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Solitary long-bone epiphyseal lesions in children: radiologic–pathological correlation and epidemiology

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Abstract

Background

Solitary epiphyseal lesions are rare and present with nonspecific imaging features. Knowledge regarding etiologies of pediatric epiphyseal lesions is limited to small studies.

Objective

The purpose of this study was to determine the relative incidence of pathologies affecting the pediatric epiphysis based on biopsy-proven cases with imaging.

Materials and methods

We conducted a retrospective review of imaging studies including the terms “biopsy” or “resection” and entities known to affect the epiphysis and cross-referenced these with pathology reports, recording the relevant clinical data. Two radiologists performed comprehensive imaging review and recorded relevant features.

Results

Forty-nine children and adolescents met inclusion criteria. The long-bone epiphyseal lesion etiologies included chondroblastoma (n=22, 45%), nonspecific nonmalignant pathology (n=11, 22%), osteomyelitis (n=9, 18%), lymphoma (n=2, 4%) and 1 case of each of aneurysmal bone cyst, chondrosarcoma, enchondroma, hemangioendothelioma, and non-Langerhans cell histiocytosis. Median age was 13.1 years old (range 1.5–18.6 years). We performed comparative analysis of the two most common lesions in our series, chondroblastoma and osteomyelitis. Chondroblastoma was significantly more likely to be peripherally located (94% vs. 33%, P=0.002) and to demonstrate a discrete T1-weighted hypointense rim (94% vs. 33%, P=0.002); there were no significant differences in enhancement or intrinsic signal properties. Children with chondroblastoma were older (15.1 years vs. 7.3 years, P=0.001), and chondroblastoma lesions were significantly larger, with mean maximum lesion diameter of 25 mm (interquartile range [IQR] 20–30) vs. 12 mm (IQR 11–18) (P=0.001) and lesion volumes of 4.4 mL (IQR 2.4–7.9) vs. 0.4 mL (IQR 0.2–1.4) (P=0.01).

Conclusion

This study reports the relative frequency of pathology of pediatric solitary epiphyseal lesions and describes several features that might assist in differentiating between chondroblastoma and osteomyelitis.

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Authors and Affiliations

  1. Department of Pediatric Radiology, The Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Alexander M. El-Ali, Ailish Coblentz & Andrew J. Degnan

  2. Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada

    Ailish Coblentz

  3. American Institute for Radiologic Pathology, Silver Spring, MD, USA

    Andrew J. Degnan

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  1. Alexander M. El-Ali
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  2. Ailish Coblentz
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  3. Andrew J. Degnan
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Correspondence to Alexander M. El-Ali.

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El-Ali, A.M., Coblentz, A. & Degnan, A.J. Solitary long-bone epiphyseal lesions in children: radiologic–pathological correlation and epidemiology. Pediatr Radiol 50, 1724–1734 (2020). https://doi.org/10.1007/s00247-020-04752-8

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  • DOI: https://doi.org/10.1007/s00247-020-04752-8

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