Magnetic Resonance Imaging in Legg-Calvè-Perthes Disease

Sanctis, N. de

doi:10.1097/bpo.0b013e318223b575

Cited by 13 publications

(7 citation statements)

References 18 publications

(25 reference statements)

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“…11,22 Gadoliniumenhanced MRI is a sensitive modality for diagnosing LCPD at the early stages of the disease, with accuracy comparable to bone scintigraphy. 14 However, gadolinium-enhanced MRI can provide a greater accuracy in depicting necrosis and revascularization.…”

Section: Discussionmentioning

confidence: 99%

MR Perfusion Index as a Quantitative Method of Evaluating Epiphyseal Perfusion in Legg-Calve-Perthes Disease and Correlation With Short-term Radiographic Outcome

Dempsey

et al. 2013

Journal of Pediatric Orthopaedics

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Section: Discussionmentioning

confidence: 99%

MR Perfusion Index as a Quantitative Method of Evaluating Epiphyseal Perfusion in Legg-Calve-Perthes Disease and Correlation With Short-term Radiographic Outcome

Dempsey

et al. 2013

Journal of Pediatric Orthopaedics

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“…Some authors speak of true containment in MRI. 26 , 27 With MRI, not only is an early diagnosis of LCPD possible, 11 so is an early determination of the loss of containment. Arthrography and MRI reveal a loss of containment, although it was not detectable in conventional X-ray photography.…”

Section: Discussionmentioning

confidence: 99%

MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment

Jandl

Schmidt

Schulz

et al. 2018

Journal of Children's Orthopaedics

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Abstract:PurposeThe containment orientated treatment of Legg-Calvé-Perthes disease (LCPD) affected hip joints is broadly accepted in the literature. The prerequisite is early recognition of loss of containment. An often-used quantitative MRI containment parameter is the cartilaginous acetabulum-head-index (CAHI). Based on ultrasound (US), we analyzed the newly created ‘femoral head extrusion angle’ (HA) as a containment parameter in comparison with the CAHI in severe LCPD.MethodsIn a prospective study with 40 children (mean age 5.8 years sd 2.3) with unilateral LCPD classified as Catterall group III/IV, we measured the CAHI versus HA to assess the containment of the femoral head. HA in US was determined by the tangent from the bony acetabular rim to the cartilaginous cranio-lateral femoral head.ResultsThe HA was significantly higher in LCPD-affected hip joints (25° sd 7°) than in healthy ones (13° sd 5°; p < 0.001). Correlation analysis of all hip joints revealed a significant correlation between HA and CAHI (r = −0.69; p < 0.001). Hip joints with a low CAHI indicating loss of containment showed a higher HA in sonography.ConclusionThe results of our study suggest that the HA in US is a reliable containment parameter in severe LCPD with a HA > 22° defining a pathologic value. In comparison with the CAHI, HA measurement in ultrasound is easier than the assessment of various parameters to calculate an index. Frequent sonographical follow-up assessment in critical joints is an alternative if MRI is not available, helping to detect an impending loss of containment early enough.Level of EvidenceLevel II

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“…Since the anterior femoral head is more often involved, sagittal images most accurately depict the full extent of involvement (74). Studies have shown that MR imaging can be used to detect early growth plate involvement (75), and the development of transphyseal enhancement is a risk factor for bridge formation (76). Poor prognostic indicators include older patient age (>7 years) at disease onset (77), severe head deformity (78), lateral pillar collapse (67), growth plate involvement (79,80), and metaphyseal lesions (71).…”

Section: Legg-calvé-perthes Diseasementioning

confidence: 99%

Imaging of Pediatric Growth Plate Disturbances

et al. 2017

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The growth plates, or physes, are visible on virtually all images obtained in skeletally immature children. The proper function of these growth plates depends on an intricate balance between chondrocyte proliferation, which requires nourishment from the epiphyseal vessels, and chondrocyte death, which requires the integrity of the metaphyseal vessels. Therefore, injury to the growth plate (ie, direct insult) or vascular compromise on either side of the growth plate (ie, indirect insult) can cause growth plate dysfunction. Direct growth plate insults occur most commonly with Salter-Harris fractures, and injuries that allow the transphyseal communication of vessels are at a higher risk for subsequent transphyseal bone bridge formation. Indirect insults lead to different sequelae that are based on whether the epiphyseal blood supply or metaphyseal blood supply is compromised. Epiphyseal osteonecrosis can result in slowed longitudinal bone growth, with possible growth plate closure, and is often accompanied by an abnormal secondary ossification center. In contrast, the disruption of metaphyseal blood supply alters endochondral ossification and allows the persistence of chondrocytes within the metaphysis, which appear as focal or diffuse growth plate widening. Imaging remains critical for detecting acute injuries and identifying subsequent growth disturbances. Depending on the imaging findings and patient factors, these growth disturbances may be amenable to conservative or surgical treatment. Therefore, an understanding of the anatomy and physiologic features of the normal growth plate and the associated pathophysiologic conditions can increase diagnostic accuracy, enable radiologists to anticipate future growth disturbances, and ensure optimal imaging, with the ultimate goal of timely and appropriate intervention. RSNA, 2017.

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Magnetic Resonance Imaging in Legg-Calvè-Perthes Disease

Cited by 13 publications

References 18 publications

MR Perfusion Index as a Quantitative Method of Evaluating Epiphyseal Perfusion in Legg-Calve-Perthes Disease and Correlation With Short-term Radiographic Outcome

MR Perfusion Index as a Quantitative Method of Evaluating Epiphyseal Perfusion in Legg-Calve-Perthes Disease and Correlation With Short-term Radiographic Outcome

MRI and sonography in Legg-Calvé-Perthes disease: Clinical relevance of containment and influence on treatment

Imaging of Pediatric Growth Plate Disturbances

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