Ron Gefen, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Recent investigations have been performed to evaluate for causation of bone marrow edema in various locations in pediatric patients. Since marrow edema in adults is quite common, we sought to evaluate the patterns of bone marrow T2 hyperintensity seen in the pediatric cervical spine. Methods and Materials: At 1.5T, the C2 - T3 vertebrae of 82 pediatric patients 0 - 17 years (mean 12.3) were retrospectively reviewed, blinded to patients' age. The frequency, intensity, and location of foci of marrow T2 hyperintensity were assessed and correlated with the patients' age using the following scheme: 1) vertebrae were divided into zones: superior, inferior, anterior and posterior; 2) one point was given for each zone with edema; 3) if area of marrow edema overlapped two zones but was not larger than one zone, 1 point was given; 4) a multiplier of 1-3 was assigned based on the relative intensity of the edema. Results: Foci of marrow hyperintensity were seen in 46/82 (56.1%) patients and in 241/734 (32.8%) vertebrae. Foci were seen in 27 C2, 36 C3, 34 C4, 37 C5, 31 C6, 29 C7, 19 T1, 16 T2, and 12 T3 vertebrae. Locations of foci were: inferior endplate (188 foci), anterior endplate (123), superior endplate (78), posterior endplate (64), ant-inferior corner (26), post-superior corner (5), post-inferior corner (3), ant-superior corner (2). Patterns noted were: inferior endplate (71 vertebrae), picture frame (49), ant/inferior endplates (39), ant-inferior corner (20), ant. endplate (16), inf/superior endplates (15), ant/superior endplates (5), diffuse (5), incomplete picture frame (4), ant/posterior end plates (4), ant-inferior corner and inferior end plate (4), posterior end plate (2), ant/inferior end plates, and posterior corners (2), ant-inferior corner and superior corners (2), inferior and posterior end plates (1), posterior corners (1), and superior endplate (1). Analysis by the CORR procedure revealed no significant correlation between age and marrow score (Spearman = -0.147, P = 0.19. Analysis by age group revealed a trend towards increased presence of marrow edema in ages 8 - 14 (22/27 or 81.5% of patients) versus ages 0 - 7 (4/15 (26.7%)) and 15 - 17 (20/40 (50%)). Conclusion: Since marrow T2 hyperintensity was most common in mid-cervical spine (area of maximal kyphotic stress), and since the edema predominated at the anterior vertebral edges, and since there was a slight peak in adolescence, we believe that these pediatric cervical marrow changes are related to stress.       Questions about this event email: rxg004@jefferson.edu

Gefen, R, Is Pediatric Cervical Spine Marrow Edema Stress Related?.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3101108.html