Children with back pain - a radiologist's approach

Abstract

Purpose: The aim of the study was to analyse magnetic resonance imaging (MRI) of paediatric patients referred because of back pain.

Material and methods: The retrospective analysis included the medical records of 328 patients referred in 2020-2022 to the Department of Paediatric Radiology for spine examination. The criterion for inclusion in the analysed group was back pain as the dominant symptom. This symptom occurred in 20% (68 patients) of referrals for MRI examinations. The examination was performed with the 3T Magnetom Spectra.

Results: In 68 patients aged 2 to 17 years, with back pain as the first diagnosis, 53% (36 patients - 16 girls and 20 boys) showed abnormalities. The rest of the tests were assessed as normal. Among the patients with an abnormal MR image, the largest group were children with degenerative changes diagnosed: 10 children (28%) aged 13-17 years. In 9 patients (25%) aged 2-16 years the final diagnosis qualified the patients to the group of oncological diagnoses. Another group of 7 (19%) patients, aged 6-14 years, comprised children diagnosed with inflammation. The group of 5 patients, aged 3-17 years, presented symptoms most likely related to the trauma. One 7-year-old boy was diagnosed with large calcifications within the intervertebral disc.

Conclusions: Back pain, with accompanying neurological symptoms, should not be underestimated. Although in most clinical situations the MR image is normal, in the case of persistent symptoms and neurological abnormalities confirmed by the clinician, extending the diagnostics with MR imaging should be considered. This imaging can accelerate the correct diagnostic path or make a very precise diagnosis.

Keywords: back pain; children; imaging; magnetic resonance.

Figure 1

Magnetic resonance examination of spine. PT3 – 14-year-old girl with disc herniation – arrow. A) T1-weighted sag, B) T2-weighted sag, C) T1-weighted axial, D) T2-weighted axial. A left-sided intraforaminal disc herniation at L3/L4 with suspected impingement of the left exiting L3 nerve

Figure 2

Magnetic resonance examination of spine. PT21 – 5-year-old girl with histiocytosis – arrow. A) T1-weighted sag, B) T1-weighted post contrast sag, C) T2-weighted sag, D) T2-weighted short time inversion recovery TIRM sag. Well-defined lesion in the central part of the L2 vertebra with a low-signal band visible in all sequences, slightly enhancing after contrast administration

Figure 3

Magnetic resonance examination of spine. PT16 – 9-year-old boy with acute myeloid leukaemia, myeloid sarcoma – arrows. A) T1-weighted sag, B) T1-weighted post-contrast sag, C) T2-weighted short time inversion recovery TIRM sag. Multifocal mass of the tumour, enhancing after contrast administration, visible inside the spinal canal, epidural. Second lesion visible on the anterior surface of the sacrum

Figure 4

Magnetic resonance examination of spine. PT26 – 10-year-old boy with tuberculosis – arrow. A) T1-weighted sag, B) T1-weighted post contrast sag, C) T2-weighted sag, D) T2-weighted short time inversion recovery TIRM sag. Irregularity of both the endplate and anterior aspect of the vertebral bodies Th10-Th11, with bone marrow oedema and post-contrast enhancement. Complete destruction of the intervertebral disc

Figure 5

Magnetic resonance examination of spine. PT 27 – 12-year-old boy with acute transverse myelitis – arrow. A) T1-weighted sag, B) T1-weighted post contrast sag, C) T2-weighted sag, D) T2-weighted short time inversion recovery TIRM sag. Changes involve numerous segments of the spine, more than two-thirds of the cross-sectional area of the core with spinal cord enlargement. T1-isointense, T2-hyperintense signal, T1-post-contrast enhancement

Figure 6

Magnetic resonance and computed tomography (CT) examinations of spine. PT 36 – 7-year-old boy with Iintervertebral disc calcification – arrow. A) T1-weighted sag, B) T2-weighted sag, C) T2-weighted short time inversion recovery TIRM sag, D) – CT MPR sag bone window. CT of the spine confirmed the presence of calcification. MRI of the cervical spine showed an altered signal intensity involving the intervertebral disc at C3-4 with areas of T1 and T2 hypointensity consistent with calcification

Figure 7

Magnetic resonance examination of spine. PT 33 – 3-year-old boy with haematoma – arrow. A) T1-weighted FS sag, B) T1-weighted FS post contrast sag, C) T2-weighted sag. Mass effect extradural haematoma in spinal canal. High signal on T1- and T2-weighted imaging