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Comparing Sonography with MR Imaging of Apophyseal Injuries of the Pelvis in Four Boys

¹ Both authors: Department of Radiology, North Shore University Hospital, 825 Northern Blvd., Great Neck, NY 11021.

View larger version (98K): [in a new window]   Fig. 1A. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Anteroposterior radiograph of pelvis (A) and coned radiographic view of symptomatic right side (B) obtained 1 day after injury show no abnormality.

View larger version (127K): [in a new window]   Fig. 1B. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Anteroposterior radiograph of pelvis (A) and coned radiographic view of symptomatic right side (B) obtained 1 day after injury show no abnormality.

View larger version (121K): [in a new window]   Fig. 1C. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Sagittal fat-suppressed fast spin-echo T2-weighted MR image (TR/TE, 4400/52; echo train length, 8) of asymptomatic side shows normal anteroinferior iliac spine (large arrow) and rectus femoris tendon (small arrow).

View larger version (128K): [in a new window]   Fig. 1D. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Sagittal fat-suppressed fast spin-echo T2-weighted MR image (4400/52; echo-train length, 8) of symptomatic side shows widening of physis (large arrow). Note high-signal-intensity edema and hemorrhage (small arrows) in gap and surrounding soft tissues.

View larger version (156K): [in a new window]   Fig. 1E. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Longitudinal sonogram of asymptomatic side shows rectus femoris tendon (R) arising from normal anteroinferior iliac spine (S), apophysis of which is thin echogenic line (curved arrow) closely apposed to anteroinferior iliac spine. Hypoechoic region between tendon and apophysis is due to anisotropy of tendon. Note echogenic cortex (straight arrow) of femoral head.

View larger version (153K): [in a new window]   Fig. 1F. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Longitudinal sonogram of symptomatic side shows widening of physis with heterogeneous echogenicity (arrow) in gap.

View larger version (125K): [in a new window]   Fig. 1G. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Power Doppler sonogram obtained through left anteroinferior iliac spine shows normal background flow.

View larger version (150K): [in a new window]   Fig. 1H. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 14 days after injury. Power Doppler sonogram obtained through avulsed right anteroinferior iliac spine shows marked hyperemia in widened apophysis and surrounding soft tissues.

View larger version (89K): [in a new window]   Fig. 2A. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Anteroposterior radiograph of pelvis (A) and coned radiographic view of symptomatic left side (B) obtained 2 days after injury show ill-defined density adjacent to anterosuperior iliac spine (arrows, B), which was misinterpreted as periosteal reaction, for which patient was referred for additional imaging.

View larger version (101K): [in a new window]   Fig. 2B. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Anteroposterior radiograph of pelvis (A) and coned radiographic view of symptomatic left side (B) obtained 2 days after injury show ill-defined density adjacent to anterosuperior iliac spine (arrows, B), which was misinterpreted as periosteal reaction, for which patient was referred for additional imaging.

View larger version (64K): [in a new window]   Fig. 2C. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Axial fat-suppressed fast spin-echo T2-weighted MR image (TR/TE, 3200/52; echo-train length, 8) obtained through pelvis at level of anterosuperior iliac spine shows normal right side (curved solid arrow), avulsed and laterally displaced left anterosuperior iliac spine, and attached sartorius tendon (curved open arrow) with marked edema and hemorrhage (straight arrow) in surrounding soft tissues.

View larger version (126K): [in a new window]   Fig. 2D. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Transverse sonogram of asymptomatic right side shows normal apophysis (arrow) and anterosuperior iliac spine (S).

View larger version (94K): [in a new window]   Fig. 2E. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Transverse sonogram of left symptomatic side shows avulsed and displaced left apophysis (arrow). S = anterosuperior iliac spine.

View larger version (106K): [in a new window]   Fig. 2F. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Power Doppler sonogram of normal anterosuperior iliac spine shows normal background flow.

View larger version (114K): [in a new window]   Fig. 2G. —14-year-old boy injured while sprinting. MR imaging and sonography were performed 4 days after injury. Power Doppler sonogram of affected side shows hyperemia surrounding avulsed apophysis.

View larger version (130K): [in a new window]   Fig. 3A. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Anteroposterior radiograph of pelvis (A) and coned radiographic view of symptomatic right side (B) obtained 1 day after injury show no abnormality.

View larger version (115K): [in a new window]   Fig. 3B. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Anteroposterior radiograph of pelvis (A) and coned radiographic view of symptomatic right side (B) obtained 1 day after injury show no abnormality.

View larger version (83K): [in a new window]   Fig. 3C. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Axial fat-suppressed fast spin-echo T2-weighted MR image (TR/TE, 4500/52, echo-train length, 8) obtained through pelvis at level of anteroinferior iliac spine shows widening (arrow) of avulsed right side.

View larger version (125K): [in a new window]   Fig. 3D. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Longitudinal sonogram of asymptomatic left side shows normal apophysis (curved arrow) overlying anteroinferior iliac spine (S). Note echogenic cortex (straight arrow) of femoral head.

View larger version (153K): [in a new window]   Fig. 3E. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Longitudinal sonogram of right symptomatic side shows displacement of avulsed apophysis (white arrow) from underlying anteroinferior iliac spine (S) and widening of physis (black arrow).

View larger version (152K): [in a new window]   Fig. 3F. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Power Doppler sonogram of normal anteroinferior iliac spine shows normal background flow.

View larger version (156K): [in a new window]   Fig. 3G. —13-year-old boy injured while playing soccer. MR imaging and sonography were performed 4 days after injury. Power Doppler sonogram of avulsed anteroinferior iliac spine shows hyperemia in apophysis and surrounding soft tissues.

View larger version (66K): [in a new window]   Fig. 4A. —15-year-old boy injured while playing soccer. MR imaging and sonography were performed 60 days after injury. Axial fat-suppressed fast spin-echo T2-weighted MR image (TR/TE, 4000/56; echo-train length, 8) obtained through pelvis at level of anteroinferior iliac spine shows widening (arrow) of avulsed right side.

View larger version (170K): [in a new window]   Fig. 4B. —15-year-old boy injured while playing soccer. MR imaging and sonography were performed 60 days after injury. Sagittal fat-suppressed fast spin-echo T2-weighted MR image (400/48; echo-train length, 8) of symptomatic side shows widening of physis (arrow). Note absence of edema and hemorrhage in adjacent soft tissues.

View larger version (145K): [in a new window]   Fig. 4C. —15-year-old boy injured while playing soccer. MR imaging and sonography were performed 60 days after injury. Longitudinal sonogram of asymptomatic left side shows normal apophysis (arrow) overlying anteroinferior iliac spine (S).

View larger version (143K): [in a new window]   Fig. 4D. —15-year-old boy injured while playing soccer. MR imaging and sonography were performed 60 days after injury. Longitudinal sonogram of right symptomatic side shows displacement of avulsed apophysis (curved arrow) from underlying anteroinferior iliac spine (S) and widening of physis (straight arrow).

View larger version (153K): [in a new window]   Fig. 4E. —15-year-old boy injured while playing soccer. MR imaging and sonography were performed 60 days after injury. Power Doppler sonogram of avulsed anteroinferior iliac spine shows no hyperemia.

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