Purpose: To evaluate the frequency and patterns of T2 hyperintense marrow in the pediatric lumbar spine.
Methods and Materials: At 1.5T, 82 lumbar spines (574 vertebrae, from L1 to S2) of children without a history of significant trauma or infection were evaluated by two observers, blinded to the patients' age, for the presence of edema in the vertebral bodies on sagittal fluid sensitive sequences (fat suppressed T2 weighted FSE or STIR). The children were divided to the following age groups: 0-3ys (8 children), 4-7ys (N=6), 8-9 (N=6), 10-11 (N=9), 12-13 (N=16), 14 (N=11), 15 (N=12), 16-17 (N=14).
Results: Sixty-one children (74%) showed vertebral T2 hyperintensity. Out of 574 vertebrae, 307 were positive (54%). The frequency of T2 hyperintensity correlated with age (with a sine curve), 67% at 0-3, 50% at 4-7, 90% at 10-11ys, 60% at 12-13ys, 58% at 14ys, 43% at 15ys and 28% at 16-17ys. The most common pattern of T2 hyperintensity within the vertebral bodies was at the endplates (24%); followed by hyperintensity at the corners (19%), picture frame (11%), diffuse edema (1%) and rarely around the venous plexus (0.5%). Correlation between age and pattern showed the following: The most common pattern of hyperintensity at 0-3ys was pictureframe (56%); at 4-7 the common pattern was hyperintensity at the corners; at 8-9, 10-11, 12-13ys- endplates (38%, 65%, 32% respectively), at 14, 15, 16-17, corners was the most common (24%, 30%, 43%). The endplates and corners showed two peaks: at a younger age (0-3ys, 4-6ys respectively) and at a later age (10-11, 14ys, respectively). Picture frame was mostly seen at 10-11ys as well (25%). The distribution within the lumbar spine was most frequent at L2 and L3 (63% positive), followed by L4 and L5 (57%), L1 (42%), S1 (41%) and least common at S2 (29%). At 0-3ys the distribution was even. The end plate hyperintensity usually involves both superior and inferior endplates (No=104/121, 86%).
Conclusion: Lumbar spine marrow hyperintensity progresses in a recognizable pattern in children. It is most frequent at the age of 10-11years, and in the mid lumbar levels. Because of its variable appearance and complex distribution curve, we believe it is likely related to a combination of stress, physical activity, as well as the normal red to yellow marrow conversion.
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