Zusammenfassung.
Zielsetzung: Bestimmung der Durchführbarkeit und diagnostischen Aussagekraft (Magnetom Open, Siemens®)
an Kindern und Jugendlichen mit vorwiegend traumatischen Läsionen des oberen Sprunggelenkes.
Material und Methoden: 55 Patienten unterzogen sich zusätzlich zur konventionellen Röntgendiagnostik einer
MRT des oberen Sprunggelenkes. Das Untersuchungsprotokoll beinhaltete eine coronare
STIR-Sequenz, T2-gewichtete TSE-Sequenzen in anguliert-axialer sowie eine T1-gewichtete SE-Sequenz in sagittaler Schnittführung. Das Bildmaterial wurde von zwei
Radiologen in Unkenntnis klinischer und/oder operativer Befunde im Konsens ausgewertet.
Ergebnisse: Bandrupturen ließen sich in 33/55 (60 %) Fällen nachweisen; knöcherne Bandausrisse
fanden sich in rund 50 % der Fälle. Distale Tibia- und Fibula-Frakturen lagen in 28/55
(51 %) Fällen vor. 15/28 (54 %) Patienten zeigten eine Beteiligung der Epiphysenfuge.
Okkulte Frakturen fanden sich bei 11/28 (39 %) Kindern. Konventionell radiologisch
vermutete Frakturen konnten in 6 Fällen ausgeschlossen werden. Aufgrund der MRT-Befunde
erfolgte eine Änderung der Therapie bei 35/55 Kindern. Schlußfolgerungen: Wir empfehlen die MRT des OSG bei Kindern mit persistierenden oder unklaren Schmerzen
und konventionell-radiologisch unauffälligem Röntgenbild.
Low-field MRI of the ankle joint-first experience in the pediatric age group.
Purpose: To evaluate the feasibility and diagnostic confidence of MRI with an open low field
System (Magnetom open®, Siemens, Germany) in children with predominantly traumatic
disorders. Material and methods: Conventional X-rays and MRI examinations have been evaluated in 55 children. MRI
was performed at an open 0.2 T MR-unit. The study protocol comprised coronal STIR-sequence,
an angulated T2 weighted TSE-sequence and T1 weighted SE-sequence. Results: MRI showed ligamental ruptur in 33/50 (60 %) cases. Injuries of the ATFL were most
frequent (27/33); osseous ligamental tears occurred in approx. 50 % of all cases.
Fractures of the distal tibia and fibula were diagnosed in 28/55 children. 15/28 cases
showed an involvement of the epiphysis. We found occult fractures in 11/28 children.
Fractures, diagnosed by conventional x-rays, were excluded in 6 cases. Therapy changed
in 35/55 patients on the basis of MRI-findings. Conclusion: Low-field MRI of the ankle joint in children and adolescents is able to show numerous
pathological conditions. We recommend low-field MRI of the ankle in children with
persistent or unclear pain of the ankle joint and inconspicuous conventional x-ray.
Schlüsselwörter:
Niederfeld-MRT - Kinder - Sprunggelenk - Okkulte Fraktur
Key words:
Low-field MRI - Children - Ankle joint - Occult fracture
Literatur
- 1
Garrick J G, Requa R K.
The epidemiology of foot and ankle injuries in sports.
Clin Sports Med.
1988;
7
29-36
- 2 Erlemann R, Wuisman P, Just A, Peters P E. Radiologe 1991 31: 601-608
- 3
Zanetti M, De-Simoni C, Wetz H H, Zollinger H, Hodler J.
Magnetic resonance imaging of injuries to the ankle joint: can it predict clinical
outcome?.
Skeletal Radiol.
1997;
26
82-88
- 4
lwinska-Zelder J, Schmidt S, Ishaque N, Hoppe M, Schmitt J, Klose K J, Gotzen L.
Epiphysenfugenverletzungen der distalen Tibia. Sinnvolle Mehrinformation durch die
MRT?.
Radiologe.
1999;
39
25-29
- 5
Deutsch A L, Mink J H, Waxmann A D.
Occult fractures of the proximal femur: MR imaging.
Radiology..
1989;
170
113-116
- 6 Breitenseher M L. Radiologe 1999 39: 16-24
- 7
Yao L, Lee J K.
Occult intraosseous fracture: detection with MR imaging.
Radiology.
1988;
167
749-751
- 8
Jaramillo D, Hoffer F A.
Cartilaginous epiphysis and growth plate: normal and abnormal MR imaging findings.
AJR.
1992;
158
1105-1110
- 9
Carey J, Spence L, Blickman H, Eustace S.
MRI of pediatric growth plate injury: correlation with plain film radiographs and
clinical outcome.
Skeletal Radiol.
1998;
27
250-255
- 10
Kreitner K F, Ferber A, Grebe P, Runkel M, Berger S, Thelen M.
