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Primary and Secondary Growth Centers
Arthur B. Meyers, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Synonyms

              • Primary (1°) growth (ossification) center
              • Secondary (2°) growth (ossification) center
            • Definitions

              • Endochondral ossification: Bone formation of preexisting cartilage model at 1° & 2° growth centers
                • Occurs at limbs, pelvis, vertebral column, & portions of clavicles, scapulae, skull base
              • Intramembranous ossification: Bone formation from mesenchymal cells without prior cartilage model
                • Occurs at cranial vault, facial bones, & portions of clavicles, scapulae
              • 1° growth centers: Where majority of ossification occurs
                • Predominately at long bone physes in childhood
                  • Account for majority of longitudinal growth
              • 2° growth centers: Ossification centers that do not significantly contribute to longitudinal growth; in general
                • Surrounded by growth plate & unossified cartilage
                • Found at articulations of long bones (epiphyses) & nonarticular equivalents (apophyses, carpals, tarsals, etc.)
              • Accessory ossicles: Supernumerary bones commonly derived from unfused secondary ossification centers

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          CLINICAL ISSUES

                          • Presentation

                            • Natural History & Prognosis

                              DIAGNOSTIC CHECKLIST

                              • Image Interpretation Pearls

                                Selected References

                                1. Jaimes C et al: MR imaging of normal epiphyseal development and common epiphyseal disorders. Radiographics. 34(2):449-71, 2014
                                2. Kwong S et al: Skeletal development of the proximal humerus in the pediatric population: MRI features. AJR Am J Roentgenol. 202(2):418-25, 2014
                                3. Kan HJ et al: Embryology, anatomy, and normal findings. In Coley BD et al: Caffey's Pediatric Imaging. 12th ed. Philadelphia: Saunders. 1327-46, 2013
                                4. Keats TE et al: Atlas of normal roentgen variants that may simulate disease. Philadelphia, Pa: Elsevier/Saunders, 2013
                                5. Karwacki GM et al: Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol. 33(10):1882-7, 2012
                                6. 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
                                7. Thapa MM et al: MRI of pediatric patients: Part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
                                8. Thapa MM et al: MRI of pediatric patients: Part 1, normal and abnormal cartilage. AJR Am J Roentgenol. 198(5):W450-5, 2012
                                9. Khanna PC et al: The growing skeleton: MR imaging appearances of developing cartilage. Magn Reson Imaging Clin N Am. 17(3):411-21, v, 2009
                                10. Laor T et al: MR imaging insights into skeletal maturation: what is normal? Radiology. 250(1):28-38, 2009
                                11. Nemzek WR et al: MR, CT, and plain film imaging of the developing skull base in fetal specimens. AJNR Am J Neuroradiol. 21(9):1699-706, 2000
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Top Differential Diagnoses

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Synonyms

                                            • Primary (1°) growth (ossification) center
                                            • Secondary (2°) growth (ossification) center
                                          • Definitions

                                            • Endochondral ossification: Bone formation of preexisting cartilage model at 1° & 2° growth centers
                                              • Occurs at limbs, pelvis, vertebral column, & portions of clavicles, scapulae, skull base
                                            • Intramembranous ossification: Bone formation from mesenchymal cells without prior cartilage model
                                              • Occurs at cranial vault, facial bones, & portions of clavicles, scapulae
                                            • 1° growth centers: Where majority of ossification occurs
                                              • Predominately at long bone physes in childhood
                                                • Account for majority of longitudinal growth
                                            • 2° growth centers: Ossification centers that do not significantly contribute to longitudinal growth; in general
                                              • Surrounded by growth plate & unossified cartilage
                                              • Found at articulations of long bones (epiphyses) & nonarticular equivalents (apophyses, carpals, tarsals, etc.)
                                            • Accessory ossicles: Supernumerary bones commonly derived from unfused secondary ossification centers

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Natural History & Prognosis

                                                            DIAGNOSTIC CHECKLIST

                                                            • Image Interpretation Pearls

                                                              Selected References

                                                              1. Jaimes C et al: MR imaging of normal epiphyseal development and common epiphyseal disorders. Radiographics. 34(2):449-71, 2014
                                                              2. Kwong S et al: Skeletal development of the proximal humerus in the pediatric population: MRI features. AJR Am J Roentgenol. 202(2):418-25, 2014
                                                              3. Kan HJ et al: Embryology, anatomy, and normal findings. In Coley BD et al: Caffey's Pediatric Imaging. 12th ed. Philadelphia: Saunders. 1327-46, 2013
                                                              4. Keats TE et al: Atlas of normal roentgen variants that may simulate disease. Philadelphia, Pa: Elsevier/Saunders, 2013
                                                              5. Karwacki GM et al: Normal ossification patterns of atlas and axis: a CT study. AJNR Am J Neuroradiol. 33(10):1882-7, 2012
                                                              6. 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
                                                              7. Thapa MM et al: MRI of pediatric patients: Part 2, normal variants and abnormalities of the knee. AJR Am J Roentgenol. 198(5):W456-65, 2012
                                                              8. Thapa MM et al: MRI of pediatric patients: Part 1, normal and abnormal cartilage. AJR Am J Roentgenol. 198(5):W450-5, 2012
                                                              9. Khanna PC et al: The growing skeleton: MR imaging appearances of developing cartilage. Magn Reson Imaging Clin N Am. 17(3):411-21, v, 2009
                                                              10. Laor T et al: MR imaging insights into skeletal maturation: what is normal? Radiology. 250(1):28-38, 2009
                                                              11. Nemzek WR et al: MR, CT, and plain film imaging of the developing skull base in fetal specimens. AJNR Am J Neuroradiol. 21(9):1699-706, 2000