MRI Evaluation of Legg Calve’ Perthes Disease – A Preliminary Study
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 3
Abstract
Abstract: Legg-Calvé-Perthes disease is a common cause of hip pain in preadolescent children that may be initially clinically and radiographically difficult to diagnose and stage. Till recently, diagnosis and treatment decisions were based on X-rays. At present, MR Imaging plays a crucial role in the management of Perthes disease. The purpose of this article is to analyze the femoral head pathology in Perthes Disease at tissue level by different MR sequences. A total of 20 MRI of hips with Perthes disease were analyzed in 18 children aged 3 to 13 yrs. Nine patients had unilateral Perthes disease with normal contralateral hip, 2 children had bilateral Perthes disease and the remaining 7 patients had unilateral Perthes disease with the other hip showing varied changes in epiphysis and synovium. Five hips (25%) showed air pockets in the epiphyses, fluid intense areas were appreciated in 50% of the affected epiphysis and fat was the most frequent component (70%) noted. Migration index of LCPD hips had a wide range (14.52 - 53.15). Statistically significant correlation was documented for MI and Catterall group (P < 0.01). Fifteen hips (75%) showed physeal bars and sixteen hips (80%) had metaphyseal cysts. Metaphyseal cysts were heterogenous with fat, cartilage, fluid and air as contents. Air was detected in metaphyseal cysts in three hips (18.75%). All the 20 hips showed synovial effusion. Seventeen hips showed synovial enhancement (85%), 6 hips showed synovial thickening and 1 patient had marked, irregular synovial thickening. In conclusion, MR images could show most of the pathological changes in Perthes disease, even upto the level of tissue characterization. Secondary changes due to weight-bearing influence the MRI findings in Perthes disease and hence optimization of MRI technique and timing is essential for further improvement in imaging. Using MR perfusion for demonstration of avascularity and diffusion imaging for detection of early ischemia can help in timely interventions in the avascular phase and thereby prevent further progression and complications. Keywords:MRI, Perthes disease
Authors and Affiliations
Jayasree L, Gopakumar TS, Rakul Nambiar. K, Manoj . T. Pillai
Keywords
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