Rapid MRI Protocol Gets Kids with Musculoskeletal Infections the Care They Need Faster

Lurie Children’s orthopedic surgeons and radiologists have implemented and are working together to publish findings on a protocol that will help children with suspected musculoskeletal infections get the treatment they need faster. 

In an effort led by orthopaedic surgeon Dr. Romie Gibly and radiologist Dr. Jonathan Samet, Lurie Children’s has developed and implemented a rapid MRI protocol for pediatric musculoskeletal infection diagnosis.  

Because MRIs are considered the gold standard for accurate diagnosis of a suspected musculoskeletal infection, Dr. Gibly and Dr. Samet sought a way to dramatically improve the speed and access to the scan so that patients could be imaged and diagnosed much faster – from what used to be up to 24 hours down to as little as two hours. 

Common pediatric osteoarticular infections include osteomyelitis, septic arthritis and pyomyositis. These infections often require evaluation in the emergency department, hospital admission and possible interventional radiology drainage or surgical debridement. Multiple research articles have demonstrated worse complication and outcomes with delayed treatment. Many factors that can result in delayed access to a scan to help determine best treatment, such as long wait times in the emergency department, COVID testing, anesthesia requirements for sedation, MRI availability and long MRI scan times, Dr. Gibly said.  

The new MRI protocol developed by Drs. Gibly and Samet is without sedation or contrast, and includes sequences optimized for speed and fluid detection. With these parameters in place, it is easier to fit patients with suspected musculoskeletal infections into the MRI schedule with less notice, the physicians say, resulting in faster scan results according to their early findings. 

The team already has seen evidence of improved time to treatment initiation, decreased costs and decreased length of hospital stay.  

The protocol is optimized specifically for acute infections, meaning that it cannot be effectively used for other indications such as injury and trauma, Dr. Gibly said. 

Drs. Gibly and Samet continue to study this effort and are presenting their early results at national orthopedic and radiology meetings this winter and spring.