Pediatric Radiology

, Volume 43, Issue 9, pp 1166–1173

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

Authors

    • Center of Excellence in Hip DisordersTexas Scottish Rite Hospital for Children
    • Department of Orthopedic SurgeryUniversity of Texas Southwestern
  • Sue Kaste
    • Department of Radiological SciencesSt. Jude Children’s Research Hospital
    • Department of OncologySt. Jude Children’s Research Hospital
    • Department of RadiologyUniversity of Tennessee School of Health Sciences
  • Molly Dempsey
    • Department of RadiologyTexas Scottish Rite Hospital for Children
  • David Wilkes
    • Department of RadiologyTexas Scottish Rite Hospital for Children
Original Article

DOI: 10.1007/s00247-013-2664-7

Cite this article as:
Kim, H.K.W., Kaste, S., Dempsey, M. et al. Pediatr Radiol (2013) 43: 1166. doi:10.1007/s00247-013-2664-7

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.

Keywords

Legg-Calvé-Perthes diseaseHipAvascular necrosisFemoral headPediatricContrast MRIPerfusion MRI

Copyright information

© Springer-Verlag Berlin Heidelberg 2013