title: Differentiating os acromiale from normally developing acromial ossification centers using magnetic resonance imaging.
abstract: OBJECTIVE
  Acromial fusion may not be complete until age 18-25, making it questionable to diagnose os acromiale in adolescents. Os acromiale may exist in adolescents and can be differentiated from a developing acromial ossification center based on MRI findings.
  
  
  METHODS
  A total of 128 MRIs of the shoulder were randomly and blindly reviewed retrospectively by two musculoskeletal radiologists. The MRIs consisted of two groups: (1) 56 of os acromiale in adults (25-74 years old, mean, 50) and (2) 72 consecutive of adolescents (12-17 years old, mean, 14.5). The following were assessed at the interface between the distal acromion and os acromiale/developing ossification center(s): presence of os acromiale vs. developing acromion, orientation, margins, and edema within and adjacent to it.
  
  
  RESULTS
  Fifty-one adults and 49 adolescents were included. Exclusions were due to poor image quality or confounding findings (n = 7) or complete acromial fusion (n = 21 adolescents). Utilizing accepted definitions of os acromiale, all adult cases (100 %) were accurately diagnosed as os acromiale, with transverse interface orientation and irregular margins (94 %, R = 0.86, p < 0.00001). Forty-five (92 %) adolescent cases were accurately diagnosed as normally developing acromion with arched interface and lobulated margins (92 %, R = 0.92, p < 0.000001). Four (8 %) adolescent cases were diagnosed as having os acromiale, with transverse orientation and irregular margins. Thirty-five (69 %) and 46 (90 %) adults had marrow and interface edema, respectively. Six (12 %) and eight (16 %) adolescents had marrow and interface edema, respectively, including the four concluded to be os acromiale.
  
  
  CONCLUSIONS
  Adolescents may have imaging findings consistent with os acromiale. The diagnosis of os acromiale should be based on imaging features and not limited by age.
authors.affiliation: Department of Radiology, Children's National Medical Center, 111 Michigan Ave. NW, Washington, DC, 20005, USA, mattwinfeld@gmail.com.
authors.forename: Matthew
authors.initials: M
authors.lastname: Winfeld
authors.forename: Zehava Sadka
authors.initials: ZS
authors.lastname: Rosenberg
authors.forename: Annie
authors.initials: A
authors.lastname: Wang
authors.forename: Jenny
authors.initials: J
authors.lastname: Bencardino
mesh_terms: D000174:Acromion / Q000002:abnormalities* / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001848:Bone Diseases, Developmental / Q000473:pathology*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D055815:Young Adult