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Published online before print May 30, 2002, 10.1148/radiol.2241011202
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(Radiology 2002;224:120-123.)
© RSNA, 2002

Pediatric Imaging

"Missing" Sternal Ossification Center: Potential Mimicker of Disease in Young Children1

William J. Rush, BS, Lane F. Donnelly, MD, Alan S. Brody, MD, Christopher G. Anton, MD and Stacy A. Poe, MS

1 From the Departments of Radiology (W.J.R., L.F.D., A.S.B., C.G.A.) and Pediatrics (L.F.D., A.S.B., C.G.A., S.A.P.), Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039. Received July 16, 2001; revision requested September 10; revision received November 15; accepted January 8, 2002. Address correspondence to L.F.D. (e-mail: Lane.donnelly@chmcc.org).

PURPOSE: To evaluate the frequency of "missing" sternal ossification center (asynchronous nonossification) in young children.

MATERIALS AND METHODS: Lateral chest radiographs obtained in 229 children (mean age, 3.7 years) were retrospectively evaluated for sternal ossification. Four superior sternal segments were considered normal if they were ossified to a similar degree. A segment was considered asynchronous if decreased ossification, as compared with the remaining sternal segments, was demonstrated or if ossification was absent. Asynchronous ossification of inferior sternal segment 5 was recorded separately. Logistic regression analysis was applied to determine if there was a statistically significant relationship (P < .05) between age or sex and pattern of sternal ossification (normal vs asynchronous).

RESULTS: Of the 916 superior four sternal segments (four segments in each of 229 patients) evaluated, 32 (3.5%) showed asynchronously decreased or absent ossification. Locations of these 32 segments follow: segment 1, two (0.2%) instances; segment 2, 14 (1.5%) instances; segment 3, two (0.2%) instances; and segment 4, 14 (1.5%) instances. Inferior segment 5 was not ossified in 73 (31.9%) patients. There was a statistically significant relationship between decreased age and increased likelihood of occurrence of asynchronous ossification of one of the sternal ossification centers 1–4 (P > .003) and of occurrence of asynchronous ossification at sternal segment 2 (P < .018).

CONCLUSION: Missing sternal ossification centers occur most commonly at segments 2 and 4. Such asynchronous nonossifications become less common in older children.

© RSNA, 2002

Index terms: Bones, growth and development, 472.81 • Sternum, abnormalities, 472.81 • Thorax, MR, 472.121411






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