Kathleen H. Emery

Adjustments of the standard helical CT protocols for adults can result in reduced radiation dose when imaging children. It is the radiologist's responsibility to critically evaluate the CT techniques used at their institution. Adjustments to CT protocols should be made to choose the appropriate mA and pitch when imaging children.

BACKGROUND: The purpose of the present study was to determine if patient age, lesion size, lesion location, presenting knee symptoms, and sex predict the healing status after six months of a standard protocol of nonoperative treatment for stable juvenile osteochondritis dissecans of the knee. METHODS: Forty-two skeletally immature patients (forty-seven knees) who presented with a stable osteochondritis dissecans lesion were included in the present study. All patients were managed with temporary immobilization followed by knee bracing and activity restriction. The primary outcome measure of progressive lesion reossification was determined from serial radiographs every six weeks, for up to six months of nonoperative treatment. A multivariable logistic regression model was used to determine potential predictors of healing status from the listed independent variables. RESULTS: After six months of nonoperative treatment, sixteen (34%) of forty-seven stable lesions had failed to progress toward healing. The mean surface area (and standard deviation) of the lesions that showed progression toward healing (208.7 +/- 135.4 mm(2)) was significantly smaller than that of the lesions that failed to show progression toward healing (288.0 +/- 102.6 mm(2)) (p = 0.05). A logistic regression model that included patient age, normalized lesion size (relative to the femoral condyle), and presenting symptoms (giving-way, swelling, locking, or clicking) was predictive of healing status. Age was not a significant contributor to the predictive model (p = 0.25). CONCLUSIONS: In two-thirds of immature patients, six months of nonoperative treatment that includes activity modification and immobilization results in progressive healing of stable osteochondritis dissecans lesions. Lesions with an increased size and associated swelling and/or mechanical symptoms at presentation are less likely to heal.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of MR imaging in predicting the pathologic diagnosis of soft-tissue masses, both neoplastic and nonneoplastic, and in distinguishing benign from malignant lesions. MATERIALS AND METHODS: The imaging features of 225 soft-tissue tumors (179 benign, 46 malignant) in 222 patients were analyzed. Univariate analysis of multiple individual imaging features was done, along with stepwise logistic regression analysis of combinations of imaging features, to determine how useful these are for predicting malignancy or benignity. A subjective (group consensus) analysis of each case was done prospectively, and each tumor was placed into one of three diagnostic categories: (1) benign, diagnostic of a specific entity; (2) nonspecific, most likely benign; or (3) nonspecific, most likely malignant. Results were compared with the final diagnosis established by pathologic examination (n = 184) or imaging/clinical data (n = 41). RESULTS: By quantitative analysis, no single imaging feature or combination of features could reliably be used to distinguish benign from malignant lesions. For the subjective analysis, a correct and specific benign diagnosis could be made on the basis of MR imaging findings in 100 (44%) of the 225 tumors. For the entire cohort, the sensitivity was 78%, the specificity was 89%, the positive predictive value was 65%, and the negative predictive value was 94% for a malignant diagnosis. When the diagnostic benign tumors were excluded, the specificity and negative predictive value decreased to 76% and 86%, respectively, whereas the sensitivity and positive predictive value remained the same. CONCLUSION: Many benign soft-tissue masses can be correctly and confidently diagnosed with MR imaging. The prevalence of benign lesions among soft-tissue masses accounts for the relatively high specificity and negative predictive value that can be achieved with MR imaging for tissue characterization. However, the accuracy of MR imaging declines when these characteristic benign tumors are excluded from analysis. A significant percentage of malignant lesions may appear deceptively "benign" with the currently used criteria. For lesions whose imaging appearance is nonspecific, MR imaging is not reliable for distinguishing benign from malignant tumors, and these lesions warrant biopsy in most cases.