Sternal development in the pediatric population: evaluation using computed tomography
Jorge Delgado1, Camilo Jaimes, Kriti Gwal
1Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Insights
Normal sternum development in children shows significant variation, particularly in mesosternal ossification centers. These developmental variations on CT imaging are common and should not be mistaken for pathology.
Area of Science:
- Pediatric Radiology
- Anatomy
- Medical Imaging
Background:
- The typical development of the sternum in children is not well-established through CT imaging.
- Understanding normal sternal development is crucial for accurate diagnosis in pediatric patients.
Purpose of the Study:
- To delineate the normal developmental patterns of the sternum in children using computed tomography (CT) imaging.
- To provide a reference for evaluating sternal ossification and fusion in pediatric populations.
Main Methods:
- Retrospective analysis of CT scans from 300 pediatric patients (0.01-9.9 years).
- Evaluation of ossification centers in the manubrium, mesosternum, and xiphoid.
- Statistical analysis to identify age and gender-related differences in sternal development.
Main Results:
- Manubrium: 88% showed a single ossification center; more centers correlated with younger age.
- Mesosternum: Varied ossification patterns observed across segments, with no significant age-related differences in fusion.
- Xiphoid: Absent in 67% of patients; 1% exhibited a bifid xiphoid.
Conclusions:
- Sternal development in children exhibits considerable variability, especially in mesosternal ossification.
- Recognizing the wide range of normal sternal ossification patterns is essential to avoid misinterpreting findings as pathological.
- CT imaging provides valuable insights into the complex process of pediatric sternal development.
Background:
The normal development of the sternum using CT imaging is not known.
Objective:
To describe the normal development of the sternum in children on chest CT imaging.
Materials And Methods:
CT imaging of 300 patients (150 male, 150 female), mean age: 4.97 years (range: 0.01-9.9 years), were evaluated retrospectively. The presence and number of ossification centers in the manubrium, each individual mesosternal segment and the xiphoid were reviewed. Additionally, the vertical and horizontal fusion between ossification centers was evaluated. Differences among age and gender were calculated. Descriptive statistics, analysis of variances (ANOVA), chi-square and Fisher exact tests were performed for statistical analysis.
Results:
Manubrium: A single ossification center was seen in 88% of cases and two or three ossification centers were seen in 12%. More manubrial ossification centers were correlated to a younger age (P < 0.001, R = -0.2). Mesosternum: Majority of patients had a single ossification center in the first segment (85%). The majority of patients had double ossification centers in the second and third segments (51% and 64%, respectively). No ossification center was seen in the fourth segment in 38% of patients. No significant difference among the age of vertical ossification between mesosternal segments was found. (ANOVA; P > 0.05). Xiphoid: Absence was seen in 67% of the patients. Bifid xiphoid was seen in 1% of the patients.
Conclusion:
The normal development of the different components of the sternum is a process with wide variation among children. The large variability of mesosternal ossification center types should not be confused with pathology.
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