High-signal T2 changes of the bone marrow of the foot and ankle in children: red marrow or traumatic changes?

• Published in: Pediatric radiology Vol. 36; no. 7; pp. 670 - 676
• Main Authors: Shabshin, Nogah, Schweitzer, Mark E, Morrison, William B, Carrino, John A, Keller, Marc S, Grissom, Leslie E
• Format: Journal Article
• Language: English
• Published: Germany Springer Nature B.V 01-07-2006
• Subjects: Adolescent; Ankle - anatomy & histology; Ankle Injuries - diagnosis; Bone Marrow - anatomy & histology; Bone Marrow Diseases - diagnosis; Child; Child, Preschool; Diagnosis, Differential; Female; Foot - anatomy & histology; Foot Injuries - diagnosis; Humans; Infant; Magnetic Resonance Imaging - methods; Male; Retrospective Studies
• DOI: 10.1007/s00247-006-0129-y
• EISSN: 1432-1998
• ISSN: 0301-0449

High-signal T2-weighted bone marrow changes can be found in both bone marrow edema and hematopoietic marrow and are often seen on pediatric MR images of the feet and ankle.
To evaluate whether high-signal T2 changes of the bone marrow seen on pediatric MRI of feet and ankles represent residual hematopoietic marrow.
A total of 402 bones in 41 pediatric MRI studies of feet and ankles (34 children, 1-18 years) were reviewed by two observers who were blinded to the patients' ages. The studies were reviewed for the presence of high-signal changes of the bone marrow on sagittal fluid-sensitive images. The frequency and location of these foci were correlated with the patients' ages.
High-signal T2 changes of the bone marrow were seen in 45/402 bones (11%) and in 24/41 patients younger than 16 years (59%). The changes were most commonly located in the calcaneus (54%), followed by the talus (35%) and navicular bone (35%), invariably at the endosteal surface. In 16 ankles, such foci were seen in the feet but not in the distal tibia/fibula. Symmetric presence (two ankles) or absence (four ankles) of high-signal marrow were seen in six of seven patients with bilateral ankles.
High-signal T2 changes of the bone marrow in pediatric feet and ankle MRIs have a symmetric, fairly consistent pattern and disappear after the age of 15 years. We believe that these high-signal areas are normal and represent residual hematopoietic marrow.