Focal periphyseal edema zone
Elite junior AFL footballer with low grade knee ache. No acute injury, normal physical examination.
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The growth plates have begun to close. PD sequence shows a focus of sclerosis along the medial aspect of the distal femoral growth plate, representing a bony bar across the physis.
PD FS sequence shows marrow edema signal radiating outward from this bony bar into the metaphysis and epiphysis, i.e., "periphyseal edema".
Minimal joint effusion.
No other abnormal findings.
Classic appearance of a focal periphyseal edema zone (FOPE lesion) in the appropriate demographic.
As the skeleton begins to mature, a bony bar may form across the growth plate as it closes. This focal bridge is thought to serve as an anchor around which abnormal biomechanical stress can concentrate, manifested as radiating marrow edema signal.
This is considered a normal physiologic process that can result in pain. The diagnosis is considered especially when there are no other abnormal findings.
This condition requires no further investigation, treatment or follow-up.
- Zbojniewicz AM, Laor T. Focal Periphyseal Edema (FOPE) zone on MRI of the adolescent knee: a potentially painful manifestation of physiologic physeal fusion?. AJR Am J Roentgenol. 2011;197 (4): 998-1004. doi:10.2214/AJR.10.6243 - Pubmed citation
- Harcke HT, Synder M, Caro PA et-al. Growth plate of the normal knee: evaluation with MR imaging. Radiology. 1992;183 (1): 119-23. Pubmed citation
- Sasaki T, Ishibashi Y, Okamura Y et-al. MRI evaluation of growth plate closure rate and pattern in the normal knee joint. J Knee Surg. 2002;15 (2): 72-6. Pubmed citation