Pitfalls in MRI of the Developing Pediatric Ankle

Area of Science:

• Pediatric Radiology
• Musculoskeletal Imaging
• Skeletal Development

Background:

• Normal pediatric ankle skeletal development presents variable imaging findings.
• Misinterpretation of normal developmental variations can lead to diagnostic errors.
• Increasing use of MRI in pediatric musculoskeletal trauma necessitates clear diagnostic criteria.

Purpose of the Study:

• To provide guidance on MRI evaluation of the skeletally maturing pediatric ankle.
• To differentiate normal developmental imaging findings from true pathologic conditions.
• To highlight common and uncommon imaging manifestations unique to the pediatric ankle.

Main Methods:

• Review of normal ossification processes (endochondral, membranous, secondary).
• Description of normal bone marrow signal intensities within ossification centers.
• Analysis of periosteal and physeal contributions to bone growth and their imaging appearances.

Main Results:

• Detailed description of normal but variable findings in preossification, secondary ossification, and ossification centers.
• Guidance on distinguishing normal physeal and periosteal appearances (e.g., trilaminar cortex, Kump bump) from pathology.
• Tips for differentiating normal bone marrow signal variations from contusion, fracture, or tumor.

Conclusions:

• Accurate interpretation of pediatric ankle MRI relies on understanding normal skeletal maturation.
• Familiarity with normal developmental variations prevents misdiagnosis of common abnormalities.
• This knowledge is crucial for correct evaluation of trauma and other conditions in pediatric ankle MRI.