Classifications for radiographic evaluation of radiolucent bone lesions have poor inter- and intra-observer agreement.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declarations. Ethics approval and consent to participate: This study was subject to ethics board approval and deemed IRB exempt (SUNY Upstate IRB, Syracuse, NY #2191652-1). Participants were limited to voluntary and informed orthopedic trainees and faculty. All included images were deidentified. Consent for publication: Not applicable. Competing interests: One author (TAD) has received funding from: BMC Musculoskeletal Disorders: Editorial or governing board. Bone Support (Cerament): Paid consultant. BoneSupport (Cerament): Research support. Clinical Orthopaedics and Related Research: Editorial or governing board. eMedicine: Editorial or governing board; Publishing royalties, financial or material support. Journal of Orthopaedic Research: Editorial or governing boardJournal of Surgical Oncology: Editorial or governing board. Journal of the American Academy of Orthopaedic Surgeons: Publishing royalties, financial or material support. Medicina: Editorial or governing board. Open Journal of Orthopedics: Editorial or governing board. OREF: Research support. PLOS One: Editorial or governing board. Stryker: Research support. Up To Date: Publishing royalties, financial or material support. Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Wright Medical Technology, Inc.: Research support. The remaining authors (TJW, SMP, KAM, SC) do not have any disclosures. 19. Br J Radiol. 2022 Jun 1;95(1134):20211397. doi: 10.1259/bjr.20211397. Epub 2022 Mar 28. Differential diagnosis of hip pain in children referred to a specialist bone tumour service. Choraria A(1), O'Donnell P(1), Saifuddin A(1). Author information: (1)Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7, LP, UK. OBJECTIVE: 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. METHODS: 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. RESULTS: 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 (p < 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. CONCLUSION: 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. ADVANCES IN KNOWLEDGE: 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. DOI: 10.1259/bjr.20211397 PMCID: PMC10996422