Pediatric Radiology

, Volume 40, Issue 3, pp 318–325 | Cite as

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

  • Laura MerliniEmail author
  • Christophe Combescure
  • Vincenzo De Rosa
  • Mehrak Anooshiravani
  • Sylviane Hanquinet
Original Article



Legg-Calvé-Perthes disease (LCP) is necrosis of the proximal femoral epiphysis of vascular origin. Clinical course and outcome in LCP disease varies considerably between different patients. Earlier prognostic criteria than those offered by conventional radiography are necessary to identify children who require prompt surgical treatment.


To assess the significance of signal alteration on diffusion-weighted MR imaging (DWI MR) in LCP.

Materials and methods

Twelve boys with unilateral LCP disease (Catterall grade 2 and 3), at the initial sclerotic stage and early fragmentation phase, underwent dynamic gadolinium-enhanced subtracted (DGS) and DWI MR. For DGS MR, the lateral pillar enhancement was recorded. For DWI imaging, we measured ADC values in the diseased and the unaffected epiphyses and metaphyses. Receiver operating characteristic curves were performed to analyze the performance of DWI in establishing agreement with the results of DGS MR, which is the gold standard for prognosis.


Femoral epiphysis increased diffusivity was observed in the affected hip in all cases. Increased metaphysis diffusivity in the affected side was observed in all cases with absent lateral pillar enhancement at DGS MR.


DWI seems to be a noninvasive means of distinguishing between Perthes disease with favourable and unfavourable prognosis.


Legg-Calvé-Perthes disease MR Diffusion Child 


  1. 1.
    Wall EJ (1999) Legg-Calve-Perthes’ disease. Curr Opin Pediatr 11:76–79CrossRefPubMedGoogle Scholar
  2. 2.
    Salter RB (1980) Legg-Perthes disease: the scientific basis for the methods of treatment and their indications. Clin Orthop Relat Res 150:8–11PubMedGoogle Scholar
  3. 3.
    Wiig O, Terjesen T, Svenningsen S (2008) Prognostic factors and outcome of treatment in Perthes’ disease: a prospective study of 368 patients with five-year follow-up. J Bone Joint Surg Br 90:1364–1371CrossRefPubMedGoogle Scholar
  4. 4.
    Comte F, De Rosa V, Zekri H et al (2003) Confirmation of the early prognostic value of bone scanning and pinhole imaging of the hip in Legg-Calve-Perthes disease. J Nucl Med 44:1761–1766PubMedGoogle Scholar
  5. 5.
    Tsao AK, Dias LS, Conway JJ et al (1997) The prognostic value and significance of serial bone scintigraphy in Legg-Calve-Perthes disease. J Pediatr Orthop 17:230–239CrossRefPubMedGoogle Scholar
  6. 6.
    Conway JJ (1993) A scintigraphic classification of Legg-Calve-Perthes disease. Semin Nucl Med 23:274–295CrossRefPubMedGoogle Scholar
  7. 7.
    Ducou le Pointe H, Haddad S, Silberman B et al (1994) Legg-Perthes-Calve disease: staging by MRI using gadolinium. Pediatr Radiol 24:88–91CrossRefPubMedGoogle Scholar
  8. 8.
    Lamer S, Dorgeret S, Khairouni A et al (2002) Femoral head vascularisation in Legg Calve-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol 32:580–585CrossRefPubMedGoogle Scholar
  9. 9.
    Jaramillo D, Connolly SA, Vajapeyam S et al (2003) Normal and ischemic epiphysis of the femur: diffusion MR imaging study in piglets. Radiology 227:825–832CrossRefPubMedGoogle Scholar
  10. 10.
    Menezes NM, Connolly SA, Shapiro F et al (2007) Early ischemia in growing piglet skeleton: MR diffusion and perfusion imaging. Radiology 242:129–136CrossRefPubMedGoogle Scholar
  11. 11.
    Catterall A (1981) Legg-Calve-Perthes syndrome. Clin Orthop Relat Res 158:41–52PubMedGoogle Scholar
  12. 12.
    Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843PubMedGoogle Scholar
  13. 13.
    Lee J, Koh D, Ong CC (1989) Statistical evaluation of agreement between two methods for measuring a quantitative variable. Comput Biol Med 19:61–70CrossRefPubMedGoogle Scholar
  14. 14.
    Nonomura Y, Yasumoto M, Yoshimura R et al (2001) Relationship between bone marrow cellularity and apparent diffusion coefficient. J Magn Reson Imaging 13:757–760CrossRefPubMedGoogle Scholar
  15. 15.
    MacKenzie JD, Gonzalez L, Hernandez A et al (2007) Diffusion-weighted and diffusion tensor imaging for pediatric musculoskeletal disorders. Pediatr Radiol 37:781–788CrossRefPubMedGoogle Scholar
  16. 16.
    Herneth AM, Ringl H, Memarsadeghi M et al (2007) Diffusion weighted imaging in osteoradiology. Top Magn Reson Imaging 18:203–212CrossRefPubMedGoogle Scholar
  17. 17.
    Kim HK, Skelton DN, Quigley EJ (2004) Pathogenesis of metaphyseal radiolucent changes following ischemic necrosis of the capital femoral epiphysis in immature pigs. A preliminary report. J Bone Joint Surg Am 86-A:129–135PubMedGoogle Scholar
  18. 18.
    Oner AY, Aggunlu L, Akpek S et al (2007) Diffusion-weighted imaging of the appendicular skeleton with a non-Carr-Purcell-Meiboom-Gill single-shot fast spin-echo sequence. AJR 189:1494–1501CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Laura Merlini
    • 1
    Email author
  • Christophe Combescure
    • 2
  • Vincenzo De Rosa
    • 3
  • Mehrak Anooshiravani
    • 1
  • Sylviane Hanquinet
    • 1
  1. 1.Unit of Pediatric RadiologyGeneva University HospitalGenevaSwitzerland
  2. 2.Department of BiostatisticsUniversity Hospital of GenevaGenevaSwitzerland
  3. 3.Clinic of Pediatric OrthopedicsUniversity Hospital of GenevaGenevaSwitzerland

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