Skeletal Radiology

, Volume 35, Issue 4, pp 212–219 | Cite as

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

  • Hung-Ta H. Wu
  • William B. Morrison
  • Mark E. Schweitzer
Scientific Article

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.

Keywords

Spine MR Spine Intervertebral discs Spine Abnormality 

References

  1. 1.
    Kaplan PA, Helms CA, Dussault R, Anderson MW, Major NM Spine. In: Kaplan PA (ed) Musculoskeletal MRI. W.B. Saunders, Philadelphia; 2001. pp 306–308Google Scholar
  2. 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 1430–1432Google Scholar
  3. 3.
    Walters G, Coumas JM, Akins CM, Ragland RL Magnetic resonance imaging of acute symptomatic Schmorl’s node formation. Pediatr Emerg Care 1991;7:294–296PubMedCrossRefGoogle Scholar
  4. 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;23:2272–2275PubMedCrossRefGoogle Scholar
  5. 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 1096Google Scholar
  6. 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;17:238–245PubMedGoogle Scholar
  7. 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;4:56–59PubMedCrossRefGoogle Scholar
  8. 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;176:969–972PubMedGoogle Scholar
  9. 9.
    Coulier B, Ghosez JP Lumbar radiculopathy caused by a tunneling transvertebral Schmorl’s node. Skeletal Radiol 2002;31:484–487PubMedCrossRefGoogle Scholar
  10. 10.
    Leibner ED, Floman Y Tunneling Schmorl’s nodes. Skeletal Radiol 1998;27:225–227PubMedCrossRefGoogle Scholar
  11. 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;168:933–938PubMedGoogle Scholar
  12. 12.
    Hamanishi C, Kawabata T, Yosii T, Tanaka S Schmorl’s nodes on magnetic resonance imaging. Their incidence and clinical relevance. Spine 1994;19:450–453PubMedCrossRefGoogle Scholar
  13. 13.
    Dietz GW, Christensen EE Normal “Cupid’s bow” contour of the lower lumbar vertebrae. Radiology 1976;121:577–579PubMedGoogle Scholar
  14. 14.
    Hilton RC, Ball J, Benn RT Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 1976;35:127–132PubMedCrossRefGoogle Scholar
  15. 15.
    Lipson SJ, Fox DA, Sosman JL Symptomatic intravertebral disc herniation (Schmorl’s node) in the cervical spine. Ann Rheum Dis 1985;44:857–859PubMedGoogle Scholar
  16. 16.
    Tsuji H, Yoshioka T, Sainoh H Developmental balloon disc of the lumbar spine in healthy subjects. Spine 1985;10:907–911PubMedCrossRefGoogle Scholar
  17. 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;219:368–374PubMedGoogle Scholar
  18. 18.
    Resnick D, Niwayama G Intravertebral disk herniations: cartilaginous (Schmorl’s) nodes. Radiology 1978;126:57–65PubMedGoogle Scholar
  19. 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;21:276–281PubMedGoogle Scholar
  20. 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;166:193–199PubMedGoogle Scholar
  21. 21.
    Seymour R, Williams LA, Rees JI, Lyons K, Lloyd DC Magnetic resonance imaging of acute intraosseous disc herniation. Clin Radiol 1998;53:363–368PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2006

Authors and Affiliations

  • Hung-Ta H. Wu
    • 1
  • William B. Morrison
    • 2
  • Mark E. Schweitzer
    • 3
  1. 1.Department of Radiology, Taipei Veterans General HospitalNational Yang Ming UniversityTaipeiTaiwan
  2. 2.Department of RadiologyThomas Jefferson University HospitalPhiladelphiaUSA
  3. 3.New York University-Hospital for Joint DiseasesNew YorkUSA

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