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Radiology Today
E-Newsletter    August 2022
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Editor's E-Note

Identifying bone conditions is not always straightforward. At times, subtle signs can be misinterpreted or missed altogether. This month, we’re checking out some radiography news that sheds light on the process of image interpretation and a potential aid to early detection.

Enjoy the newsletter. Let us know what you think about it on Twitter and/or Facebook.

— Dave Yeager, editor
In This E-Newsletter
E-News Exclusive
Radiologists Reliably Differentiate Rickets and CMLs

Rickets and classic metaphyseal lesions (CMLs) exhibit distinct radiographic signs, and radiologists can reliably differentiate these two entities, according to a study in the American Journal of Roentgenology. Noting both high interobserver agreement and diagnostic performance for differentiating the two entities in this seven-center study, “recognition that CMLs mostly occur in children younger than 6 months and are unusual in children older than one year may assist interpretations,” notes corresponding author Boaz Karmazyn from the Riley Hospital for Children in Indianapolis.

Karmazyn and colleagues’ retrospective study included children younger than two years old who underwent knee radiographs from January 2017 to December 2018 and either had rickets (25-hydroxy vitamin D <20 ng/mL and abnormal knee radiographs) or knee CMLs and a diagnosis of child abuse from a pediatrician. Eight radiologists independently interpreted radiographs for rickets or CML diagnoses, rating confidence levels and logging associated radiographic signs.

Ultimately, children with CML were younger than children with rickets (3.9% vs 65.7% >1 year old). The rate of false-positive moderate or high-confidence interpretations was 0.6% for CML and 1.6% for rickets. Only a single child with CML and low vitamin D received an interpretation of combined CML and rickets.

Reiterating that less- and more-experienced pediatric and nonpediatric radiologists had high diagnostic performance in differentiating rickets and CML—regardless of the presence of vitamin D deficiency, with few false-positive interpretations for these diagnoses—the authors conclude, "findings suggestive of both rickets and CML should be viewed as indeterminate.”

— Source: American Roentgen Ray Society

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