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Unusual Presentations of Focal Periphyseal Edema Zones: A Report of Bilateral Symmetric Presentation and Partial Physeal Closure.

Beckmann N, Spence S - Case Rep Radiol (2015)

Bottom Line: Since the original case series describing these areas of periphyseal edema, there has been little published in regard to FOPE zone outside of review articles.We present a set of three patients identified with focal periphyseal edema zones around the knee and compare our findings with the initial case series.We include a patient presenting with bilateral, nearly symmetric, focal periphyseal edema zones of the proximal tibia physis and a patient with partial closure of the physis at time of presentation, which were not reported in the original case series.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Imaging, Memorial Hermann, University of Texas Health Science Center, 6431 Fannin Street, No. 2.130B, Houston, TX 77030, USA.

ABSTRACT
Focal periphyseal edema (FOPE) zones are areas of periphyseal edema seen near the time of physeal closure which are believed to be a physiologic phenomenon related to changes in distribution of forces around the physis as it closes. Since the original case series describing these areas of periphyseal edema, there has been little published in regard to FOPE zone outside of review articles. We present a set of three patients identified with focal periphyseal edema zones around the knee and compare our findings with the initial case series. We include a patient presenting with bilateral, nearly symmetric, focal periphyseal edema zones of the proximal tibia physis and a patient with partial closure of the physis at time of presentation, which were not reported in the original case series.

No MeSH data available.


Related in: MedlinePlus

A 13-year-3-month-old female with FOPE zones at both proximal tibiae. Findings: (a) sagittal proton density fat-saturated image on the 6-month follow-up MRI of the right knee shows interval development of 9 mm in diameter area of periphyseal edema on both the epiphyseal and metaphyseal sides of the proximal tibia physis (arrow). The proximal tibia physis is narrowed but remains open. (b) Axial proton density fat-saturated image at the level of the proximal tibia physis shows the periphyseal edema located at the anterolateral aspect of the central physis (asterisk). Technique: (a) sagittal PD fat-saturated MRI (TR = 2,958.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 14 cm, and matrix = 364 × 261; (b) axial PD fat-saturated MRI (TR = 2,843.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 15 cm, and matrix = 376 × 297.
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fig4: A 13-year-3-month-old female with FOPE zones at both proximal tibiae. Findings: (a) sagittal proton density fat-saturated image on the 6-month follow-up MRI of the right knee shows interval development of 9 mm in diameter area of periphyseal edema on both the epiphyseal and metaphyseal sides of the proximal tibia physis (arrow). The proximal tibia physis is narrowed but remains open. (b) Axial proton density fat-saturated image at the level of the proximal tibia physis shows the periphyseal edema located at the anterolateral aspect of the central physis (asterisk). Technique: (a) sagittal PD fat-saturated MRI (TR = 2,958.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 14 cm, and matrix = 364 × 261; (b) axial PD fat-saturated MRI (TR = 2,843.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 15 cm, and matrix = 376 × 297.

Mentions: The patient's medial joint line pain improved, but she continued to have mild anterior knee pain. A repeated MRI of the right knee was performed 6 months after the initial MRI to assess for changes in the osteochondral lesion. MRI of the left knee was performed at the same time due to the patient complaining of vague anterior left knee pain similar to the presenting right knee pain, which raised clinical concern for an occult osteochondral lesion of the left knee. She was at chronologic age of 13 years and 3 months at the time of the bilateral knee MRI. The osteochondral lesion of the right medial femoral condyle was unchanged in appearance between the two MRI exams (Figure 3). However, in the interim, a 9 mm focal periphyseal edema (FOPE) zone developed in the anterolateral aspect of the central proximal right tibia (Figure 4). A similar appearing 13 mm FOPE zone was present in the anterior aspect of the central proximal left tibia on the left knee MRI (Figures 5 and 6). While the distribution of FOPE zone periphyseal edema was equal on the epiphyseal and metaphyseal sides of the proximal right tibia, the periphyseal edema was more exuberant on the epiphyseal side of the proximal left tibia. The remainder of the left knee MRI was normal. The proximal tibial physis was narrowed, but open, bilaterally.


