Rapid MRI for acute pediatric MSK infections: survey of current utilization and procedural practices

Background: Some institutions have implemented rapid MRI protocols for acute musculoskeletal (MSK) infections as an attempt to improve early diagnosis. Objective: To assess current utilization of pediatric rapid MSK MRI protocols (abbreviated protocol, no IV (intravenous) contrast, and no sedation) using a survey. Materials and methods: A 10-question survey was sent to members of the Society for Pediatric Radiology (SPR) and the Society of Skeletal Radiology, which differed depending on whether a rapid protocol was used or not. The survey was conducted by the SPR MSK and MRI committees. Results: A total of 134 surveys (representing 99 institutions) were completed. Twenty-two percent (22/99) of institutions used a rapid protocol. Pediatric institutions were more likely to perform it when compared to adult institutions (P-value<0.01, 37% (14/38) vs. 13% (8/61)). Comparing institutions that use rapid protocol with institutions that do not, the availability of on-call MRI technologists did not differ (P-value=0.33), and pediatric radiologists were more likely to interpret these studies (73% (16/22) vs. 36% (28/77), P-value=0.02). Reported rapid MRI completion times took less than 15 min in 64% (14/22) of the institutions. Seventy-three percent (16/22) of institutions performing rapid protocols have radiologists check images to evaluate the need for additional sequences or contrast. Sixty-eight percent (25/37) reported being very satisfied with rapid protocols. Seventy-seven of 99 institutions do not use a rapid protocol due to a lack of a consensus protocol and concerns about missing findings. Of these institutions, 62% (48/77) administer IV contrast routinely. Conclusion: There is limited and variable utilization of rapid MRI protocols for acute pediatric MSK infection. Lack of accepted consensus protocol is the most common reason for non-implementation, highlighting the need for consensus-driven rapid protocols.