Legg-Perthes-Calvé disease: Staging by MRI using gadolinium

Abstract

Twenty-one patients (26 hips) with typical signs of Legg-Perthes-Calvé (LPC) disease on plain radiographs were explored by MRI. Patients were imaged with a 0.5 T MR unit. Gadolinium-enhanced spin-echo MR images were obtained after nonenhanced T1-weighted (spin-echo) and T2*-weighted (gradient-echo) images. Four different areas were identified in the femoral epiphysis (necrosis, regenerative, cartilaginous and normal fatty bone tissue). The histological evolution of LPC is well described by Catterall and others. Comparing their descriptions with our MR findings, we suggest classification of LPC into five phases: necrosis: regeneration, reconstruction, reossification and sequelae.

Femoral Head Deformation and Repair Following Induction of Ischemic Necrosis

“…Studies from humans with the disease have recognized the changes to be intermingling of necrosis and repair 25,27 , new bone formation by intramembranous ossification 30 , increased thickness of the surface cartilage 31 , retained shape and internal structure of the most medial portion of the head, and (in the central and lateral aspects of the head) a callus-like fibrocartilage, vascular granulation tissue, new bone formation on necrotic trabeculae, and chondroid tissue 32,33 . Magnetic resonance imaging has been used over the past two decades to assess Legg-Calvé-Perthes disease, but the studies lack histologic correlation [34][35][36][37] . The tissue responses in human specimens and in this model are similar to bone repair induced by fracture in an environment of variable vascularity and micromotion 38 .…”

Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study

“…Many studies have assessed the very high reproducibility of a scintigraphic model on dynamic gadolinium-enhanced subtracted (DGS) MR allowing the use of the latter as the new gold standard in assessing prognosis in Perthes disease [4,7,8]. The early appearance of lateral pillar enhancement is indicative of uncomplicated revascularisation of the femoral head and, thus, of good prognosis.…”

“…The second mechanism represents a slower rate of neovascularisation and healing and is depicted by DGS MR as absence of lateral pillar enhancement. Enhancement of the metaphyseal region is reported in the literature as having a high positive predictive value (92%) for a poor prognosis [4,7,8].…”

Concordância intra e interobservadores das diferentes classificações usadas na doença de Legg‐Calvé‐Perthes

“…[13][14][15] Diante disso, em alguns casos, principalmente no início da doença, o estudo dessa cartilagem com exames como a ressonância magnética 2,16,17 e a pneumoartrografia da articulação 13,14 pode ser mais esclarecedor e nortear de forma mais eficaz o tratamento a ser instituído. 4,14,15,[18][19][20] Portanto, consideramos que o conhecimento do comportamento das estruturas cartilaginosas do quadril é fundamental para estadiar a DLCP e indicar o tratamento adequado.…”