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Patterns of premature physeal arrest: MR imaging of 111 children
Kirsten Ecklund1, Diego Jaramillo
1Department of Radiology, Children's Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA.
Insights
MR imaging identifies growth arrest patterns in children with physeal bone bridges, most commonly posttraumatic and affecting the distal tibia and femur. This technique aids in understanding growth disturbances and surgical planning.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Skeletal Development
Background:
- Physeal injuries in children can lead to premature bony bridging, causing growth arrest and limb deformities.
- Accurate identification of physeal bridges is crucial for effective management and surgical intervention.
Purpose of the Study:
- To utilize MR imaging, specifically fat-suppressed 3D spoiled gradient-recalled echo sequences, to characterize patterns of growth arrest following physeal insult in pediatric patients.
- To correlate imaging findings with the etiology, location, and characteristics of physeal bone bridges.
Main Methods:
- MR imaging was performed on 111 children with physeal bone bridges.
- Analysis included bridge size, physeal location, signal intensity, growth recovery lines, avascular necrosis, and metaphyseal cartilage tongues.
- Fat-suppressed 3D spoiled gradient-recalled echo imaging was used for physeal mapping in 58 patients.
Main Results:
- Posttraumatic bridges were most common (70%), frequently involving the distal tibia and femur.
- Bridge location correlated with the affected bone, with anteromedial involvement in distal tibial bridges and central involvement in distal femoral bridges.
- Larger bridges showed higher T1 signal intensity, and oblique growth recovery lines were associated with smaller, peripheral bridges.
Conclusions:
- Premature physeal bony bridging is predominantly posttraumatic, with a predilection for the distal tibia and femur at sites of early physiologic closure.
- MR imaging, particularly fat-suppressed 3D spoiled gradient-recalled echo, effectively visualizes growth disturbances and associated abnormalities after physeal injury.
- Advanced MR imaging techniques guide surgical management of physeal bridging in children.
Objective:
The purpose of this study was to use MR imaging, especially fat-suppressed three-dimensional (3D) spoiled gradient-recalled echo sequences, to identify patterns of growth arrest after physeal insult in children.
Materials And Methods:
We evaluated 111 children with physeal bone bridges (median age, 11.4 years) using MR imaging to analyze bridge size, location in physis, signal intensity, growth recovery lines, avascular necrosis, and metaphyseal cartilage tongues. Fifty-eight patients underwent fat-suppressed 3D spoiled gradient-recalled echo imaging with physeal mapping. The cause, bone involved, radiographic appearance, and surgical interventions (60/111) were also correlated. Data were analyzed with the two-tailed Fisher's exact test.
Results:
Posttraumatic bridges, accounting for 70% (78/111) of patients, were most often distal, especially of the tibia (n = 43) and femur (n = 14), whereas those due to the other miscellaneous causes were more frequently proximal (p < 0.0001). The position of the bridge in the physis was related to the bone involved (p < 0.0001). Sixty-five percent of distal tibial bridges involved the anteromedial physis, whereas 60% of the distal femoral arrests were central. Larger bridges had higher T1 signal intensity (p < 0.008). Oblique growth recovery lines were seen exclusively with bridges involving the peripheral physis (p = 0.002) and smaller, more potentially resectable bridges. Metaphyseal cartilaginous tongues were seen with all causes, but avascular necrosis was exclusively posttraumatic (p = 0.03). Signal characteristics and bridge size did not vary with the cause.
Conclusion:
Premature physeal bony bridging in children is most often posttraumatic and disproportionately involves the distal tibia and femur where bridges tend to develop at the sites of earliest physiologic closure, namely anteromedially and centrally, respectively. MR imaging, especially with the use of fat-suppressed 3D spoiled gradient-recalled echo imaging, exquisitely shows the growth disturbance and associated abnormalities that may follow physeal injury and guides surgical management.
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