (average 90%) versus 89-94% (average 92%), respectively. All four readers demonstrated an intra-reader trend for improvement in the diagnosis of adolescent hip dysplasia after the addition of LCEA measurements but was only statistically significant in one of the four readers. The combined accuracy of all four readers for subjective and LCEA measurement-based interpretation was 81% and 85%, respectively with p = 0.006.

CONCLUSION

Compared with subjective interpretation, LCEA measurements demonstrate increased diagnostic accuracy amongst pediatric radiologists for the correct diagnosis of adolescent hip dysplasia.

Risk factors of mental retardation in children attending an educationally subnormal/mental school in Dammam, Saudi Arabia

The objective of this case control study was no identify the possible associated risk factors of mild mental retardation in children. Sixty-nine parents of mildly mentally retarded (MR group) male children and a similar number of matched parents of normal male children (control) were interviewed using a questionnaire. The MR group was found to belong to the middle and the lower socioeconomic classes. Histories of maternal smoking, skin rash, fever, and less attendance to antenatal clinics during pregnancy were reported significantly more by mothers of the MR group (P = 0.027, 0.008, 0.027 and 0.0018, respectively). Furthermore, these mothers reported more collective occurrence of newborn jaundice, fever, convulsions, incubator need, and head trauma (P = 0.004). More consanguineous marriages were found in the control group (73.9%) as compared to the MR group (59.4%) (P = 0.056). A family history of mental retardation was, however, more in the latter group compared to the former group (P=0.027). The risk of having another mentally retarded member in the family was found to be a higher if the familial degree of another closeness to the mentally retarded member was more. Well planned health education programs, genetic counseling units, and sufficient antenatal and neonatal services are of prime importance.