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Pediatric Radiology

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01-09-2013 | Original Article

A comparison of non-contrast and contrast-enhanced MRI in the initial stage of Legg-Calvé-Perthes disease

Authors: Harry K. W. Kim, Sue Kaste, Molly Dempsey, David Wilkes

Published in: Pediatric Radiology | Issue 9/2013

Abstract

Background

A prognostic indicator of outcome for Legg-Calvé-Perthes disease (LCP) is needed to guide treatment decisions during the initial stage of the disease (stage 1), before deformity occurs. Radiographic prognosticators are applicable only after fragmentation (stage II).

Objective

We investigated pre- and postcontrast MRI in depicting stage I femoral head involvement.

Materials and methods

Thirty children with stage I LCP underwent non-contrast coronal T1 fast spin-echo (FSE) and corresponding postcontrast fat-suppressed T1-weighted fast spin-echo (FSE) sequences to quantify the extent of femoral head involvement. Three pediatric radiologists and one pediatric orthopedic surgeon independently measured central head involvement.

Results

Interobserver reliability of percent head involvement using non-contrasted MR images had intraclass correlation coefficient (ICC) of 0.72. Postcontrast MRI improved interobserver reliability (ICC 0.82). Qualitatively, the area of involvement was more clearly visible on contrast-enhanced MRI. A comparison of results obtained by each observer using the two MRI techniques showed no correlation. ICC ranged from −0.08 to 0.03 for each observer. Generally, greater head involvement was depicted by contrast compared with non-contrast MRI (Pearson r = −0.37, P = 0.04).

Conclusion

Pre- and postcontrast MRI assess two different components of stage I LCP. However, contrast-enhanced MRI more clearly depicts the area of involvement.

Molloy MK, MacMahon B (1966) Incidence of Legg-Perthes disease (osteochondritis deformans). N Engl J Med 275:988–990PubMedCrossRef

Kim HK, Herring JA (2011) Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am 42:285–295PubMedCrossRef

Catterall A (1981) The natural history of Perthes’ disease. J Bone Joint Surg Br 53:37–53

Catterall A (1981) Legg-Calve-Perthes syndrome. Clin Orthop Relat Res 158:41–52PubMed

Ritterbusch JF, Shantharam SS, Gelinas C (1993) Comparison of lateral pillar classification and Catterall classification of Legg-Calve-Perthes’ disease. J Pediatr Orthop 13:200–202PubMed

Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am 86-A:2103–2120PubMed

Herring JA, Neustadt JB, Williams JJ et al (1992) The lateral pillar classification of Legg-Calve-Perthes disease. J Pediatr Orthop 12:143–150PubMedCrossRef

Lappin K, Kealey D, Cosgrove A (2002) Herring classification: how useful is the initial radiograph? J Pediatr Orthop 22:479–482PubMed

Price CT (2007) The lateral pillar classification for Legg-Calve-Perthes disease. J Pediatr Orthop 27:592–593PubMedCrossRef

10.

Lamer S, Dorgeret S, Khairouni A et al (2002) Femoral head vascularisation in Legg-Calve-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol 32:580–585PubMedCrossRef

11.

Kaniklides C, Lonnerholm T, Moberg A et al (1995) Legg-Calve-Perthes disease. Comparison of conventional radiography, MR imaging, bone scintigraphy and arthrography. Acta Radiol 36:434–439PubMed

12.

Uno A, Hattori T, Noritake K et al (1995) Legg-Calve-Perthes disease in the evolutionary period: comparison of magnetic resonance imaging with bone scintigraphy. J Pediatr Orthop 15:362–367PubMedCrossRef

13.

Elsig JP, Exner GU, von Schulthess GK et al (1989) False-negative magnetic resonance imaging in early stage of Legg-Calve-Perthes disease. J Pediatr Orthop 9:231–235PubMedCrossRef

14.

