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Normal gadolinium-enhanced MR images of the developing appendicular skeleton: Part I. Cartilaginous epiphysis and
C E Barnewolt1, F Shapiro, D Jaramillo
1Department of Radiology, Children's Hospital, Boston, MA, USA.
Insights
Gadolinium-enhanced MRI reveals how cartilage and vascular patterns in developing bone growth plates change with age. This imaging technique helps differentiate bone structures and track maturation in children.
Area of Science:
- Pediatric Radiology
- Skeletal Development
- Medical Imaging
Background:
- Epiphyseal and physeal development is crucial for longitudinal bone growth.
- Understanding normal maturation patterns is essential for diagnosing skeletal abnormalities.
Purpose of the Study:
- To characterize the normal appearance of developing cartilaginous epiphyses and physes in children using gadolinium-enhanced MRI.
- To define age-related changes in epiphyseal vascular patterns and cartilage enhancement.
Main Methods:
- Analysis of gadolinium-enhanced MRI scans from 48 children (1 month to 15.5 years).
- Evaluation of 80 normal epiphyses, assessing enhancement ratios and vascular patterns.
- Correlation of MRI findings with histologic and injection studies.
Main Results:
- Gadolinium enhancement effectively differentiated physeal and epiphyseal cartilage.
- Physeal cartilage showed significantly greater enhancement than epiphyseal cartilage.
- Epiphyseal vascular canals transitioned from a parallel to a radial pattern with ossification center development.
- Physeal enhancement decreased with physeal closure.
Conclusions:
- Gadolinium-enhanced MRI provides detailed visualization of the physis, epiphyseal vascular canals, and cartilage.
- The epiphyseal vascular pattern and physeal enhancement are reliable indicators of skeletal maturity.
Objective:
We have used gadolinium-enhanced MR imaging to define the expected normal appearance of the developing cartilaginous epiphyses and physes in neonates, infants, and children and to define the changes with maturity in epiphyseal vascular pattern.
Materials And Methods:
We analyzed gadolinium-enhanced MR images of 80 normal epiphyses in 48 neonates, infants, and children who were 1 month to 15.5 years old. We studied the differences in enhancement ratios for the epiphyses and physes and the epiphyseal vascular pattern at various development stages. We correlated the MR imaging findings with histologic and injection studies of immature epiphyses.
Results:
Gadolinium enhancement allowed differentiation between physeal and epiphyseal cartilage and revealed epiphyseal vascular canals. Enhancement proved to be greater in the physeal than in the epiphyseal cartilage (p < .001). In the unossified epiphysis, the vascular canals were mainly parallel. After the development of the secondary ossification center, these canals came to have a radial pattern (p < .0001). Comparison with cadaveric specimens confirmed how, with age, the arrangement of these canals changed. Also, physeal enhancement decreased with physeal closure.
Conclusion:
Gadolinium-enhanced MR imaging reveals differential enhancement of the physis, epiphyseal vascular canals, and epiphyseal cartilage. The pattern of epiphyseal vessels and degree of enhancement of the physis change with maturity.