The Prognostic Value and Significance of Serial Bone Scintigraphy in Legg-Calvé-Perthes Disease

Abstract

We reviewed 44 consecutive patients treated for Legg-Calvé-Perthes disease who underwent serial technetium 99m diphosphonate bone scintigraphy. The average follow-up was 4.4 years. The bone-scintigraphy classification characterizes the A pathway by early lateral column formation not seen in the B pathway. Pathway A had 20 hips. The average age at presentation was 6.1 years. At last follow-up, this group had an average Mose classification of 1.2 and Catterall score of 2.4, without any patient having "head-at-risk" signs or requiring operative treatment. Pathway B had 20 hips. The average age at presentation was 5.8 years. At last follow-up, this group had an average Mose classification of 5.2, a Catterall score of 3.5, and 18 patients had head-at-risk signs, with 11 requiring operative treatment. Our bone-scintigraphy classification preceded the radiographic head-at-risk signs by an average of 3 months, allowing earlier treatment and correlated with subsequent femoral head involvement.

Diffusion-weighted MRI Reveals Epiphyseal and Metaphyseal Abnormalities in Legg-Calvé-Perthes Disease: A Pilot Study

“…However, metaphyseal ADC is quite variable. We suspect the variability is related to the presence of patients with varying types of reperfusion: one with transphyseal reperfusion and the other with periphyseal reperfusion, as prior studies using other modalities have shown [5,12,26]. Conway et al [5] suggested that the epiphyseal reperfusion pattern observed in bone scintigraphy has a prognostic value in LCP.…”

“…Conway et al [5] suggested that the epiphyseal reperfusion pattern observed in bone scintigraphy has a prognostic value in LCP. Some authors support this concept through observations of serial bone scintigraphy [26] and dynamic gadolinium-enhanced subtraction MR imaging [12]. According to this concept, reperfusion occurs spontaneously and follows one of three patterns: periphyseal reperfusion involving the lateral or Less than or equal to 50%…”

“…Some authors suggest the pattern of epiphyseal reperfusion evaluated with those modalities could be an important determinant of prognosis [5,12,24,26]. However, in a contrast-enhanced subtraction MR imaging study, Sebag et al [24] suggested metabolically inactive tissue might be enhanced by reperfusion of the necrotic tissue.…”

Legg-Calvé-Perthes hastalığında MR görüntüleme

“…LCP olgularında, lateral epifizyel arterler ile oluşan erken beslenmenin, yavaş transfizyel neovaskülarizasyona göre daha iyi prognoza sahip olduğu bildirilmiştir. [10] DAG'nin, femur başı epifizi iskemisinin erken tespitinde oldukça duyarlı bir yöntem olduğu, birçok hayvan çalışması ile ortaya konulmuştur. [11] İskemik olayın hemen sonrasında diffüzyon kısıtlaması görülse de, saatler ya da günler içe-risinde hem diffüzyon hem de ADC değerlerinde artış görüldüğü ifade edilmiştir.…”

Comparison between innominate osteotomy and arthrodistraction as a primary treatment for Legg-Calvé-Perthes disease: a prospective controlled trial

“…The natural history of the disease and the concept of "joint at risk" have been accepted as conclusive elements for prognosis and treatment options [7]. In recent times, imaging methods, such as scintigraphy and magnetic resonance, have been introduced for patient assessment and represent additional information that enables the best management strategy for each case to be selected [8][9][10][11]. Despite such an armamentarium, many cases fail to respond to treatment, often resulting in a non-congruent hip.…”