A comparison of sagittal MRI and lateral radiography in determining the Insall-Salvati ratio and diagnosing patella alta in the pediatric knee.

BACKGROUND: The Insall-Salvati ratio is a technique for determining patellar height that relies on bony landmarks. Magnetic resonance imaging (MRI) and plain radiography are used interchangeably to assess the Insall-Salvati ratio in the pediatric population despite the lack of validity in the literature. OBJECTIVE: The purpose of this study was to investigate if the Insall-Salvati ratio and patella alta as determined on MRI are comparable to those determined on radiography in pediatric patients. MATERIALS AND METHODS: We conducted a retrospective review of 49 pediatric patients (age range: 7.5-17.0 years) with unfused growth plates who underwent both knee MRI and lateral knee radiography. Measurements for calculating the Insall-Salvati ratio (the ratio of patella tendon length to patella length) were obtained by three observers. Data were analyzed using paired t-tests and Pearson's correlation. A reliability assessment and inter-method agreements were performed. Patella alta was defined as an Insall-Salvati ratio > 1.2. Additional cutoffs of Insall-Salvati ratios > 1.3 and > 1.4 were also analyzed. RESULTS: There was no statistically significant difference between Insall-Salvati ratio as determined on MRI (mean: 1.20) and radiographs (mean: 1.25; P > 0.05). There was a strong correlation between Insall-Salvati ratio as determined on MRI and radiographs (Pearson's r = 0.6) with moderate consistency (Cronbach's alpha = 0.78). There was a good level of agreement between the diagnosis of patella alta on MRI and radiographs when defined as an Insall-Salvati ratio greater than 1.2 and 1.3 (Cohen's kappa = 0.61). CONCLUSION: The results demonstrate a strong association between Insall-Salvati ratio and patella alta derived from MRI and radiographs in children ages 7.5 years and older.

Benign sacrococcygeal teratoma incidentally found on routine scoliosis radiographs in a 12-year-old female: a case report.

OBJECTIVE: To describe the imaging characteristics of sacrococcygeal teratomas and to review appropriate diagnostic evaluation and management. CLINICAL FEATURES: 12-year-old otherwise healthy, asymptomatic female with an incidental pelvic mass found on routine scoliosis radiographs. INTERVENTION AND OUTCOME: The pelvic mass was further evaluated by MRI and CT scan. Management consisted of successful surgical resection with no postoperative complications. Pathology confirmed a mature, benign, sacrococcygeal teratoma. CONCLUSIONS: Chiropractors manage patients with scoliosis, which may include radiographic surveillance. Familiarity with the radiographic features of masses such as sacrococcygeal teratomas is important for prompt diagnosis and management.

OBJECTIF: Décrire les caractéristiques d'imagerie des tératomes sacrococcygiens et examiner l'évaluation et la prise en charge du diagnostic approprié. CARACTÉRISTIQUES CLINIQUES: Jeune fille asymptomatique de 12 ans en bonne santé avec une masse pelvienne découverte fortuitement après des radiographies de routine pour la scoliose. INTERVENTION ET RÉSULTATS: La masse pelvienne a davantage été évaluée à partir d'images d'IRM et de TDM. La solution était la résection chirurgicale réussie sans complications postopératoires. La pathologie a confirmé un tératome sacrococcygien mature bénin. CONCLUSIONS: Les chiropraticiens prennent en charge les patients atteints de scoliose, ce qui peut inclure la surveillance radiographique. La familiarité avec les caractéristiques radiographiques des masses, comme les tératomes sacrococcygiens, est importante pour leur diagnostic et la prise en charge rapide.

Congenital infantile fibrosarcoma: review of imaging features.

BACKGROUND: Fibrosarcoma is a rare tumor in children with limited information on imaging features of these tumors in the literature. OBJECTIVE: To retrospectively review the imaging features of histologically proven congenital infantile fibrosarcoma. MATERIALS AND METHODS: The list of histologically confirmed congenital infantile fibrosarcomas between November 1999 and June 2013 was obtained from the oncology-pathology database. Imaging features and pathology reports of these tumors were reviewed. Patient charts were reviewed and clinical features, management and outcomes were recorded. RESULTS: During the study period, 13 children (9 girls and 4 boys; age range: 0 day-16 months, median age: 2.5 months) with congenital infantile fibrosarcomas were available for complete radiological review. The translocation (t[12;15]) was present in 11/13 (84.6%) and absent in 2/13. Eight/thirteen (61.5%) tumors were located in extremities (5 in lower and 3 in upper), 3/13 in thoracolumbar paraspinal regions, and one each in abdomen and sternocleidomastoid muscle. Imaging features included iso- to hyperintensity on T1-W, hyperintensity on T2-W as compared to skeletal muscles and heterogeneous enhancement. Six (37.5%) tumors showed hemorrhagic components and 2 (15.4%) showed low intensity foci. None of the patients had evidence of regional or distant metastases at diagnosis. Management included surgical resection only (1/13) and combined surgery and chemotherapy (10/13). Overall survival was 100% with a median follow-up of 49.3 months. CONCLUSION: Congenital infantile fibrosarcoma has nonspecific imaging characteristics but should be high on the differential diagnosis in a soft-tissue tumor presenting in infancy, located in an extremity and showing tumoral hemorrhage. Patients have a favorable outcome.