MRI Spine MRI of the total spine is sensitive for the imaging evaluation of soft-tissue and bony abnormalities associated with pediatric back pain, including paraspinous soft-tissue pathology, disc disease, marrow edema, and intraspinal masses [8,24-26,32]. Nonneoplastic intraspinal etiologies of back pain such as syrinx and meningoceles are well demonstrated using MRI [34,35]. Two large prospective studies have used MRI in an algorithm for evaluation of pediatric back pain in a total of 348 patients [1,5]. These studies found that MRI had high diagnostic accuracy in identifying and delineating the etiology of pediatric back pain. MRI is especially useful in evaluation of children with positive neurologic findings and should be considered the primary imaging modality in this subset of patients. An imaging algorithm has been proposed that includes only MRI in the imaging evaluation of children with positive neurologic findings [4]. Contrast is helpful in the evaluation of back pain in children when there is clinical or laboratory evidence of infection, inflammation, or tumor [8,13,33]. If contrast is administered, precontrast images are helpful to assess enhancement. There is little use for performing an MRI with contrast only. MRI of the spine in the clinical setting of back pain should always be performed with fat-saturated imaging techniques, especially following the administration of contrast. CT Spine Fractures and bone lesions are well delineated on targeted noncontrast CT [7,15]. CT has been found to be complementary to bone scan in evaluation of spondylolysis [4,30]. CT with contrast can be used when infection or tumor is suspected; however, MRI without and with contrast is the modality of choice in the evaluation of these patients. CT with contrast targeted to the area of interest should be considered only when MRI is contraindicated or not feasible. Performing CT both without and with contrast is not usually indicated.
Back Pain Child PCAs. MRI Spine MRI of the total spine is sensitive for the imaging evaluation of soft-tissue and bony abnormalities associated with pediatric back pain, including paraspinous soft-tissue pathology, disc disease, marrow edema, and intraspinal masses [8,24-26,32]. Nonneoplastic intraspinal etiologies of back pain such as syrinx and meningoceles are well demonstrated using MRI [34,35]. Two large prospective studies have used MRI in an algorithm for evaluation of pediatric back pain in a total of 348 patients [1,5]. These studies found that MRI had high diagnostic accuracy in identifying and delineating the etiology of pediatric back pain. MRI is especially useful in evaluation of children with positive neurologic findings and should be considered the primary imaging modality in this subset of patients. An imaging algorithm has been proposed that includes only MRI in the imaging evaluation of children with positive neurologic findings [4]. Contrast is helpful in the evaluation of back pain in children when there is clinical or laboratory evidence of infection, inflammation, or tumor [8,13,33]. If contrast is administered, precontrast images are helpful to assess enhancement. There is little use for performing an MRI with contrast only. MRI of the spine in the clinical setting of back pain should always be performed with fat-saturated imaging techniques, especially following the administration of contrast. CT Spine Fractures and bone lesions are well delineated on targeted noncontrast CT [7,15]. CT has been found to be complementary to bone scan in evaluation of spondylolysis [4,30]. CT with contrast can be used when infection or tumor is suspected; however, MRI without and with contrast is the modality of choice in the evaluation of these patients. CT with contrast targeted to the area of interest should be considered only when MRI is contraindicated or not feasible. Performing CT both without and with contrast is not usually indicated.