Download PDF
Semin Musculoskelet Radiol 2023; 27(04): 432-438
DOI: 10.1055/s-0043-1770125
Review Article

Metaphyseal and Diaphyseal Contours: Variants and Pitfalls

Anne Cotten
1   Department of Musculoskeletal Imaging, CIAL, Lille University Hospital, Lille University, Lille, France
2   Lille University, MABLab ULR 4490, Lille, France
,
Nathalie Boutry
3   Department of Pediatric Imaging, Jeanne de Flandre Hospital, Lille University Hospital, Lille University, Lille, France
,
Xavier Demondion
1   Department of Musculoskeletal Imaging, CIAL, Lille University Hospital, Lille University, Lille, France
4   University Lille, CHU Lille, ULR 7367 - UTML&A - Unité de Taphonomie Médico-Légale & d'Anatomie, Lille, France
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

We discuss several variants of the metaphyseal and diaphyseal bone surfaces that may be misleading in clinical practice. They include metaphyseal stripes, spiculated metaphyseal cortex, cortical desmoid, laminated lateral supracondylar ridge, cortical vascular canals, variations in shape or lucency of normal tuberosities, cortical thickening of normal ridges, and well-organized undulated hyperostosis at the proximal phalanges.

Keywords

anatomy - diaphysis - metaphysis - normal variant radiography


Publication History

Article published online:
25 September 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Dwek JR. The periosteum: what is it, where is it, and what mimics it in its absence?. Skeletal Radiol 2010; 39 (04) 319-323
    CrossrefPubMedSearch in Google Scholar
  • 2 Bisseret D, Kaci R, Lafage-Proust MH. et al. Periosteum: characteristic imaging findings with emphasis on radiologic-pathologic comparisons. Skeletal Radiol 2015; 44 (03) 321-338
    CrossrefPubMedSearch in Google Scholar
  • 3 Laor T, Chun GF, Dardzinski BJ, Bean JA, Witte DP. Posterior distal femoral and proximal tibial metaphyseal stripes at MR imaging in children and young adults. Radiology 2002; 224 (03) 669-674
    CrossrefPubMedSearch in Google Scholar
  • 4 Kwong S, Kothary S, Poncinelli LL. Skeletal development of the proximal humerus in the pediatric population: MRI features. AJR Am J Roentgenol 2014; 202 (02) 418-425
    CrossrefPubMedSearch in Google Scholar
  • 5 Zember JS, Rosenberg ZS, Kwong S, Kothary SP, Bedoya MA. Normal skeletal maturation and imaging pitfalls in the pediatric shoulder. Radiographics 2015; 35 (04) 1108-1122
    CrossrefPubMedSearch in Google Scholar
  • 6 Ogden JA. Anatomy and physiology of skeletal development. In: Skeletal Injury in the Child. 3rd ed. New York, NY: Springer; 2000: 1-37
    Search in Google Scholar
  • 7 Keats TE, Joyce JM. Metaphyseal cortical irregularities in children: a new perspective on a multi-focal growth variant. Skeletal Radiol 1984; 12 (02) 112-118
    CrossrefPubMedSearch in Google Scholar
  • 8 Ozonoff MB, Ziter Jr FM. The femoral head notch. Skeletal Radiol 1987; 16 (01) 19-22
    CrossrefPubMedSearch in Google Scholar
  • 9 Resnick D, Greenway G. Distal femoral cortical defects, irregularities, and excavations. Radiology 1982; 143 (02) 345-354
    CrossrefPubMedSearch in Google Scholar
  • 10 Kay M, Counsel P, Wood D, Breidahl W. Cortical desmoid of the humerus: radiographic and MRI correlation. Skeletal Radiol 2017; 46 (07) 1011-1015
    CrossrefPubMedSearch in Google Scholar
  • 11 Craigen MA, Bennet GC, MacKenzie JR, Reid R. Symptomatic cortical irregularities of the distal femur simulating malignancy. J Bone Joint Surg Br 1994; 76 (05) 814-817
    CrossrefPubMedSearch in Google Scholar
  • 12 Vieira RL, Bencardino JT, Rosenberg ZS, Nomikos G. MRI features of cortical desmoid in acute knee trauma. AJR Am J Roentgenol 2011; 196 (02) 424-428
    CrossrefPubMedSearch in Google Scholar
  • 13 Sweet DE. The Pathogenesis of Benign Fibrous and Cystic Lesions of Bone: Henry L. Jaffe Memorial Lecture. Washington, DC: Armed Forces Institute of Pathology; 1994
    Search in Google Scholar
  • 14 Simon H. Medial distal metaphyseal femoral irregularity in children. Radiology 1968; 90: 258-260
    CrossrefPubMedSearch in Google Scholar
  • 15 Stern C, Galley J, Fröhlich S, Peterhans L, Spörri J, Sutter R. Distal femoral cortical irregularity at knee MRI: increased prevalence in youth competitive Alpine skiers. Radiology 2020; 296 (02) 411-419
    CrossrefPubMedSearch in Google Scholar
  • 16 Tscholl PM, Biedert RM, Gal I. Cortical desmoids in adolescent top-level athletes. Acta Radiol Open 2015; 4 (05) 2058460115580878
    PubMedSearch in Google Scholar
  • 17 Kontogeorgakos VA, Xenakis T, Papachristou D. et al. Cortical desmoid and the four clinical scenarios. Arch Orthop Trauma Surg 2009; 129 (06) 779-785