Unusual Presentations of Focal Periphyseal Edema Zones: A Report of Bilateral Symmetric Presentation and Partial Physeal Closure.

Beckmann N, Spence S - Case Rep Radiol (2015)

A 13-year-3-month-old female with FOPE zones at both proximal tibiae. Findings: (a) sagittal proton density fat-saturated image on the 6-month follow-up MRI of the right knee shows interval development of 9 mm in diameter area of periphyseal edema on both the epiphyseal and metaphyseal sides of the proximal tibia physis (arrow). The proximal tibia physis is narrowed but remains open. (b) Axial proton density fat-saturated image at the level of the proximal tibia physis shows the periphyseal edema located at the anterolateral aspect of the central physis (asterisk). Technique: (a) sagittal PD fat-saturated MRI (TR = 2,958.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 14 cm, and matrix = 364 × 261; (b) axial PD fat-saturated MRI (TR = 2,843.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 15 cm, and matrix = 376 × 297.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660012&req=5

fig4: A 13-year-3-month-old female with FOPE zones at both proximal tibiae. Findings: (a) sagittal proton density fat-saturated image on the 6-month follow-up MRI of the right knee shows interval development of 9 mm in diameter area of periphyseal edema on both the epiphyseal and metaphyseal sides of the proximal tibia physis (arrow). The proximal tibia physis is narrowed but remains open. (b) Axial proton density fat-saturated image at the level of the proximal tibia physis shows the periphyseal edema located at the anterolateral aspect of the central physis (asterisk). Technique: (a) sagittal PD fat-saturated MRI (TR = 2,958.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 14 cm, and matrix = 364 × 261; (b) axial PD fat-saturated MRI (TR = 2,843.3, TE = 30), ST = 3 mm, spacing = 3.3 mm, FOV = 15 cm, and matrix = 376 × 297.
Mentions: The patient's medial joint line pain improved, but she continued to have mild anterior knee pain. A repeated MRI of the right knee was performed 6 months after the initial MRI to assess for changes in the osteochondral lesion. MRI of the left knee was performed at the same time due to the patient complaining of vague anterior left knee pain similar to the presenting right knee pain, which raised clinical concern for an occult osteochondral lesion of the left knee. She was at chronologic age of 13 years and 3 months at the time of the bilateral knee MRI. The osteochondral lesion of the right medial femoral condyle was unchanged in appearance between the two MRI exams (Figure 3). However, in the interim, a 9 mm focal periphyseal edema (FOPE) zone developed in the anterolateral aspect of the central proximal right tibia (Figure 4). A similar appearing 13 mm FOPE zone was present in the anterior aspect of the central proximal left tibia on the left knee MRI (Figures 5 and 6). While the distribution of FOPE zone periphyseal edema was equal on the epiphyseal and metaphyseal sides of the proximal right tibia, the periphyseal edema was more exuberant on the epiphyseal side of the proximal left tibia. The remainder of the left knee MRI was normal. The proximal tibial physis was narrowed, but open, bilaterally.

Bottom Line: Since the original case series describing these areas of periphyseal edema, there has been little published in regard to FOPE zone outside of review articles.We present a set of three patients identified with focal periphyseal edema zones around the knee and compare our findings with the initial case series.We include a patient presenting with bilateral, nearly symmetric, focal periphyseal edema zones of the proximal tibia physis and a patient with partial closure of the physis at time of presentation, which were not reported in the original case series.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic and Interventional Imaging, Memorial Hermann, University of Texas Health Science Center, 6431 Fannin Street, No. 2.130B, Houston, TX 77030, USA.

ABSTRACT
Focal periphyseal edema (FOPE) zones are areas of periphyseal edema seen near the time of physeal closure which are believed to be a physiologic phenomenon related to changes in distribution of forces around the physis as it closes. Since the original case series describing these areas of periphyseal edema, there has been little published in regard to FOPE zone outside of review articles. We present a set of three patients identified with focal periphyseal edema zones around the knee and compare our findings with the initial case series. We include a patient presenting with bilateral, nearly symmetric, focal periphyseal edema zones of the proximal tibia physis and a patient with partial closure of the physis at time of presentation, which were not reported in the original case series.

No MeSH data available.


Related in: MedlinePlus