Ecklund K, Jaramillo D
Department of Radiology, Children's Hospital, Boston, Massachusetts 02115, USA.
Radiol Clin North Am. 2001 Jul;39(4):823-41. doi: 10.1016/s0033-8389(05)70313-4.
Growth disturbance of the long bones in children is frequently post-traumatic but also occurs because of physeal, epiphyseal, or metaphyseal ischemia. The imaging features of growth arrest depend more on the anatomic site involved than on the cause. The physes of the distal tibia and femur and proximal tibia are disproportionately at risk because of their complex geometry. The central undulation in the distal femur and the bump in the anteromedial physis (Kump's bump) in the distal tibia are the sites of initial physiologic closure and the most frequent areas of premature fusion. The MR imaging features of growth disturbance are characteristic. T1-weighted images show low signal intensity GRL and variable signal intensity bony bridges. On GRE sequences, a bridge appears as low signal intensity interruption in the otherwise high signal intensity physeal cartilage. Physeal widening on GRE and T2-weighted images implies physeal dysfunction without bridge formation. Proton density and T2-weighted images best reveal associated metaphyseal and soft tissue changes. Regardless of the cause, MR imaging exquisitely depicts cartilaginous pathology at the physis. MR evaluation should be considered in patients at high risk for growth disturbance including young children with extensive residual growth potential; those with involvement of particularly vulnerable growth plates; and those with severe, complex fractures.
儿童长骨生长紊乱常由创伤后引起，但也可因骨骺、骺或干骺端缺血而发生。生长停滞的影像学特征更多取决于受累的解剖部位，而非病因。由于其复杂的几何形状，胫骨远端、股骨远端和胫骨近端的骨骺面临的风险不成比例地高。股骨远端的中央起伏和胫骨远端前内侧骨骺的隆起（坎普隆起）是生理性闭合的起始部位，也是最常见的过早融合区域。生长紊乱的磁共振成像（MR）特征具有特异性。T1加权像显示生长板低信号强度及骨桥信号强度各异。在梯度回波（GRE）序列上，骨桥表现为原本高信号强度的骨骺软骨内低信号强度中断。GRE和T2加权像上的骨骺增宽提示骨骺功能障碍但无骨桥形成。质子密度加权像和T2加权像能最佳地显示相关的干骺端和软组织改变。无论病因如何，MR成像都能精确显示骨骺处的软骨病变。对于生长紊乱高危患者，包括有大量剩余生长潜能的幼儿、累及特别易受损生长板的患者以及有严重复杂骨折的患者，都应考虑进行MR评估。
