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Normal childhood developmental patterns in skull bone marrow by MR imaging
1Department of Radiology, University of Iowa College of Medicine, Iowa City 52242.
Insights
This study maps pediatric skull bone marrow development using MR imaging, revealing a predictable red-to-yellow marrow conversion pattern before sinus pneumatization. These findings provide essential normative data for diagnosing immature skull conditions.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Skeletal Development
Background:
- Understanding bone marrow changes in children is crucial for interpreting MR imaging findings.
- Normal developmental patterns of skull bone marrow are not well-established.
- MR imaging offers detailed insights into bone marrow composition.
Purpose of the Study:
- To establish normative data for skull bone marrow development in children using MR imaging.
- To describe the pattern and timing of red-to-yellow marrow conversion in the pediatric skull.
- To provide a reference for evaluating immature skulls in disease states.
Main Methods:
- Review of sagittal T1-weighted MR skull images from 324 normal children (newborn to 18 years).
- Classification of bone marrow intensity into four grades relative to muscle and fat.
- Spearman correlation analysis to assess the relationship between age and marrow intensity.
Main Results:
- Bone marrow becomes isointense with fat (yellow marrow) at specific mean ages across different skull bones, ranging from 8.5 years (sphenoid) to 11.9 years (basiocciput).
- A strong correlation exists between age and marrow intensity (p < 0.001) across various skull and cervical spine locations.
- Red-yellow marrow conversion precedes paranasal sinus pneumatization, with facial bones converting before calvarial bones.
Conclusions:
- MR imaging demonstrates a predictable pattern of skull bone marrow conversion in children.
- Normative data on marrow conversion timing are essential for accurate MR imaging interpretation in pediatric skull pathologies.
- No significant sex differences were observed in the pattern or rate of marrow conversion.
Abstract:
To establish the normal developmental pattern of skull bone marrow in children by MR imaging, sagittal T1-weighted MR skull images of 324 normal children (newborn to 18 years) were reviewed. Bone marrow intensity was assigned four gradations as compared with that of muscle and fat on the same image. Bone marrow became isointense with fat (yellow marrow) at a mean age +/- S.E.M. (in years) of 8.5 +/- 0.24 in sphenoid, 9.1 +/- 0.29 in mandible, 9.3 +/- 0.28 in hard palate, 9.7 +/- 0.26 in frontal, 11.0 +/- 0.26 in squamous occiput, 11.5 +/- 0.28 in parietal, and 11.9 +/- 0.24 in basiocciput. There is a strong correlation between age and marrow intensity by Spearman analysis (p < 0.001): hard palate 0.64, mandible 0.61, parietal 0.42, sphenoid 0.70, cervical spine 0.50, basi-occiput 0.58 and occiput 0.52. Two consistent overall patterns of red-yellow marrow conversion were observed. Bone marrow became isointense with fat prior to pneumatization of the paranasal sinuses. Marrow conversion in the bones of the face occurred before those of the calvarium in a specific pattern. There was no significant sex difference in the pattern or rate of marrow conversion. These normative data are necessary to evaluate the immature skull by MR imaging in disease states.