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

  • Harry K. W. Kim
  • Sue Kaste
  • Molly Dempsey
  • David Wilkes
Original Article

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 disease Hip Avascular necrosis Femoral head Pediatric Contrast MRI Perfusion MRI 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Harry K. W. Kim
    • 1
    • 2
  • Sue Kaste
    • 4
    • 5
    • 6
  • Molly Dempsey
    • 3
  • David Wilkes
    • 3
  1. 1.Center of Excellence in Hip DisordersTexas Scottish Rite Hospital for ChildrenDallasUSA
  2. 2.Department of Orthopedic SurgeryUniversity of Texas SouthwesternDallasUSA
  3. 3.Department of RadiologyTexas Scottish Rite Hospital for ChildrenDallasUSA
  4. 4.Department of Radiological SciencesSt. Jude Children’s Research HospitalMemphisUSA
  5. 5.Department of OncologySt. Jude Children’s Research HospitalMemphisUSA
  6. 6.Department of RadiologyUniversity of Tennessee School of Health SciencesMemphisUSA

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