T2- weighted images and fat-suppression techniques are necessary for evaluating for marrow edema and paraspinal pathology. MRI without contrast is often able to determine a cause of mechanical back pain, most commonly spondylolysis, with high sensitivity [22-24]. Recent studies have demonstrated MRI to be more sensitive than computed tomography (CT) and a potential first-line test in the evaluation of spondylolysis [23,24]. Fluid- sensitive and fat-suppressed MRI techniques are able to identify stress reaction (marrow edema) in the pedicles as well as spondylolisthesis, which are the 2 findings that guide management of these patients [22,24]. MRI is optimal for demonstrating degenerative disc pathology, which may be more common in the pediatric population than previously suspected [25,26]. The main advantage of MRI is optimal intraspinal and paraspinal soft-tissue evaluation. Intraspinal tumors can present with back pain and MRI is the indicated imaging modality in this subset of patients [27,28]. Osteomyelitis and epidural and paraspinal infection are well demonstrated on MRI and can guide surgical intervention [13,14,29]. Fat-suppressed T2 and T1 postcontrast MRI sequences such as short tau inversion recovery, Dixon, and fat-suppressed turbo spin echo are necessary for evaluation of suspected infectious or neoplastic disease involving the vertebrae, discs, or paraspinous soft tissues [8]. Computed Tomography CT without contrast provides excellent bone detail. The modality is suboptimal for evaluating the intraspinal contents and the paraspinal soft tissues in comparison with MRI. The ability of CT to reconstruct in multiple planes and perform 3D volume-rendered images is an advantage. CT targeted to the area of interest can be useful in the evaluation of suspected spondylolysis as well as primary bone tumors such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst [15,27,30]. However, CT does not demonstrate associated marrow edema.
Back Pain Child PCAs. T2- weighted images and fat-suppression techniques are necessary for evaluating for marrow edema and paraspinal pathology. MRI without contrast is often able to determine a cause of mechanical back pain, most commonly spondylolysis, with high sensitivity [22-24]. Recent studies have demonstrated MRI to be more sensitive than computed tomography (CT) and a potential first-line test in the evaluation of spondylolysis [23,24]. Fluid- sensitive and fat-suppressed MRI techniques are able to identify stress reaction (marrow edema) in the pedicles as well as spondylolisthesis, which are the 2 findings that guide management of these patients [22,24]. MRI is optimal for demonstrating degenerative disc pathology, which may be more common in the pediatric population than previously suspected [25,26]. The main advantage of MRI is optimal intraspinal and paraspinal soft-tissue evaluation. Intraspinal tumors can present with back pain and MRI is the indicated imaging modality in this subset of patients [27,28]. Osteomyelitis and epidural and paraspinal infection are well demonstrated on MRI and can guide surgical intervention [13,14,29]. Fat-suppressed T2 and T1 postcontrast MRI sequences such as short tau inversion recovery, Dixon, and fat-suppressed turbo spin echo are necessary for evaluation of suspected infectious or neoplastic disease involving the vertebrae, discs, or paraspinous soft tissues [8]. Computed Tomography CT without contrast provides excellent bone detail. The modality is suboptimal for evaluating the intraspinal contents and the paraspinal soft tissues in comparison with MRI. The ability of CT to reconstruct in multiple planes and perform 3D volume-rendered images is an advantage. CT targeted to the area of interest can be useful in the evaluation of suspected spondylolysis as well as primary bone tumors such as osteoid osteoma, osteoblastoma, and aneurysmal bone cyst [15,27,30]. However, CT does not demonstrate associated marrow edema.