    CrossrefPubMedSearch in Google Scholar
  • 18 Suh JS, Cho JH, Shin KH. et al. MR appearance of distal femoral cortical irregularity (cortical desmoid). J Comput Assist Tomogr 1996; 20 (02) 328-332
    CrossrefPubMedSearch in Google Scholar
  • 19 Goldin A, Muzykewicz DA, Dwek J, Mubarak SJ. The aetiology of the non-ossifying fibroma of the distal femur and its relationship to the surrounding soft tissues. J Child Orthop 2017; 11 (05) 373-379
    CrossrefPubMedSearch in Google Scholar
  • 20 Brower AC. Cortical defect of the humerus at the insertion of the pectoralis major. AJR Am J Roentgenol 1977; 128 (04) 677-678
    CrossrefPubMedSearch in Google Scholar
  • 21 Fulton MN, Albright JP, El-Khoury GY. Cortical desmoid-like lesion of the proximal humerus and its occurrence in gymnasts (Ringman's shoulder lesion). Am J Sports Med 1979; 7 (01) 57-61
    CrossrefPubMedSearch in Google Scholar
  • 22 Lerisson H, Tillaux C, Boutry N. Radiographic/MR imaging correlation of the pediatric knee growth. Magn Reson Imaging Clin N Am 2019; 27 (04) 737-751
    CrossrefPubMedSearch in Google Scholar
  • 23 Imre N, Battal B, Acikel CH, Akgun V, Comert A, Yazar F. The demonstration of the number, course, and the location of nutrient artery canals of the femur by multidetector computed tomography. Surg Radiol Anat 2012; 34 (05) 427-432
    CrossrefPubMedSearch in Google Scholar
  • 24 Chandrasekaran S, Shanthi KC. A study on the nutrient foramina of adult humerii. J Clin Diagn Res 2013; 7 (06) 975-977
    PubMedSearch in Google Scholar
  • 25 Craig JG, Widman D, van Holsbeeck M. Longitudinal stress fracture: patterns of edema and the importance of the nutrient foramen. Skeletal Radiol 2003; 32 (01) 22-27
    CrossrefPubMedSearch in Google Scholar
  • 26 Saifuddin A, Chalmers AG, Butt WP. Longitudinal stress fractures of the tibia: MRI features in two cases. Clin Radiol 1994; 49 (07) 490-495
    CrossrefPubMedSearch in Google Scholar
  • 27 Almansour H, Jacoby J, Baumgartner H, Reumann MK, Nikolaou K, Springer F. Injury of the tibial nutrient artery canal during external fixation for lower extremity fractures: a computed tomography study. J Clin Med 2020; 9 (07) 2235
    CrossrefPubMedSearch in Google Scholar
  • 28 Ramelet AA, Crebassa V. D Alotto C, et al. Anomalous intraosseous venous drainage: bone perforators?. Phlebology 2017; 32 (04) 241-248
    CrossrefPubMedSearch in Google Scholar
  • 29 Moraes FB, Camelo CP, Brandão ML, Fávaro PI, Barbosa TA, Barbosa RC. Intraosseous anomalous drainage: a rare case of pretibial varicose vein. Rev Bras Ortop 2016; 51 (06) 716-719
    PubMedSearch in Google Scholar
  • 30 Asghar A, Kumar A, Kant Narayan R, Naaz S. Is the cortical capillary renamed as the transcortical vessel in diaphyseal vascularity?. Anat Rec (Hoboken) 2020; 303 (11) 2774-2784
    CrossrefPubMedSearch in Google Scholar
  • 31 Grüneboom A, Hawwari I, Weidner D. et al. A network of trans-cortical capillaries as mainstay for blood circulation in long bones. Nat Metab 2019; 1 (02) 236-250
    CrossrefPubMedSearch in Google Scholar
  • 32 Uniyal P, Sihota P, Tikoo K, Kumar N. Anatomical variation in intracortical canal network microarchitecture and its influence on bone fracture risk. J Mech Behav Biomed Mater 2021; 123: 104770
    CrossrefPubMedSearch in Google Scholar
  • 33 Núñez JA, Goring A, Javaheri B. et al. Regional diversity in the murine cortical vascular network is revealed by synchrotron X-ray tomography and is amplified with age. Eur Cell Mater 2018; 35 (35) 281-299
    CrossrefPubMedSearch in Google Scholar
  • 34 Perilli E, Bala Y, Zebaze R, Reynolds KJ, Seeman E. Regional heterogeneity in the configuration of the intracortical canals of the femoral shaft. Calcif Tissue Int 2015; 97 (04) 327-335
    CrossrefPubMedSearch in Google Scholar
  • 35 Gheorghiu D, Leinenkugel A. The linea aspera-pilaster complex as a possible cause of confusion with the ‘flame sign’: a case report. Acta Orthop Traumatol Turc 2010; 44 (03) 254-256
    CrossrefPubMedSearch in Google Scholar
  • 36 Ichimura K, Kinose S, Kawasaki Y, Okamura T, Kato K, Sakai T. Anatomic characterization of the humeral nutrient artery: application to fracture and surgery of the humerus. Clin Anat 2017; 30 (07) 978-987
    CrossrefPubMedSearch in Google Scholar
  • 37 Kinose S, Kanaya Y, Kawasaki Y. et al. Anatomic characterization of the radial and ulnar nutrient arteries in humans. Ann Anat 2018; 216: 23-28
    CrossrefPubMedSearch in Google Scholar
  • 38 Kawasaki Y, Kinose S, Kato K, Sakai T, Ichimura K. Anatomic characterization of the femoral nutrient artery: application to fracture and surgery of the femur. Clin Anat 2020; 33 (04) 479-487
    CrossrefPubMedSearch in Google Scholar