Streamlining pediatric musculoskeletal infection workup: the why, what, and how of rapid MRI protocols

Acute musculoskeletal infection is a common pediatric emergency that requires early diagnosis and management, without which adverse sequelae can include functional impairment, limb deformities, persistent infection, progression to sepsis, and mortality. Magnetic resonance imaging (MRI) is the gold standard for diagnosis. In recent years, there has been growing interest in the use of rapid MRI protocols for acute pediatric musculoskeletal infection, with benefits including quicker scan times with decreased need for sedation and contrast. In the present study, we discuss key considerations, practical challenges, and clinical applications of rapid musculoskeletal MRI in children. We also include various case examples of rapid MRI scans with a practical guide for interpretation to be used by the practicing radiologist. Rapid MRI protocols ultimately present a powerful diagnostic tool that can condense the workup of patients being evaluated for acute musculoskeletal infection, and their incorporation into hospital systems should continue to be investigated.