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Skeletal Radiology
Published in: Skeletal Radiology 4/2006

01-04-2006 | Scientific Article

Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time

Authors: Hung-Ta H. Wu, William B. Morrison, Mark E. Schweitzer

Published in: Skeletal Radiology | Issue 4/2006

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Abstract

Objective

To describe the patterns and note the evolution of edematous Schmorl’s nodes.

Materials and methods

In 47 patients (M:F=26:21, 24–86 years, average 60), 84 Schmorls nodes with T2 hyperintensity with serial MR exams were evaluated. Interval between MR exams was 2–72 months (average 17). Two observers noted size, location, margins, internal and surrounding T1/T2 signal, adjacent disc herniation or bulge, concentric ring, underlying fracture, malignancy, infection, or prior disc surgery, and serial MR changes in these characteristics over time.

Results

Node size averaged 7×9 mm. Most were located at L3 (29%, 24/84), L4 (19%, 16/84) and L2 (13%, 11/84), at the central (39%, 33/84) or outer (30%, 25/84) third of the endplate. 55% (39/71) had a bulging disc, 7% (5/71) had disc herniation. 10% (8/84) had evidence of associated fracture, 17% (14/84) tumor, 7% (6/84) infection. Most nodes had well-defined margins (82%, 69/84). The most common node internal signal was isointense to adjacent disc on T1/T2 (33%, 28/84); surrounding marrow was most commonly hypointense on T1 and hyperintense on T2 (54%, 38/71). A common finding was concentric rings (38%, 32/84) in the marrow surrounding the node, a finding which had 72% negative predictive value for absence of infection, tumor and fracture. On follow-up, there was no interval change in node size in 46%(39/84) of Schmorl’s nodes. 26% (22/84) had increased size. Most (60%, 50/84) showed no temporal change in internal T2 signal. 21% (18/84) of nodes showed decreased internal T2 signal, 13% (11/84) showed increased T2 signal. Regarding the surrounding marrow, most (58%, 49/84) showed no temporal change in T2 signal; 21%(18/84) showed decreased T2 signal, 13% (11/84) showed increased T2 signal. In 13 Schmorl’s nodes with intranodal enhancement, eight (62%) showed no interval change; among eight with enhancement in surrounding marrow, five (63%) showed no change on follow-up.

Conclusion

Although most remain unchanged, a relatively large minority of edematous Schmorl's nodes evolve in size and signal over a relatively short time. Some evolve to form well-defined concentric rings in the surrounding marrow that appear to be analogous to degenerative changes of endplates. Concentric ring formation has a high negative predictive value for “idiopathic” Schmorl’s nodes without underlying fracture, infection, or malignancy.
Literature
1.
Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM Spine. In: Kaplan PA (ed) Musculoskeletal MRI. W.B. Saunders, Philadelphia; 2001. pp 306–308
2.
Resnick D Degenerative disease of the spine. In: Resnick D (ed) Diagnosis of bone and joint disorders, 4th ed. W.B. Saunders, Philadelphia; 2002. pp 1430–1432
3.
Walters G, Coumas JM, Akins CM, Ragland RL Magnetic resonance imaging of acute symptomatic Schmorl’s node formation. Pediatr Emerg Care 1991;7:294–296PubMedCrossRef
4.
Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C The pathogenesis of Schmorl’s nodes in relation to acute trauma. An autopsy study. Spine 1998;23:2272–2275PubMedCrossRef
5.
Stoller DW, Hu SS, Kaiser JA The spine. In: Stoller DW (ed) Magnetic resonance imaging in orthopaedics & sports medicine, 2nd ed. Lippincott-Raven, Philadelphia; 1997. p 1096
6.
Marchiori DM, McLean I, Firth R, Tatum R A comparison of radiographic signs of degeneration to corresponding MRI signal intensities in the lumbar spine. J Manipulative Physiol Ther 1994;17:238–245PubMed
7.
Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K Schmorl’s nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals. Eur Spine J 1995;4:56–59PubMedCrossRef
8.
Hauger O, Cotten A, Chateil JF, Borg O, Moinard M, Diard F Giant cystic Schmorl’s nodes: imaging findings in six patients. AJR Am J Roentgenol 2001;176:969–972PubMed
9.
Coulier B, Ghosez JP Lumbar radiculopathy caused by a tunneling transvertebral Schmorl’s node. Skeletal Radiol 2002;31:484–487PubMedCrossRef
10.
11.
Stabler A, Bellan M, Weiss M, Gartner C, Brossmann J, Reiser MF MR imaging of enhancing intraosseous disk herniation (Schmorl’s nodes). AJR Am J Roentgenol 1997;168:933–938PubMed
12.
Hamanishi C, Kawabata T, Yosii T, Tanaka S Schmorl’s nodes on magnetic resonance imaging. Their incidence and clinical relevance. Spine 1994;19:450–453PubMedCrossRef
13.
Dietz GW, Christensen EE Normal “Cupid’s bow” contour of the lower lumbar vertebrae. Radiology 1976;121:577–579PubMed
14.
Hilton RC, Ball J, Benn RT Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 1976;35:127–132PubMedCrossRef
15.
Lipson SJ, Fox DA, Sosman JL Symptomatic intravertebral disc herniation (Schmorl’s node) in the cervical spine. Ann Rheum Dis 1985;44:857–859PubMed
16.
Tsuji H, Yoshioka T, Sainoh H Developmental balloon disc of the lumbar spine in healthy subjects. Spine 1985;10:907–911PubMedCrossRef
17.
Pfirrmann CW, Resnick D Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 2001;219:368–374PubMed
18.
Resnick D, Niwayama G Intravertebral disk herniations: cartilaginous (Schmorl’s) nodes. Radiology 1978;126:57–65PubMed
19.
Wagner AL, Murtagh FR, Arrington JA, Stallworth D Relationship of Schmorl’s nodes to vertebral body endplate fractures and acute endplate disk extrusions. AJNR Am J Neuroradiol 2000;21:276–281PubMed
20.
Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193–199PubMed
21.
Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC Magnetic resonance imaging of acute intraosseous disc herniation. Clin Radiol 1998;53:363–368PubMedCrossRef
Metadata
Title
Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time
Authors
Hung-Ta H. Wu
William B. Morrison
Mark E. Schweitzer
Publication date
01-04-2006
Publisher
Springer-Verlag
Published in
Skeletal Radiology / Issue 4/2006
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-005-0068-y

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