Henderson RC, Renner JB, Sturdivant MC et al (1990) Evaluation of magnetic resonance imaging in Legg-Perthes disease: a prospective, blinded study. J Pediatr Orthop 10:289–297PubMedCrossRef

15.

Lahdes-Vasama T, Lamminen A, Merikanto J et al (1997) The value of MRI in early Perthes’ disease: an MRI study with a 2-year follow-up. Pediatr Radiol 27:517–522PubMedCrossRef

16.

Bos CF, Bloem JL, Bloem RM (1991) Sequential magnetic resonance imaging in Perthes’ disease. J Bone Joint Surg Br 73:219–224PubMed

17.

Sebag G, Ducou Le Pointe H, Klein I et al (1997) Dynamic gadolinium-enhanced subtraction MR imaging–a simple technique for the early diagnosis of Legg-Calve-Perthes disease: preliminary results. Pediatr Radiol 27:216–220PubMedCrossRef

18.

Mahnken AH, Staatz G, Ihme N et al (2002) MR signal intensity characteristics in Legg-Calve-Perthes disease. Value of fat-suppressed (STIR) images and contrast-enhanced T1-weighted images. Acta Radiol 43:329–335PubMedCrossRef

19.

Waldenstrom H (1922) The definitive forms of coxa plana. Acta Radiol 1:384

20.

Canale ST, D’Anca AF, Cotler JM et al (1972) Innominate osteotomy in Legg-Calve-Perthes disease. J Bone Joint Surg Am 54:25–40PubMed

21.

Hochbergs P, Eckervall G, Wingstrand H et al (1997) Epiphyseal bone-marrow abnormalities and restitution in Legg-Calve-Perthes disease. Evaluation by MR imaging in 86 cases. Acta Radiol 38:855–862PubMed

22.

Dillman JR, Hernandez RJ (2009) MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol 193:1394–1407PubMedCrossRef

23.

de Sanctis N, Rega AN, Rondinella F (2000) Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part I: the role of physeal involvement. J Pediatr Orthop 20:455–462PubMed

24.

de Sanctis N, Rondinella F (2000) Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part II: pathomorphogenesis and new classification. J Pediatr Orthop 20:463–470PubMed

25.

Jaramillo D, Kasser JR, Villegas-Medina OL et al (1995) Cartilaginous abnormalities and growth disturbances in Legg-Calvé-Perthes disease: evaluation with MR imaging. Radiology 197:767–773PubMed

26.

Jaramillo D, Laor T, Zaleske DJ (1993) Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology 187:171–178PubMed

27.

Eckerwall G, Hochbergs P, Simesen K et al (1997) Metaphyseal histology and magnetic resonance imaging in Legg-Calvé-Perthes disease. J Pediatr Orthop 17:659–662PubMed

28.

Song HR, Dhar S, Na JB et al (2000) Classification of metaphyseal change with magnetic resonance imaging in Legg-Calvé-Perthes disease. J Pediatr Orthop 20:557–561PubMedCrossRef

29.

Tsuchida Y, Kim WC, Takahashi KA et al (2005) Usefulness of epiphyseal quotient measurement on magnetic resonance images for outcome prediction in patients with early stage Legg-Calve-Perthes disease. J Pediatr Orthop B 14:16–23PubMedCrossRef

30.

Merlini L, Combescure C, De Rosa V et al (2010) Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol 40:318–325PubMedCrossRef

31.

Winzenrieth R, Claude I, Hobatho MC et al (2006) Is there functional vascular information in anatomical MR sequences? A preliminary in vivo study. IEEE Trans Biomed Eng 53:1190–1196PubMedCrossRef

Title: A comparison of non-contrast and contrast-enhanced MRI in the initial stage of Legg-Calvé-Perthes disease
Authors: Harry K. W. Kim
Sue Kaste
Molly Dempsey
David Wilkes
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 9/2013
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-013-2664-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A comparison of non-contrast and contrast-enhanced MRI in the initial stage of Legg-Calvé-Perthes disease

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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