Injuries of the lateral collateral ligaments of the ankle: assessment with MR imaging.
Eur Radiol.
1999;
9
519-524
- 11
Kersting-Sommerhoff B, Gerhardt P, Golder W, Hof N, Riel K.-A., Helmberger H, Lenz M,
Lehner K.
MRI of the knee joint: First results of a comparison of a 0.2. T dedicated system
with a 1.5 T high field strength magnet.
Fortschr Röntgenstr.
1995;
162
390-395
- 12
Breitenseher M J, Trattnig S, Kukla C, Gabler C, Kaider A, Haller J, Heinz-Peer G,
Imhof H.
Injuries to the lateral ligaments of the ankle joint: study technic and demonstration
by means of MRI.
Fortschr Röntgenstr.
1996;
164
226-232
- 13 Heuck A, Bonel H, Huber A, Muller-Lisse G U, Sittek H, Reiser M. Radiologe 1997
37: 778-784
- 14 Grebe P, Kreitner K F, Roeder W, Kersjes W, Hennes R, Runkel M. Fortschr Röntgenstr
1995 163: 225-229
- 15
Cardone B W, Erickson S J, Den-Hartog B D, Carrera G F.
MRI of injury to the lateral collateral Iigamentous complex of the ankle.
J Comput Assist Tomogr.
1993;
17
102-107
- 16
Altermatt S.
Ankle injuries in children and adolescents.
Swiss Surgery.
1998;
4
63-69
- 17
Breitenseher M J, Metz V M, Gilula L A, Gaebler C, Kukla C, Fleischmann D, Imhof H,
Trattnig S.
Radiographically occult scaphoid fractures: value of MR imaging in detection [see
comments].
Radiology.
1997;
203
245-250
- 18
Verhoek G, Zanetti M, Duewell S, Zollinger H, Hodler J.
MRI of the foot and ankle: diagnostic performance and patient acceptance of a dedicated
low field MR scanner.
J Magn Reson Imaging.
1998;
8
711-716
- 19 Trattnig S, Kontaxis G, Breitenseher M, Czerny C, Rand T, Turetschek K, Barth M,
Imhof H. Radiologe. 1997 37: 773-777
- 20 Merhemic Z, Breitenseher M, Trattnig S, Happel B, Kukla C, Rand T, Imhof H. Radiologe
1999 39: 41-46
- 21
Mizuta T, Benson W M, Foster B K, Paterson D C, Morris L L.
Statistical analysis of the incidence of physeal injuries.
J Pediatr Orthop.
1987;
7
518-523
- 22
Naranja R J, Gregg J R, Dormans J P, Drummond D S, Davidson R S, Hahn M.
Pediatric fracture without radiographic abnormality. Description and significance.
Clin Orthop.
1997;
342
141-146
- 23 Schick S, Trattnig S, Gabler C, Kukla C, Gahleitner A, Kainberger F, Ba-Ssalamah A,
Breitenseher M. Fortschr Röntgenstr 1999 170: 16-21
- 24
Lakatos K, Schadmand-Fischer S, Schumacher R.
Stressfraktur der Tibia beim Kleinkind. Aussagekraft bildgebender Diagnostik.
Fortschr Röntgenstr.
1998;
168
531-533
- 25
Hilfiker P, Zanetti M, Debatin J F, McKinnon G, Hodler J.
Fast spin-echo inversion-recovery imaging versus fast T2-weighted spin-echo imaging
in bone marrow abnormalities.
Invest Radiol.
1995;
30
110-114
- 26
Mirowitz S A, Apicella P, Reinus W R, Hammerman A M.
MR imaging of bone marrow lesions: relative conspicuousness on T1-weighted, fat-suppressed
T2-weighted, and STIR images.
AJR.
1994;
162
215-221
- 27
Rubin S J, Marquardt J D, Gottlieb R H, Meyers S P, Totterman S M, O'Mara R E.
Magnetic resonance imaging: a cost-effective alternative to bone scintigraphy in the
evaluation of patients with suspected hip fractures.
Skeletal Radiol.
1998;
27
199-204
- 28
Newberg A H, Wetzner S M.
Bone bruises: their patterns and significance.
Semin Ultrasound CT MR.
1994;
15
396-409
- 29
Nishimura G, Yamato M, Togawa M.
Trabecular trauma of the talus and medial malleolus concurrent with lateral collateral
ligamentous injuries of the ankle: evaluation with MR imaging.
Skeletal Radiol.
1996;
25
49-54
- 30
Anzilotti K, Schweitzer M E, Hecht P, Wapner K, Kahn M, Ross M.
Effect of foot and ankle MR imaging on clinical decision making.
Radiology.
1996;
201
515-517
Dr. Sascha Herber
Johannes-Gutenberg-Universität Mainz
Langenbeckstraße 1
55131 Mainz
Email: E-mail: herber@radiologie.klinik.uni-mainz.de
