Jaremko Jacob L, Siminoski Kerry, Firth Gregory B, Matzinger Mary Ann, Shenouda Nazih, Konji Victor N, Roth Johannes, Sbrocchi Anne Marie, Reed Martin H, O'Brien Mary Kathleen, Nadel Helen, McKillop Scott, Kloiber Reinhard, Dubois Josée, Coblentz Craig, Charron Martin, Ward Leanne M
Department of Radiology and Diagnostic Imaging, 2A2.41 WC Mackenzie Health Sciences Centre, University of Alberta, 8440-112 St., Edmonton, T6G 2B7, Canada,
Pediatr Radiol. 2015 Apr;45(4):593-605. doi: 10.1007/s00247-014-3210-y. Epub 2015 Apr 1.
Children with glucocorticoid-treated illnesses are at risk for osteoporotic vertebral fractures, and growing awareness of this has led to increased monitoring for these fractures. However scant literature describes developmental changes in vertebral morphology that can mimic fractures. The goal of this paper is to aid in distinguishing between normal variants and fractures. We illustrate differences using lateral spine radiographs obtained annually from children recruited to the Canada-wide STeroid-Associated Osteoporosis in the Pediatric Population (STOPP) observational study, in which 400 children with glucocorticoid-treated leukemia, rheumatic disorders, and nephrotic syndrome were enrolled near glucocorticoid initiation and followed prospectively for 6 years. Normal variants mimicking fractures exist in all regions of the spine and fall into two groups. The first group comprises variants mimicking pathological vertebral height loss, including not-yet-ossified vertebral apophyses superiorly and inferiorly, which can lead to a vertebral shape easily over-interpreted as anterior wedge fracture, physiological beaking, or spondylolisthesis associated with shortened posterior vertebral height. The second group includes variants mimicking other radiologic signs of fractures: anterior vertebral artery groove resembling an anterior buckle fracture, Cupid's bow balloon disk morphology, Schmorl nodes mimicking concave endplate fractures, and parallax artifact resembling endplate interruption or biconcavity. If an unexpected vertebral body contour is detected, careful attention to its location, detailed morphology, and (if available) serial changes over time may clarify whether it is a fracture requiring change in management or simply a normal variant. Awareness of the variants described in this paper can improve accuracy in the diagnosis of pediatric vertebral fractures.
接受糖皮质激素治疗的儿童有发生骨质疏松性椎体骨折的风险，对此认识的不断提高促使对这些骨折的监测增加。然而，很少有文献描述可模仿骨折的椎体形态发育变化。本文的目的是帮助区分正常变异和骨折。我们使用从参与全加拿大儿科人群类固醇相关骨质疏松症（STOPP）观察性研究的儿童每年获得的脊柱侧位X线片来说明差异，该研究纳入了400名接受糖皮质激素治疗的白血病、风湿性疾病和肾病综合征患儿，在糖皮质激素开始使用时入组并进行了6年的前瞻性随访。模仿骨折的正常变异存在于脊柱的所有区域，可分为两组。第一组包括模仿病理性椎体高度丢失的变异，包括上下未骨化的椎体附属结构，这可导致椎体形状容易被过度解读为前缘楔形骨折、生理性喙突或与椎体后缘高度缩短相关的椎体滑脱。第二组包括模仿其他骨折放射学征象的变异：类似前缘扣锁骨折的前椎动脉沟、丘比特弓样气球样椎间盘形态、模仿凹陷终板骨折的Schmorl结节以及类似终板中断或双凹形的视差伪影。如果检测到意外的椎体轮廓，仔细关注其位置、详细形态以及（如有）随时间变化情况，可能有助于明确其是需要改变治疗的骨折还是仅仅是正常变异。了解本文所述的变异可提高儿童椎体骨折诊断的准确性。
