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Developing spinal column: gadolinium-enhanced MR imaging
1Department of Neuroradiology, Yale University School of Medicine, New Haven, CT 06510.
Insights
Magnetic resonance imaging reveals that normal bone marrow and cartilage in children
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Skeletal Development
Background:
- The developing pediatric spine exhibits unique enhancement patterns on magnetic resonance (MR) imaging.
- Understanding these normal enhancement characteristics is crucial for accurate interpretation of pediatric spinal MR studies.
Purpose of the Study:
- To characterize the enhancement patterns of the normally developing pediatric spinal column using MR imaging.
- To differentiate normal enhancement from potential pathological findings in children.
Main Methods:
- Retrospective analysis of MR images from 58 children (7 days to 9 years old).
- Utilized a 1.5-T imager with short-repetition-time spin-echo sequences.
- Images acquired before and after gadolinium-based contrast agent administration (0.1 mmol/kg gadopentetate dimeglumine).
Main Results:
- Normal bone marrow enhancement was observed in all children under 7 years, most pronounced in those under 2 years.
- Cartilage enhancement was noted in all children under 1.5 years, representing a key finding in infant spine MR.
- Enhancement is attributed to prominent vasculature, capillary permeability, and extravascular space in pediatric bone marrow and cartilage.
Conclusions:
- Vertebral body and cartilage enhancement are normal findings in the pediatric spine, particularly in younger children.
- Radiologists must exercise caution when interpreting diffuse vertebral body enhancement in children, as it differs from adult pathological criteria.
- These findings aid in the accurate diagnosis of spinal conditions in pediatric patients.
Abstract:
Enhancement characteristics of the normally developing spinal column were examined in magnetic resonance (MR) images obtained in 58 children aged 7 days to 9 years. With a 1.5-T imager, short-repetition-time spin-echo images were obtained before and after the administration of 0.1 mmol/kg gadopentetate dimeglumine. Enhancement of normal bone marrow was seen in all patients aged less than 7 years; it was marked only in patients aged less than 2 years. Enhancement of normal cartilage, seen in all patients aged less than 1 1/2 years, may be the most striking feature of enhanced MR images of the infant spine. Enhancement of both bone marrow and cartilage in children appears to be due to the unusual prominence of vasculature, associated with permeability of the capillary endothelium and a plentiful extravascular space. Although marked and diffuse enhancement of vertebral bodies in adults is often thought to indicate a pathologic marrow state, caution must be used before the same criteria are applied to children.