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KEY FACTS
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
- Skeletally immature patients have numerous radiolucent growth centers composed of cartilage
- Primary physis: Site of majority of longitudinal growth; lies between epiphysis & metaphysis
- Secondary physis: Surrounds secondary ossification center (SOC) in epiphysis or equivalent bone
- Interface where cartilaginous precursor is transformed into bone from central to peripheral
- Process is uniform in some centers (capitellum, femoral head), nonuniform in others (fragmented trochlea, irregular medial femoral condyle)
- Apophysis: Nonarticular SOC with muscle/tendon attachment (ischial & tibial tuberosities)
- Zone of provisional calcification (ZPC): Thin, radiodense line at interface of physeal growth cartilage & newly mineralized bone
- Accessory ossification centers: Separate small rounded ossicles vs. SOCs in same unossified cartilage as adjacent epiphysis or equivalent
- Pseudoepiphysis: False appearance of growth centers at distal 1st & proximal 2nd-5th metatarsals & metacarpals
- Physiologic periosteal reaction (PPR): Smooth, solid, new bone being laid down rapidly along entire lengths of long bone diaphyses in infants
- Skeletally immature patients have numerous radiolucent growth centers composed of cartilage
IMAGING
General Features
Radiographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
- Berko NS et al: Imaging appearances of musculoskeletal developmental variants in the pediatric population. Curr Probl Diagn Radiol. 44(1):88-104, 2015
- Oestreich AE: Concave distal end of ulna metaphysis alone is not a sign of rickets. Pediatr Radiol. 45(7):998-1000, 2015
- Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
- Kan JH et al: Embryology, anatomy, and normal findings. In: Caffey's Pediatric Diagnostic Imaging, 12th ed. Philadelphia: Elsevier Saunders. 1327-46, 2013
- Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
- Varich LJ et al: Normal maturation of the distal femoral epiphyseal cartilage: age-related changes at MR imaging. Radiology. 214(3):705-9, 2000
- Laor T et al: Musculoskeletal system. In Kirks DR: Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children. 3rd ed. Philadelphia: Lippincott-Raven. 327-510, 1998
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References
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Tables
KEY FACTS
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Definitions
- Skeletally immature patients have numerous radiolucent growth centers composed of cartilage
- Primary physis: Site of majority of longitudinal growth; lies between epiphysis & metaphysis
- Secondary physis: Surrounds secondary ossification center (SOC) in epiphysis or equivalent bone
- Interface where cartilaginous precursor is transformed into bone from central to peripheral
- Process is uniform in some centers (capitellum, femoral head), nonuniform in others (fragmented trochlea, irregular medial femoral condyle)
- Apophysis: Nonarticular SOC with muscle/tendon attachment (ischial & tibial tuberosities)
- Zone of provisional calcification (ZPC): Thin, radiodense line at interface of physeal growth cartilage & newly mineralized bone
- Accessory ossification centers: Separate small rounded ossicles vs. SOCs in same unossified cartilage as adjacent epiphysis or equivalent
- Pseudoepiphysis: False appearance of growth centers at distal 1st & proximal 2nd-5th metatarsals & metacarpals
- Physiologic periosteal reaction (PPR): Smooth, solid, new bone being laid down rapidly along entire lengths of long bone diaphyses in infants
- Skeletally immature patients have numerous radiolucent growth centers composed of cartilage
IMAGING
General Features
Radiographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Presentation
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Selected References
- Berko NS et al: Imaging appearances of musculoskeletal developmental variants in the pediatric population. Curr Probl Diagn Radiol. 44(1):88-104, 2015
- Oestreich AE: Concave distal end of ulna metaphysis alone is not a sign of rickets. Pediatr Radiol. 45(7):998-1000, 2015
- Zbojniewicz AM et al: Imaging of osteochondritis dissecans. Clin Sports Med. 33(2):221-50, 2014
- Kan JH et al: Embryology, anatomy, and normal findings. In: Caffey's Pediatric Diagnostic Imaging, 12th ed. Philadelphia: Elsevier Saunders. 1327-46, 2013
- Laor T et al: Juvenile osteochondritis dissecans: is it a growth disturbance of the secondary physis of the epiphysis? AJR Am J Roentgenol. 199(5):1121-8, 2012
- Varich LJ et al: Normal maturation of the distal femoral epiphyseal cartilage: age-related changes at MR imaging. Radiology. 214(3):705-9, 2000
- Laor T et al: Musculoskeletal system. In Kirks DR: Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children. 3rd ed. Philadelphia: Lippincott-Raven. 327-510, 1998
