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. CT Spine Bone lesions and fractures are well delineated on targeted noncontrast CT [7,15]. However, radiographs should be obtained initially. Although CT with contrast may be helpful when infection or tumor is suspected, MRI without and with contrast is the modality of choice in the evaluation of these patients. CT with contrast should be considered only when MRI is contraindicated or not feasible. CT both without and with contrast is not usually indicated. In the circumstance where there is a need to determine the presence of calcifications, limited noncontrast images could be obtained through the area of interest. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Tc-99m bone scan may be a useful screening tool in children with back pain and no specific neurologic findings on physical examination [4]. However, radiographs should be the initial imaging examination and may direct further evaluation. Myelography and Postmyelography CT Spine Because of the invasiveness of the procedure, myelography and postmyelography CT of the whole spine are considered in the setting of an abnormal neurologic examination only if MRI is contraindicated or will have significantly limited diagnostic yield because of spinal hardware. Variant 3: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Negative radiographs. Children with negative radiographs and back pain associated with clinical red flags should undergo additional imaging evaluation.
Back Pain Child PCAs. 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. CT Spine Bone lesions and fractures are well delineated on targeted noncontrast CT [7,15]. However, radiographs should be obtained initially. Although CT with contrast may be helpful when infection or tumor is suspected, MRI without and with contrast is the modality of choice in the evaluation of these patients. CT with contrast should be considered only when MRI is contraindicated or not feasible. CT both without and with contrast is not usually indicated. In the circumstance where there is a need to determine the presence of calcifications, limited noncontrast images could be obtained through the area of interest. Bone Scan Whole Body with SPECT or SPECT/CT Complete Spine Tc-99m bone scan may be a useful screening tool in children with back pain and no specific neurologic findings on physical examination [4]. However, radiographs should be the initial imaging examination and may direct further evaluation. Myelography and Postmyelography CT Spine Because of the invasiveness of the procedure, myelography and postmyelography CT of the whole spine are considered in the setting of an abnormal neurologic examination only if MRI is contraindicated or will have significantly limited diagnostic yield because of spinal hardware. Variant 3: Child. Back pain with 1 or more of the following clinical red flags: constant pain, night pain, radicular pain, pain lasting >4 weeks, abnormal neurologic examination. Negative radiographs. Children with negative radiographs and back pain associated with clinical red flags should undergo additional imaging evaluation.