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

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Skeletal Radiology Aims and scope Submit manuscript

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.

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Authors and Affiliations

  1. Department of Radiology, Taipei Veterans General Hospital, National Yang Ming University, 201 Shih Pai Rd, Sec. 2, Taipei, 112, Taiwan

    Hung-Ta H. Wu

  2. Department of Radiology, Thomas Jefferson University Hospital, 111, S 11th St, Philadelphia, PA, USA

    William B. Morrison

  3. New York University-Hospital for Joint Diseases, 301 East 17th St, New York, NY, 10003, USA

    Mark E. Schweitzer

Authors
  1. Hung-Ta H. Wu
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  2. William B. Morrison
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  3. Mark E. Schweitzer
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Correspondence to William B. Morrison.

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Wu, HT.H., Morrison, W.B. & Schweitzer, M.E. Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time. Skeletal Radiol 35, 212–219 (2006). https://doi.org/10.1007/s00256-005-0068-y

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  • DOI: https://doi.org/10.1007/s00256-005-0068-y

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