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CORR Insights®: What is the Accuracy and Reliability of the Peritubercle Lucency Sign on Radiographs for Early Diagnosis of Slipped Capital Femoral Epiphysis Compared With MRI as the Gold Standard?

Inthis retrospective study,Maranho and colleagues [7] compared an identifiable finding on plain radiographs (the peritubercle lucency sign) to fluid-sensitive MRI sequences in order to identify patients who were in a “preslip” state of slipped capital femoral epiphysis (SCFE). The authors described a high degree of agreement between the presence of the peritubercle lucency sign and an MRI diagnosis of “preslip”. Having a plain radiographic finding that could identify a SCFE before displacement as effectively as MRI would be an important contribution towards less-expensive diagnostic testing of preslip conditions, but several related points deserve consideration. Social and economic factors have been associated with delays in timely diagnosis and treatment of health problems in children (including SCFE) [1, 3, 11]. Such factors include access to healthcare resources, late diagnosis because of variations in knowledge, delay in referral to specialists, and inconsistent ability of providers to interpret imaging results [3, 6, 11]. Although radiographs are less costly and more widely available than MRI, we still need to test them for their predictability in the setting of clinical pathways or diagnostic algorithms. False-positives leading to unnecessary treatments remain a concern, along with uncertainty regarding the risks and morbidity reduction associated with treatment of patients with preslip or contralateral slip compared to patients with mild or moderate displacement [8, 12].