MR imaging of enhancing intraosseous disk herniation (Schmorl's nodes)

This study was conducted to show vascularization of Schmorl's nodes with enhanced MR imaging and to correlate this finding with clinical complaints.

Retrospectively, 412 gadopentetate dimeglumine-enhanced MR imaging examinations of the lumbar and thoracic spine of 372 patients were reviewed for Schmorl's nodes, vascularization of Schmorl's nodes, and associated bone marrow edema. Sagittal T2-weighted spin-echo and unenhanced and enhanced T1-weighted spin-echo images with and without fat suppression were evaluated in symptomatic and asymptomatic patients.

Of the 372 patients, 142 (38%) had 341 Schmorl's nodes. Gadopentetate dimeglumine-enhanced MR imaging revealed vascularized tissue in 30 Schmorl's nodes of 23 patients (mean age of patients, 53 years old). Associated bone marrow edema was found in nine of 30 vascularized Schmorl's nodes. The mean diameter (8.2 mm) of the nine vascularized Schmorl's nodes that were surrounded by bone marrow edema was significantly (p < .05) greater than the mean diameter (6.4 mm) of the 21 vascularized Schmorl's nodes that had no bone marrow edema. The vascularized Schmorl's nodes were significantly (p < .05) smaller in the seven asymptomatic patients (mean, 5.2 mm) than in the 23 patients with back pain (mean, 7.9 mm). We saw bone marrow edema adjacent to Schmorl's nodes less frequently in asymptomatic patients (one of seven) than in symptomatic patients (10 of 23).

Vascularized Schmorl's nodes were larger and more frequently associated with bone marrow edema in patients with back pain than in asymptomatic patients. Enhanced MR images of Schmorl's nodes revealed vascularity, which was not shown on unenhanced MR images.