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Society for Pediatric Radiology – Poster Archive
Final ID: Paper #: 066
Solitary Long Bone Epiphyseal Lesions in Children: Radiologic-Pathologic Correlation and Epidemiology
Purpose or Case Report: Solitary epiphyseal lesions are rare in children, and no large series describes the relative frequency of different etiologies. Understanding the incidence and nature of epiphyseal lesions is critical in informing radiologists encountering these lesions.
Methods & Materials: Retrospective review of radiology reports from 2000 - 2019 that mentioned the words biopsy or resection and one of the following: (1) epiphysis or (2) entities known to affect the epiphysis (e.g. chondroblastoma) was conducted. Cases were reviewed to ensure (1) the lesion was centered in the epiphysis, (2) tissue sampling was performed and (3) appropriate pathology reports and imaging were available. Conventional radiographs and/or advanced imaging (CT and MRI) were reviewed by 1 board eligible and 2 board certified pediatric radiologists. Clinical data was also reviewed.
Results: Out of a total of 422 studies, 49 met inclusion criteria. Median age was 13.1 years old (range 1.5 - 18.6). 14 patients (29%) patients were female. 40 patients (82 %) presented with pain with the remaining asymptomatic.
Epiphyseal lesions identified include: chondroblastoma 22 (45%), non-specific nonmalignant pathology 11 (22%), osteomyelitis 9 (18 %), lymphoma 2 (4%) and 1 case of each of the following diagnoses, aneurysmal bone cyst, chondrosarcoma, enchondroma, hemangioendothelioma, and histiocytosis. 39 (80%) patients underwent surgical excision and 10 (20%) patients underwent image-guided biopsy. Image-guided biopsy resulted in a higher rate of non-specific pathologic diagnosis, 50% vs 15%, p=0.02.
39 cases were initially imaged using radiography. Lesions that were correctly diagnosed (n=22) were larger than those that were not detected 3.4 vs 1.2 cc (p=0.23), had larger maximal dimension 2.2 vs 1.5 cm (p = 0.08), and were seen in older patients 13.9 vs 11.3 years old (p<0.01). Delay from initial radiographs to definitive advanced imaging was a median of 1.3 months (range: 0-24 months). Fever, elevated WBC, and inflammatory markers did not significantly differ between patients with and without osteomyelitis (p>0.40 for each).
Conclusions: Pediatric epiphyseal lesions are heterogeneous, but most are benign with chondroblastoma, osteomyelitis and other benign lesions accounting for over 85% of cases. Initial radiographic identification of these lesions can be challenging and imaging features are frequently nonspecific. Understanding the relative incidence of different pathologies may be helpful in informing the differential diagnosis.
Methods & Materials: Retrospective review of radiology reports from 2000 - 2019 that mentioned the words biopsy or resection and one of the following: (1) epiphysis or (2) entities known to affect the epiphysis (e.g. chondroblastoma) was conducted. Cases were reviewed to ensure (1) the lesion was centered in the epiphysis, (2) tissue sampling was performed and (3) appropriate pathology reports and imaging were available. Conventional radiographs and/or advanced imaging (CT and MRI) were reviewed by 1 board eligible and 2 board certified pediatric radiologists. Clinical data was also reviewed.
Results: Out of a total of 422 studies, 49 met inclusion criteria. Median age was 13.1 years old (range 1.5 - 18.6). 14 patients (29%) patients were female. 40 patients (82 %) presented with pain with the remaining asymptomatic.
Epiphyseal lesions identified include: chondroblastoma 22 (45%), non-specific nonmalignant pathology 11 (22%), osteomyelitis 9 (18 %), lymphoma 2 (4%) and 1 case of each of the following diagnoses, aneurysmal bone cyst, chondrosarcoma, enchondroma, hemangioendothelioma, and histiocytosis. 39 (80%) patients underwent surgical excision and 10 (20%) patients underwent image-guided biopsy. Image-guided biopsy resulted in a higher rate of non-specific pathologic diagnosis, 50% vs 15%, p=0.02.
39 cases were initially imaged using radiography. Lesions that were correctly diagnosed (n=22) were larger than those that were not detected 3.4 vs 1.2 cc (p=0.23), had larger maximal dimension 2.2 vs 1.5 cm (p = 0.08), and were seen in older patients 13.9 vs 11.3 years old (p<0.01). Delay from initial radiographs to definitive advanced imaging was a median of 1.3 months (range: 0-24 months). Fever, elevated WBC, and inflammatory markers did not significantly differ between patients with and without osteomyelitis (p>0.40 for each).
Conclusions: Pediatric epiphyseal lesions are heterogeneous, but most are benign with chondroblastoma, osteomyelitis and other benign lesions accounting for over 85% of cases. Initial radiographic identification of these lesions can be challenging and imaging features are frequently nonspecific. Understanding the relative incidence of different pathologies may be helpful in informing the differential diagnosis.
More abstracts on this topic:
PET/MR of pediatric bone tumors: What the radiologist needs to know
Farrell Crystal, Pareek Anuj, Muehe Anne, Pribnow Allison, Steffner Robert, Avedian Raffi, Daldrup-link Heike
Osteoid Osteomas of the Small Tubular Bones of the Hands and Feet: Imaging Features with Clinical CorrelationGendler Liya, Ho-fung Victor, Degnan Andrew, Sze Raymond, Nguyen Michael, Hong Shijie, Chang Benjamin, Arkader Alexandre, Nguyen Jie
Due to circumstances surrounding the coronavirus pandemic, this final ePoster exhibit was not submitted.
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