Radiologia brasileira · 2025
Multimodal imaging of apophyseal avulsion fractures in adolescent soccer players: contributions of plain radiography, power Doppler, and magnetic resonance imaging.
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Mogami Roberto, Ribeiro Filho Claudio Henrique Ivo de Araújo, Dos Santos Eduardo Brown Guedes, Vieira André de Almeida, da Luz Lucas Nascimento, Leidersnaider Caio Leal, de Azevedo Natália Fernandes, Marchiori Edson, Gomes Paulo Sérgio Chagas
Аннотация
OBJECTIVE: To evaluate, primarily, the accuracy of plain radiography (X-ray) in diagnosing apophyseal avulsion fractures in adolescent soccer players, using magnetic resonance imaging (MRI) as the gold standard. As secondary objectives, we investigated associations between findings on X-ray, MRI, and power Doppler, as well as the imaging features that distinguish avulsion fractures from apophysitis.
MATERIALS AND METHODS: This was an observational cross-sectional study involving 33 male athletes 9-17 years of age with clinical suspicion of an apophyseal avulsion fracture. Imaging examinations were performed within the first 24 h after the trauma. We evaluated diagnostic reproducibility among readers, the accuracy of X-ray compared with MRI, and the associations between findings from different imaging methods.
RESULTS: We found that X-ray had an accuracy of 56.0%, with high specificity (71.4%) and positive predictive value (81.8%), although its sensitivity and negative predictive value were relatively low (50.0% and 35.7%, respectively). The power Doppler result was significantly associated with avulsion fractures detected on MRI (p = 0.0144). Avulsion fractures were associated with periphyseal edema and intermuscular fluid collections, while apophysitis was associated with bone marrow edema.
CONCLUSION: X-ray is useful for confirming, but not for excluding, avulsion fractures. Power Doppler and MRI contribute to the differential diagnosis.
MATERIALS AND METHODS: This was an observational cross-sectional study involving 33 male athletes 9-17 years of age with clinical suspicion of an apophyseal avulsion fracture. Imaging examinations were performed within the first 24 h after the trauma. We evaluated diagnostic reproducibility among readers, the accuracy of X-ray compared with MRI, and the associations between findings from different imaging methods.
RESULTS: We found that X-ray had an accuracy of 56.0%, with high specificity (71.4%) and positive predictive value (81.8%), although its sensitivity and negative predictive value were relatively low (50.0% and 35.7%, respectively). The power Doppler result was significantly associated with avulsion fractures detected on MRI (p = 0.0144). Avulsion fractures were associated with periphyseal edema and intermuscular fluid collections, while apophysitis was associated with bone marrow edema.
CONCLUSION: X-ray is useful for confirming, but not for excluding, avulsion fractures. Power Doppler and MRI contribute to the differential diagnosis.