Musculoskeletal Imaging in Children: Prologue

Imaging of the pediatric musculoskeletal system is both challenging and rewarding. It can be perplexing for several reasons, most notably the numerous normal variants in the growing skeleton that can mimic pathology. Children often do not localize pain well, and therefore the pathology may not always be included in the field of view, or the imaging survey may be so broad as not to center on the area of greatest concern. Injuries thought to be acute by history may in fact represent exacerbations of congenital conditions. Furthermore, many pathologic processes in children have not been fully elucidated, and our understanding of these conditions evolves as new research is published. For these reasons, among others, it is important to routinely update the educational literature for the practicing radiologist and clinician.

In this issue, we have included an article discussing emerging treatment techniques such as image-guided percutaneous ablation. For 2 decades, radiofrequency ablation has been the standard treatment for osteoid osteoma. The article discusses several other ablation techniques and their efficacy for the treatment of benign musculoskeletal tumors in children. Also included in this issue is a concise overview of orthopaedic hardware specific to pediatrics.

As imaging technologies advance and new techniques emerge, other modalities may be utilized less frequently or in particular contexts. The use of nuclear medicine examinations, for example, has declined for some pediatric conditions in favor of modalities free of ionizing radiation such as magnetic resonance imaging and ultrasound. Scintigraphic bone scans and positron emission tomography, however, remain useful in several scenarios discussed here.

As previously noted, children may often present with a new limp but cannot localize their pain well. One article seeks to provide an imaging algorithm for the acutely limping child and expounds on several etiologic conditions.

Osteochondritis dissecans is a topic of considerable interest in pediatric musculoskeletal imaging because misdiagnosis or overdiagnosis can lead to unnecessary procedures, and underdiagnosis can lead to poor outcomes such as early-onset arthritis. An overview of common skeletal dysplasias and other congenital skeletal disorders is also provided in this issue. Their complexities are a source of confusion and consternation among radiologists and orthopaedists alike. We have also included topics where terminology is often changing or is misrepresented, as is often the case with the osteochondroses.

The patella is a unique anatomical structure in the musculoskeletal system that is a frequent source of pain in children. The authors have provided a detailed account of normal and abnormal development of the patella, as well as the pathology that can ensue with trauma or malalignment of this sesamoid bone. Additionally, a comprehensive review of foot and ankle injuries in the child athlete casts light on an anatomical region that can be challenging for radiologists and another potential source of misdiagnosis.

The hard work, scholarship, and creativity of the contributing authors is very much appreciated. We hope the information included in this issue is useful to readers and makes their daily clinical practice even more rewarding.