Utility of imaging for children and adolescents with musculoskeletal symptoms

Imaging has a limited role in the diagnosis of rheumatological conditions and should only be performed if the diagnosis cannot be confirmed on history and physical examination findings. Imaging often identifies abnormalities unrelated to the person’s symptoms, so should only be ordered to corroborate a suspected diagnosis.

Young children may require procedural sedation or a general anaesthetic in order to lie still for particular imaging.

The following imaging may be useful in the diagnosis or exclusion of specific conditions in children and adolescents:

• plain X-ray
  • may be useful for conditions where bone changes are expected—for example, fracture, osteochondroses (eg Perthes disease), slipped upper femoral epiphysis (SUFE), osteomyelitis or solid bone tumours
  • including both anteroposterior and ‘frog-leg’ hip views are required to rule out SUFE
  • may be able to detect a joint effusion
  • is not helpful to rule out synovitis
• ultrasound
  • may be useful for assessment of joint pain or injury (eg ligament sprain in the ankle or foot)
  • may differentiate synovitis from tendinitis
  • may demonstrate joint effusion (eg in transient synovitis (irritable hip)) but cannot differentiate between infectious and inflammatory aetiologies
  • may be used to guide joint aspiration or intra-articular injection (eg for hip pain)
• magnetic resonance imaging (MRI) scan
  • is indicated for specific conditions (eg acute soft-tissue knee injury following trauma in a young person, such as anterior cruciate ligament tear)
  • may be used to detect synovitis
• radionuclide bone scan
  • is only indicated for specific conditions, including autoinflammatory bone disease (eg chronic recurrent multifocal osteomyelitis [CRMO]).