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Local physeal widening on MR imaging: an incidental finding suggesting prior metaphyseal insult
T Laor1, A L Hartman, D Jaramillo
1Department of Radiology, Harvard Medical School, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Objective:
To offer a descriptive review which characterizes and evaluates the significance of local physeal widening, (cartilaginous signal extending from the physis into the adjacent metaphysis), identified on magnetic resonance (MR) imaging.
Materials And Methods:
MR images (recollected from exams performed between 1988 and 1995) of 31 metaphyses in 22 children where we recognized local physeal widening were examined retrospectively. These areas of physeal widening were evaluated for morphology, depth, location, signal intensity, and the coexistence of epiphyseal alterations. The characteristics of the signal abnormalities were correlated with the duration and type of any identifiable insult to the adjacent metaphysis, and with the development of growth disturbance.
Results:
Twenty-six metaphyses had identifiable insults (19 single event and 7 sustained or repetitive). The widened physes were of focal tongue (n = 15), broad band (n = 10), or mixed (n = 6) morphology. Most (n = 27) areas of widening were isointense with the physeal cartilage on all sequences. Subsequent growth disturbance was more likely when the metaphyseal insult was a single event rather than sustained or repetitive (P = 0.023), with focal tongues (P = 0.029), and with centrally located lesions (P = 0.030). In five cases, the adjacent epiphysis showed signal abnormalities; all developed growth disturbance. Histologic examinations available in two limbs confirmed that the MR findings represented extensions of hypertrophic physeal chondrocytes into the metaphysis.
Conclusion:
Incidentally observed local physeal widening in a growing bone may represent the imprint of a previous or ongoing interference with endochondral ossification from a prior metaphyseal insult, rather than a primary metaphyseal disorder. Single event insults, physeal widening of focal tongue morphology, central distribution in the metaphysis, and concomitant epiphyseal signal abnormalities on MR imaging are significant predictors of subsequent growth disturbance.
Insights
Local physeal widening on MRI may indicate prior metaphyseal insult, not a primary bone disorder. Specific MRI findings predict future growth disturbances in children.
Area of Science:
- Pediatric Radiology
- Skeletal Imaging
- Growth Plate Disorders
Background:
- Local physeal widening on magnetic resonance (MR) imaging is an incidental finding.
- It represents cartilaginous signal extending from the physis into the adjacent metaphysis.
- The significance of this finding in growing bone requires characterization.
Purpose of the Study:
- To describe and evaluate the significance of local physeal widening on MR imaging.
- To correlate MR imaging findings with metaphyseal insults and growth disturbances.
- To determine predictors of subsequent growth disturbance.
Main Methods:
- Retrospective review of MR images of 31 metaphyses in 22 children with local physeal widening.
- Evaluation of morphology, depth, location, and signal intensity of physeal widening.
- Correlation of findings with metaphyseal insult type, duration, and growth disturbance development.
Main Results:
- Twenty-six metaphyses had identifiable insults, with single events being more likely to cause growth disturbance (P = 0.023).
- Focal tongue morphology (P = 0.029) and central location (P = 0.030) predicted growth disturbance.
- Epiphyseal signal abnormalities were associated with growth disturbance in all five cases.
Conclusions:
- Local physeal widening may signify prior metaphyseal insult affecting endochondral ossification.
- Single event insults, focal tongue morphology, central location, and epiphyseal abnormalities are predictors of growth disturbance.
- This finding is not necessarily a primary metaphyseal disorder.