Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7, LP, UK.
Br J Radiol. 2022 Jun 1;95(1134):20211397. doi: 10.1259/bjr.20211397. Epub 2022 Mar 28.
To determine the differential diagnosis of bone lesions causing hip pain in children and the association between radiographic features of aggression and MRI appearances with final diagnosis.
Retrospective review of children with hip pain referred to a specialist musculoskeletal oncology service between September 2018 and December 2020. Patient demographics, lesion location, the radiographic and MRI features, and the final diagnosis, which was made either by image-guided biopsy, surgical curettage or based on typical imaging features were recorded. Statistical analysis examined the association between the Lodwick-Madewell score (determined from available radiographs) and MRI findings with final diagnosis.
Fifty-nine patients were included, 40 males and 19 females with mean age 10.9 years, (range 3-16 years). Final diagnoses were based on histology in 24 (40.7%) cases and imaging in 35 (59.3%) cases. Eighteen lesions (30.5%) were classed as non-neoplastic, 31 (52.5%) as benign and 10 (16.9%) as malignant, of which four were primary bone sarcomas. There was a significant association between the Lodwick-Madewell score and final diagnosis ( < 0.001). On MRI, bone marrow oedema, presence of a focal lesion, bone expansion and the presence of an extraosseous mass were all significantly associated with final diagnostic classification.
The differential diagnosis of hip pain in children presenting to a bone tumour service is wide. Most cases are due to benign or non-neoplastic conditions, with only 10 out of 59 children having a malignant lesion. Radiography complemented by MRI plays a major role in differentiating non-neoplastic, benign neoplastic and malignant lesions and in determining the requirement for needle biopsy.
This is the first study to consider how imaging features relate to diagnosis in suspected paediatric hip tumours. Use of this information can help in determining which cases should undergo needle biopsy.
确定导致儿童髋关节疼痛的骨病变的鉴别诊断，以及侵袭性放射学特征与 MRI 表现与最终诊断之间的关系。
回顾性分析 2018 年 9 月至 2020 年 12 月期间因髋关节疼痛而转至专业肌肉骨骼肿瘤服务的儿童患者。记录患者人口统计学资料、病变部位、放射学和 MRI 特征以及最终诊断，最终诊断是通过图像引导活检、手术刮除或基于典型影像学特征做出的。统计分析检查了 Lodwick-Madewell 评分（根据现有 X 线片确定）与 MRI 结果与最终诊断之间的关系。
共纳入 59 例患者，男 40 例，女 19 例，平均年龄 10.9 岁（范围 3-16 岁）。24 例（40.7%）的最终诊断基于组织学，35 例（59.3%）基于影像学。18 个病变（30.5%）为非肿瘤性，31 个（52.5%）为良性，10 个（16.9%）为恶性，其中 4 个为原发性骨肉瘤。Lodwick-Madewell 评分与最终诊断有显著相关性（<0.001）。在 MRI 上，骨髓水肿、局灶性病变、骨膨胀和骨外肿块的存在均与最终诊断分类有显著相关性。
在转至骨肿瘤服务的儿童髋关节疼痛的鉴别诊断广泛。大多数病例是良性或非肿瘤性的，59 例患儿中只有 10 例为恶性病变。放射学结合 MRI 在区分非肿瘤性、良性肿瘤性和恶性病变以及确定是否需要进行针吸活检方面发挥着重要作用。
这是第一项研究考虑影像学特征与疑似小儿髋关节肿瘤诊断之间的关系。利用这些信息可以帮助确定哪些病例需要进行针吸活检。
