Laor T, Hartman A L, Jaramillo D
Department of Radiology, Harvard Medical School, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Pediatr Radiol. 1997 Aug;27(8):654-62. doi: 10.1007/s002470050206.
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.
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.
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.
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.
进行一项描述性综述，以表征和评估磁共振成像（MR）上发现的局部骺板增宽（软骨信号从骺板延伸至相邻干骺端）的意义。
回顾性检查了22名儿童31个干骺端的MR图像（收集自1988年至1995年进行的检查），这些图像中我们识别出了局部骺板增宽。对这些骺板增宽区域进行形态、深度、位置、信号强度以及骨骺改变共存情况的评估。将信号异常的特征与相邻干骺端任何可识别损伤的持续时间和类型以及生长障碍的发生情况相关联。
26个干骺端有可识别的损伤（19个单次事件损伤和7个持续性或重复性损伤）。增宽的骺板形态为局灶性舌状（n = 15）、宽带状（n = 10）或混合状（n = 6）。大多数（n = 27）增宽区域在所有序列上与骺板软骨等信号。当干骺端损伤为单次事件而非持续性或重复性损伤时（P = 0.023）、为局灶性舌状时（P = 0.029）以及病变位于中央时（P = 0.030），随后发生生长障碍的可能性更大。在5例中，相邻骨骺显示信号异常；所有这些病例均发生了生长障碍。在两个肢体上进行的组织学检查证实，MR表现代表肥大的骺板软骨细胞向干骺端的延伸。
在生长中的骨骼中偶然观察到的局部骺板增宽可能代表先前或正在进行的对软骨内成骨的干扰印记，该干扰源于先前的干骺端损伤，而非原发性干骺端疾病。单次事件损伤、局灶性舌状骺板增宽、在干骺端的中央分布以及MR成像上伴随的骨骺信号异常是随后生长障碍的重要预测指标。
