Hung-Ta Wu MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To describe the MR patterns and evolution of edematous Schmorls nodes. Methods and Materials: In 38 patients (M:F=22:16, 24-83years,avg 58) 71 edematous Schmorls nodes with serial MR exams were evaluated. Interval between MR exams was 2-61 months (avg 16). 16 patients (23 nodes) had two or more follow-up exams. Two observers noted location, size, margins, internal and surrounding T1/T2 signal, morphology of the adjacent disc, and change in these characteristics over time as well as fracture, tumor, infection or prior surgery. Results: Node size averaged 7x8mm. Most were located at L3 (28%,20/71), L4 (20%,14/71) and L5 (11%,8/71), at the central or outer third of the endplate. 55%(39/71) had a bulging disc, 7%(5/71) had disc herniation; 10%(7/71) had evidence of associated fracture, 14%(10/71) tumor, and 8%(6/71) infection, each with fairly characteristic appearance; 8%(6/71) had prior surgery. On the initial exam, most nodes had well-defined margins (80%,57/71). The most common node internal signal was isointense to adjacent disc on T1/T2 (32%,23/71); surrounding marrow was most commonly hypointense on T1 and hyperintense on T2 (38%,27/71). There was no interval change in node size in 44%(31/71). 27%(19/71) had increased size, 18% (13/71) had decreased size; of nodes with multiple follow-up exams, 30%(7/23) enlarged initially and later decreased in size. Most nodes remained well-defined; 3%(2/71) evolved from ill-defined to well-defined. Most (59%,42/71) showed no temporal change in internal T2 signal. On follow-up, 20%(14/71) of nodes showed decreased internal T2 signal; 14%(10/71) increased. Of those with multiple follow-up exams, 17%(4/23) initially increased on T2 and later decreased. Regarding the surrounding marrow, most (65%,46/71) showed no temporal change in T2 signal. 18%(13/71) showed decreased T2 signal on follow-up; 13%(9/71) showed increased T2 signal. Of those with multiple follow-up exams, 9%(2/23) initially showed increased T2 signal which later decreased. The most common imaging appearance of the surrounding marrow was concentric rings (22/71), a finding which had 77% specificity for absence of infection, tumor and fracture. Over the follow-up period 9% developed well defined concentric rings. Conclusion: Although most remain unchanged, a relatively large proportion of edematous Schmorls nodes evolve in size and signal over a relatively short time. Some evolve to form well-defined concentric rings. Vertebral fracture or tumor, as well as disc infection or surgery may result in Schmorls node formation.       Questions about this event email: hondar.wu@msa.hinet.net

Wu MD, H, Edematous Schmorls Nodes on Thoracolumbar MR Imaging: Characteristic Patterns and Changes over Time.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3102916.html