Is MRI accurate for assessing the age of teen athletes?

By Wayne Forrest, AuntMinnie.com staff writer

August 18, 2016 -- A policy by the Fédération Internationale de Football Association (FIFA) of using MRI to verify the ages of young soccer players perhaps should get the boot, figuratively speaking, based on a number of clinical studies and radiology and orthopedic specialists.

FIFA has endorsed the use of MRI scans to assess bone development in the wrists of players participating in tournaments, such as those for athletes 17 years of age and younger. The goal is to prevent older players without birth certificates or other forms of age verification from entering youth tournaments.

However, the accuracy of such scans is coming into question, according to an article published August 11 in Scientific American. "The science suggests that applying a lone wrist MRI test to make such determinations is inappropriate at best and potentially harmful at worst," wrote author Dina Fine Maron.

The controversy flared when the Confederation of African Football followed FIFA's MRI scanning policy and ruled 24 players on the Nigeria team as ineligible from the Africa Cup of Nations, according to the article.

As evidence of the validity of its protocol, FIFA has cited a 2007 study by Dvorak et al in the British Journal of Sports Medicine in which the Swiss and Malaysian researchers performed wrist MRI scans on approximately 500 individuals ages 14 to 19. Using a six-stage model to match subjects' wrist bone development with their age, the group found a highly significant correlation (p < 0.001) between age and grade of wrist bone fusion (94% agreement).

However, a 2013 study by Sarkodie et al in the South African Journal of Sports Medicine contradicted those findings, concluding there was "no significant correlation between the chronological age and the degree of fusion" among 86 male soccer players from Ghana. Although the mean age of the subjects was 15.4 years, 43% of the MR images rated wrist bone development at stage 6, which would indicate the athletes were at least 17 years old. Most interestingly, 93% of the grade 6 players were only 15 to 16 years old.

Dr. Vicente Gilsanz, a professor of radiology and pediatrics at the University of Southern California, told Scientific American that the FIFA policy is rather suspect. Gilsanz said there is too much variation in how soon wrist bones fuse among teenage and young adult athletes for MRI results to be conclusive.

Even FIFA appears to be recognizing the flaws in its clinical logic. The Scientific American article cites an analysis published earlier this year by FIFA's own researchers (Tscholl et al) in the Scandinavian Journal of Sports Medicine that evaluated 487 female soccer players ages 13 to 19 from Brazil, Germany, Malaysia, and Tanzania. The conclusion was that MRI verification of age is unreliable, since approximately 15% of the study subjects already had wrist bone fusion before age 17.

As for the Confederation of African Football's next step, AfricanFootball.com reported on August 3 that the organization is advocating more transparency in the use of MRI to verify the age of soccer players.


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