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Normal maturing distal tibia and fibula: changes with age at MR imaging
1Department of Radiology, Children's Hospital, Harvard Medical School, Boston, MA 02115.
Insights
Magnetic resonance (MR) imaging reveals a predictable pattern of bone development in the maturing distal tibia and fibula. Understanding these normal MR imaging findings is crucial for accurate diagnosis in pediatric patients.
Area of Science:
- Pediatric Radiology
- Musculoskeletal Imaging
- Anatomy
Background:
- The distal tibia and fibula undergo significant developmental changes during childhood and adolescence.
- Accurate interpretation of magnetic resonance (MR) imaging in pediatric patients requires knowledge of normal evolving anatomy.
Purpose of the Study:
- To characterize the typical appearance of the developing distal tibia and fibula on MR imaging.
- To establish a reference for normal maturation patterns in pediatric lower extremities.
Main Methods:
- Retrospective analysis of 50 MR examinations in patients aged 2 months to 21 years.
- Patients were categorized into six developmental groups based on distal tibia and fibula morphology.
- Evaluation of epiphyseal ossification, physeal closure, and physeal cartilage signal characteristics.
Main Results:
- Distal tibial epiphyseal ossification and physeal closure initiate anteromedially, preceding the fibula.
- An anteromedial undulation (Kump hump) in the tibial physis can mimic premature closure due to volume averaging.
- The cartilaginous epiphysis exhibits lower signal intensity than the physis on T2-weighted images.
- Optimal visualization of the physis is achieved with gradient-recalled-echo and fat-suppressed spin-echo proton-density-weighted sequences.
Conclusions:
- Maturation of the distal tibia and fibula follows a consistent pattern of cartilaginous and bone development.
- MR imaging effectively demonstrates these normal developmental changes, aiding in the differentiation from pathology.
Purpose:
To describe the normal appearance of the maturing distal tibia and fibula at magnetic resonance (MR) imaging.
Materials And Methods:
The authors retrospectively studied 50 MR examinations of patients aged 2 months to 21 years, dividing them into six developmental groups according to the appearance of the distal tibia and fibula. Epiphyseal ossification, physeal closure, and the signal characteristics of physeal cartilage were evaluated.
Results:
Distal tibial epiphyseal ossification and physeal closure both began anteromedially and usually occurred earlier than in the fibula. The tibial physis developed an anteromedial undulation (Kump hump) before closure; volume averaging at the Kump hump simulated premature closure. The cartilaginous epiphysis had a lower signal intensity than the physis on T2-weighted images. The physis was most conspicuous on gradient-recalled-echo and fat-suppressed spin-echo proton-density-weighted images.
Conclusion:
Developmental cartilaginous and bone changes in the distal tibia and fibula follow a definite pattern and are well seen at MR imaging.