Article

Magnetic resonance imaging of the pediatric shoulder.

Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Magnetic resonance imaging clinics of North America (Impact Factor: 0.8). 05/2012; 20(2):327-47, xi. DOI: 10.1016/j.mric.2012.01.009
Source: PubMed

ABSTRACT Magnetic resonance (MR) imaging is a modality widely used to assess shoulder abnormalities in children. A thorough understanding of the development of the shoulder and adequate MR techniques are crucial in the radiologic evaluation. The immature skeleton is particularly vulnerable to insults such as trauma, infection, and inflammation, and responds in unique ways. The pediatric shoulder can also be affected by complex congenital deformities such as brachial plexus injuries. In addition, certain neoplasms can be seen specifically in the young patient. MR imaging plays a critical role in the initial diagnostic evaluation and in assessing posttreatment responses.

Download full-text

Full-text

Available from: Camilo Jaimes, Jan 15, 2014
0 Followers
 · 
179 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE. The purpose of this study was to provide a guideline of normal MRI developmental anatomy of the proximal humerus in a growing child. MATERIALS AND METHODS. Retrospective interpretation of 83 consecutive MRI studies of shoulders in children 2 months to 17 years old was performed in consensus by two radiologists. The following variables were documented: presence, number, and fusion of secondary ossification centers; appearance and closure of the growth plate; presence of the metaphyseal stripe; and proximal metaphyseal marrow signal intensity. RESULTS. Preossification centers were seen in 2- and 4-month-old patients. Secondary ossification centers appeared in the medial humeral head and greater tuberosity at 4 and 10 months, respectively, originally depicting red marrow and later converting to yellow marrow. A separate lesser tuberosity ossification center was not seen. The ossification centers began fusing by 3 years and gradually conformed to the final shape of the proximal humerus. Ossification was completed by 13 years. The multilaminar growth plate initially had a flat and smooth contour that progressively became irregular and pyramidal, closing at 17 years. The metaphyseal stripe was noted at infancy and disappeared by 15.5 years. The metaphyseal marrow signal intensity was diffusely low in infants but, with conversion to yellow marrow, showed proximal metaphyseal bright patchy or linear signal-intensity, eventually disappearing by 17 years. CONCLUSION. The postnatal skeletal development of the proximal humerus in the pediatric population follows distinctive sequential patterns of maturation, which can serve as a guideline for interpreting MRI studies in children.
    American Journal of Roentgenology 02/2014; 202(2):418-25. DOI:10.2214/AJR.13.10711 · 2.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the MRI appearance of normal skeletal development of the glenoid and glenoid-coracoid interface in the pediatric population. To the best of our knowledge, this has not yet been studied in detail in the literature. An IRB-approved, HIPAA-compliant retrospective review of 105 consecutive shoulder MRI studies in children, ages 2 months to 18 years was performed. The morphology, MR signal, and development of the following were assessed: (1) scapular-coracoid bipolar growth plate, (2) glenoid and glenoid-coracoid interface secondary ossification centers, (3) glenoid advancing osseous surface. The glenoid and glenoid-coracoid interface were identified in infancy as a contiguous, cartilaginous mass. A subcoracoid secondary ossification center in the superior glenoid was identified and fused in all by age 12 and 16, respectively. In ten studies, additional secondary ossification centers were identified in the inferior two-thirds of the glenoid. The initial concavity of the glenoid osseous surface gradually transformed to convexity, matching the convex glenoid articular surface. The glenoid growth plate fused by 16 years of age. Our study, based on MRI, demonstrated a similar pattern of development of the glenoid and glenoid coracoid interface to previously reported anatomic and radiographic studies, except for an earlier development and fusion of the secondary ossification centers of the inferior glenoid. The pattern of skeletal development of the glenoid and glenoid-coracoid interface follows a chronological order, which can serve as a guideline when interpreting MRI studies in children.
    Skeletal Radiology 07/2014; 43(9). DOI:10.1007/s00256-014-1936-0 · 1.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To provide an MRI timeline of normal skeletal developmental patterns in the acromial process and distal clavicle in children up to 18 years of age. Retrospective review of all shoulder MRIs obtained at our institution between January 2003 and March 2012, in children up to age 18, was performed. When available, radiographs and CT scans for these children were also reviewed. The following variables of the distal acromion and clavicle, with attention to morphology and MRI signal, were assessed: (1) Chondro-osseous junction and (2) Development and fusion of the secondary ossification centers. Ninety-eight children with 116 MR studies were identified from the data search. Of these, 13 patients were excluded and the final cohort included 85 children with 102 MRI studies. Forty-one of these patients also had shoulder radiographs. The cartilaginous precursors of the distal clavicle and acromion conformed to the final shape of these structures. The chondro-osseous interphases became progressively more lobulated and notched in the distal acromion and clavicle respectively. Appearance and fusion of the secondary ossification centers was significantly earlier in our study than previously reported. Acromial secondary ossification centers began forming at age 10 and clavicular ones, while uncommon, began forming at age 11. Fusion of acromial primary and secondary ossification centers began at age 14 and was generally complete after age 16. Based on MR imaging the development and fusion of the acromion and distal clavicle in children occur earlier than previously reported. They follow a sequential pattern and can serve as a blueprint for evaluating imaging studies of pediatric shoulders.
    Skeletal Radiology 10/2014; 44(2). DOI:10.1007/s00256-014-2020-5 · 1.74 Impact Factor