MR-IMAGING OF ENHANCING INTRAOSSEOUS DISK HERNIATION (SCHMORLS NODES)

OBJECTIVE. This study was conducted to show vascularization of Schmorl 's nodes with enhanced MR imaging and to con-elate this finding with c linical complaints. MATERIALS AND METHODS. Retrospectively, 412 gadope ntetate dimeglumine-enhanced MR imaging examinations of the lumbar and thoracic spine of 372 patients were reviewed for Schmorl's nodes, vas cularization of Schmorl's nodes, and associated bone marrow edema. Sag ittal T2-weighted spin-echo and unenhanced and enhanced T1-weighted sp in-echo images with and without fat suppression were evaluated in symp tomatic and asymptomatic patients. RESULTS. Of the 372 patients, 142 ( 38%) had 341 Schmorl's nodes, Gadopentetate dimeglumine-enhanced MR im aging revealed vascularized tissue in 30 Schmorl's nodes of 23 patient s (mean age of patients, 53 years old). Associated bone marrow edema w as found in nine of 30 vascularized Schmorl's nodes. The mean diameter (8.2 mm) of the nine vascularized Schmorl's nodes that were surrounde d by bone marrow edema was significantly (p <.05) greater than the mea n diameter (6.4 mm) of the 21 vascularized Schmorl's nodes that had no bone marrow edema. The vascularized Schmorl's nodes were significantl y (p <.05) smaller in the seven asymptomatic patients (mean, 5.2 mm) t han in the 23 patients with back pain (mean, 7.9 mm). We saw bone marr ow edema adjacent to Schmorl's nodes less frequently in asymptomatic p atients (one of seven) than in symptomatic patients (10 of 23). CONCLU SION. Vascularized Schmorl's nodes were larger and more frequently ass ociated with bone marrow edema in patients with back pain than in asym ptomatic patients. Enhanced MR images of Schmorl's nodes revealed vasc ularity, which was not shown on unenhanced MR images.