Imaging of Pediatric Growth Plate Disturbances

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.00
Procedures: 1.00
Head, Spine, and Musculoskeletal: 1.00

Magnetic Resonance Imaging: 1.75
Image Production: 0.25
Data Acquisition, Processing, and Storage: 0.25
Procedures: 1.50
Musculoskeletal: 1.50

Radiography: 1.00
Procedures: 1.00
Extremity Procedures: 1.00

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Musculoskeletal and Endocrine Sections: 2.75

Sonography: 1.25
Procedures: 1.25
Second/Third Trimester and High Risk Obstetrics: 0.25
Superficial Structures and Other Sonographic Procedures: 1.00

Outline

1. Introduction
2. Primary Growth Plate Complex
   1. Growth Plate
      1. Reserve Zone
      2. Proliferative Zone
      3. Hypertrophic Zone
      4. Perichondrium
   2. Epiphysis
   3. Metaphysis
3. Imaging of Hyaline Cartilage
4. Direct Growth Plate Disturbances
   1. Growth Plate Fractures
   2. Soft-Tissue Physeal Interposition
   3. Slipped Capital Femoral Epiphysis
5. Indirect Growth Plate Disturbance Involving the Epiphysis
   1. Legg-CalvÈ
   2. Hyperabduction OsteonecrosisSoft-Tissue Physeal Interposition
   3. Posttraumatic OsteonecrosisSlipped Capital Femoral Epiphysis
   4. Tibia VeraGrowth Plate Fractures
   5. OsteomyelitisSoft-Tissue Physeal Interposition
6. Indirect Growth Plate Disturbance Involving the Metaphysis
   1. Metaphyseal Fracture
   2. Treatment-related Osteonecrosis
   3. Overuse Injury
   4. Insensitivity to Pain
7. Imaging and Treatment of Growth Disturbance
8. Conclusion

Objectives

Upon completion of this course, students will:

1. differentiate between intramembranous growth and endochondral growth
2. state the only growth center in smaller bones
3. list possible outcomes of an impaired primary growth plate
4. recall the most common insult mechanism
5. state when mesenchymal cells differentiate into chondrocytes
6. state when mesenchymal cells differentiate into osteoblasts and osteoclasts
7. recall how bone remodeling and formation of the medullary cavity occurs
8. describe primary growth plate shape at birth
9. list the distinct chondrocyte zones
10. state the zone with the highest oxygen tension
11. list the sub-zones of the hypertrophic zone
12. describe the composition of the perichondrium
13. recall what aspect of the perichondrium is responsible for the latitudinal growth of the growth plate
14. state the age range in which the transphyseal channels disappear
15. list the functions of the metaphysis
16. differentiate between internal and external bone remodeling
17. understand the marrow conversion processes in long bones
18. state when growth recovery lines become present radiographically
19. identify the preferred imaging modality for evaluating the hyaline cartilage
20. describe the composition of hyaline cartilage
21. list hyaline cartilage types that can be distinguished from each other at MR imaging
22. list the phases of epiphyseal cartilage enhancement observed at MR
23. list obstacles to using MR imaging more routinely for children
24. state the percentage of growth plate fractures in children
25. relate how growth plate fractures affect children
26. state the number of Salter-Harris fracture types
27. associate the percentage of growth plate fractures to each Salter-Harris fracture type
28. state the rarest Salter-Harris fracture type
29. state the preferred initial imaging modality for acute fractures, subacute healing response, and growth disturbances
30. explain the intervention required if interposition of soft tissue into the growth plate following a fracture occurs
31. record the percentage of slipped capital femoral epiphyseal cases that can be bilateral in nature
32. state the best types of MR images to visualize different aspects of slipped capital femoral epiphysis
33. describe Legg-Calvé-Perthes disease
34. state the percentage of cases of premature growth plate closure in hyperabduction osteonecrosis
35. describe fishtail deformity
36. describe blount disease
37. recall how osteomyelitis affects children in developed countries
38. list the main functions of the metaphyseal vessels
39. recall the percentage of acute lymphoblastic leukemia affected by bone infarction
40. explain the end result of permanent growth plate injuries