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

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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.

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Acknowledgments

The authors thank Dr. Richard Browne for statistical analysis, Lela Paksoy for administrative coordination of this project and Sandra Gaither for manuscript preparation. This work was supported in part by funding from Texas Scottish Rite Hospital for Children, St. Jude Children’s Research Hospital, American Lebanese Syrian Associated Charities and the International Perthes Study Group.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Center of Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA

    Harry K. W. Kim

  2. Department of Orthopedic Surgery, University of Texas Southwestern, Dallas, TX, USA

    Harry K. W. Kim

  3. Department of Radiology, Texas Scottish Rite Hospital for Children, Dallas, TX, USA

    Molly Dempsey & David Wilkes

  4. Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Sue Kaste

  5. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Sue Kaste

  6. Department of Radiology, University of Tennessee School of Health Sciences, Memphis, TN, USA

    Sue Kaste

Authors
  1. Harry K. W. Kim
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  2. Sue Kaste
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  4. David Wilkes
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Correspondence to Harry K. W. Kim.

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Kim, H.K.W., Kaste, S., Dempsey, M. et al. A comparison of non-contrast and contrast-enhanced MRI in the initial stage of Legg-Calvé-Perthes disease. Pediatr Radiol 43, 1166–1173 (2013). https://doi.org/10.1007/s00247-013-2664-7

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  • DOI: https://doi.org/10.1007/s00247-013-2664-7

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