A youth African player presented to a FIFA Medical Centre of Excellence for an MRI to determine his be eligibility for the U17 African Cup. The player had a court-determined birthdate in his country where birth registration is not compulsory.
The T1 images of this young player’s wrist shows evidence of a residual physis in the distal radius on several consecutive sequences. This measures less than 5mm in width.
The players nine mandatory MRI images are compared to the baseline images. He was determined to be a stage 5, which allowed him to play in the competition (only stage 6 are denied participation).
There are established age-related rules in sports for males and females to guarantee equality within the game for all the different age groups and to prevent participation of older players in youth competition. FIFA has developed a protocol to help determine eligibility for age-group tournaments based on the MRI appearance of the distal radius. Football is the only international sport that has introduced this methodology.
MRI of the wrist is a simple, reliable, valid and non-invasive method of age determination. FIFA has developed a validated grading system for use in U17 tournaments. There are six possible grades from stage one (completely unfused) to stage 6 (completely fused). The grades and criteria for each are:
1. Completely unfused;
2. Early fusion (minimal hyper-intensity within physis);
3. Trabecular fusion of less than 50% of radial cross-sectional area;
4. Trabecular fusion of more than 50% of radial cross-sectional area;
5. Residual physis, less than 5mm on any one section;
6. Completely fused.
The protocol used by CAF for age determination involves collecting images on a 1.5-T magnet using a wrist coil. The left wrist is positioned above the head or at the side of the body with the third metacarpal is placed as close as possible to the same axis as the radius. Nine T1-weighted spin echo sequences (TR 350–500 ms TE 12–20 ms) with a slice thickness of 3 mm are collected and compared with normal images.
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