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Evolution of the infant spinal column: evaluation with MR imaging
1Department of Neuroradiology, Yale University School of Medicine, New Haven, CT 06510.
Insights
This study details the evolving appearance of the pediatric lumbar spine on MRI, identifying three distinct developmental stages in infants up to two years old. Understanding these dynamic changes is crucial for accurate interpretation of pediatric spinal imaging.
Area of Science:
- Pediatric Radiology
- Spinal Imaging
- Developmental Anatomy
Background:
- The normal appearance of the pediatric lumbar spine on MRI is complex and changes dynamically with growth.
- Variations in signal intensity and morphology can lead to diagnostic confusion in infants.
Purpose of the Study:
- To characterize the sequential changes in the normal pediatric lumbar spine's appearance on MRI.
- To establish distinct developmental stages for the pediatric lumbar spine based on imaging findings.
Main Methods:
- Spinal magnetic resonance imaging (MRI) was performed on 50 pediatric patients aged 2 years or less.
- Both short- and long-repetition-time spin-echo sequences were utilized on a 1.5-T imager.
- Ossification centers, cartilage, and disks of the developing vertebral bodies were analyzed.
Main Results:
- Three characteristic evolutionary stages of the lumbar spine were identified in infants.
- Stage I (0-1 month): hypointense ossification centers, prominent hyperintense cartilage.
- Stage II (1-6 months): increasing ossification center signal, decreasing cartilage.
- Stage III (7+ months): rectangular vertebral bodies, central intensity, diminishing cartilage.
Conclusions:
- The pediatric lumbar spine undergoes significant dynamic changes in signal intensity and morphology during the first two years of life.
- Recognizing these three developmental stages aids in accurate interpretation and dating of pediatric lumbar spine MRIs.
- Careful analysis of these evolutionary changes is essential to avoid misinterpretation of normal developmental findings.
Abstract:
The appearance of the normal lumbar spinal column was examined in spinal magnetic resonance images obtained in 50 pediatric patients aged 2 years or less. The ossification centers of the developing vertebral bodies, the cartilage, and the disks were studied with a 1.5-T imager by using both short- and long-repetition-time spin-echo sequences. Many of the structures of the spine were noted to undergo dynamic changes in appearance, both in signal intensity and in morphologic characteristics, with growth. The vertebrae and cartilage, especially, transform markedly in infancy and proceed through three characteristic stages of evolution. Stage I, from birth to 1 month of age, is characterized by markedly hypointense ossification centers and hyperintense, prominent cartilage. Stage II, from approximately 1 to 6 months of age, is characterized by increasing signal intensity in the ossification centers, progressing from the endplates in, and decreasing prominence of the cartilage, Stage III, from approximately 7 months of age on, is characterized by increasingly rectangular and centrally intense vertebral bodies and diminishing cartilage. The variability of the signal intensities, with that of muscle used as the standard, and morphologic characteristics of different components of the spine at different stages of development can create significant confusion. Careful analysis, however, permits one to follow the evolution of the lumbar spine and to date it on the basis of its appearance.