Pediatric Radiology

, Volume 43, Issue 9, pp 1166–1173 | Cite as

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

  • Harry K. W. KimEmail author
  • Sue Kaste
  • Molly Dempsey
  • David Wilkes
Original Article



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).


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.


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).


Pre- and postcontrast MRI assess two different components of stage I LCP. However, contrast-enhanced MRI more clearly depicts the area of involvement.


Legg-Calvé-Perthes disease Hip Avascular necrosis Femoral head Pediatric Contrast MRI Perfusion MRI 



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



  1. 1.
    Molloy MK, MacMahon B (1966) Incidence of Legg-Perthes disease (osteochondritis deformans). N Engl J Med 275:988–990PubMedCrossRefGoogle Scholar
  2. 2.
    Kim HK, Herring JA (2011) Pathophysiology, classifications, and natural history of Perthes disease. Orthop Clin North Am 42:285–295PubMedCrossRefGoogle Scholar
  3. 3.
    Catterall A (1981) The natural history of Perthes’ disease. J Bone Joint Surg Br 53:37–53Google Scholar
  4. 4.
    Catterall A (1981) Legg-Calve-Perthes syndrome. Clin Orthop Relat Res 158:41–52PubMedGoogle Scholar
  5. 5.
    Ritterbusch JF, Shantharam SS, Gelinas C (1993) Comparison of lateral pillar classification and Catterall classification of Legg-Calve-Perthes’ disease. J Pediatr Orthop 13:200–202PubMedGoogle Scholar
  6. 6.
    Herring JA, Kim HT, Browne R (2004) Legg-Calve-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am 86-A:2103–2120PubMedGoogle Scholar
  7. 7.
    Herring JA, Neustadt JB, Williams JJ et al (1992) The lateral pillar classification of Legg-Calve-Perthes disease. J Pediatr Orthop 12:143–150PubMedCrossRefGoogle Scholar
  8. 8.
    Lappin K, Kealey D, Cosgrove A (2002) Herring classification: how useful is the initial radiograph? J Pediatr Orthop 22:479–482PubMedGoogle Scholar
  9. 9.
    Price CT (2007) The lateral pillar classification for Legg-Calve-Perthes disease. J Pediatr Orthop 27:592–593PubMedCrossRefGoogle Scholar
  10. 10.
    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 32:580–585PubMedCrossRefGoogle Scholar
  11. 11.
    Kaniklides C, Lonnerholm T, Moberg A et al (1995) Legg-Calve-Perthes disease. Comparison of conventional radiography, MR imaging, bone scintigraphy and arthrography. Acta Radiol 36:434–439PubMedGoogle Scholar
  12. 12.
    Uno A, Hattori T, Noritake K et al (1995) Legg-Calve-Perthes disease in the evolutionary period: comparison of magnetic resonance imaging with bone scintigraphy. J Pediatr Orthop 15:362–367PubMedCrossRefGoogle Scholar
  13. 13.
    Elsig JP, Exner GU, von Schulthess GK et al (1989) False-negative magnetic resonance imaging in early stage of Legg-Calve-Perthes disease. J Pediatr Orthop 9:231–235PubMedCrossRefGoogle Scholar
  14. 14.
    Henderson RC, Renner JB, Sturdivant MC et al (1990) Evaluation of magnetic resonance imaging in Legg-Perthes disease: a prospective, blinded study. J Pediatr Orthop 10:289–297PubMedCrossRefGoogle Scholar
  15. 15.
    Lahdes-Vasama T, Lamminen A, Merikanto J et al (1997) The value of MRI in early Perthes’ disease: an MRI study with a 2-year follow-up. Pediatr Radiol 27:517–522PubMedCrossRefGoogle Scholar
  16. 16.
    Bos CF, Bloem JL, Bloem RM (1991) Sequential magnetic resonance imaging in Perthes’ disease. J Bone Joint Surg Br 73:219–224PubMedGoogle Scholar
  17. 17.
    Sebag G, Ducou Le Pointe H, Klein I et al (1997) Dynamic gadolinium-enhanced subtraction MR imaging–a simple technique for the early diagnosis of Legg-Calve-Perthes disease: preliminary results. Pediatr Radiol 27:216–220PubMedCrossRefGoogle Scholar
  18. 18.
    Mahnken AH, Staatz G, Ihme N et al (2002) MR signal intensity characteristics in Legg-Calve-Perthes disease. Value of fat-suppressed (STIR) images and contrast-enhanced T1-weighted images. Acta Radiol 43:329–335PubMedCrossRefGoogle Scholar
  19. 19.
    Waldenstrom H (1922) The definitive forms of coxa plana. Acta Radiol 1:384Google Scholar
  20. 20.
    Canale ST, D’Anca AF, Cotler JM et al (1972) Innominate osteotomy in Legg-Calve-Perthes disease. J Bone Joint Surg Am 54:25–40PubMedGoogle Scholar
  21. 21.
    Hochbergs P, Eckervall G, Wingstrand H et al (1997) Epiphyseal bone-marrow abnormalities and restitution in Legg-Calve-Perthes disease. Evaluation by MR imaging in 86 cases. Acta Radiol 38:855–862PubMedGoogle Scholar
  22. 22.
    Dillman JR, Hernandez RJ (2009) MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol 193:1394–1407PubMedCrossRefGoogle Scholar
  23. 23.
    de Sanctis N, Rega AN, Rondinella F (2000) Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part I: the role of physeal involvement. J Pediatr Orthop 20:455–462PubMedGoogle Scholar
  24. 24.
    de Sanctis N, Rondinella F (2000) Prognostic evaluation of Legg-Calvé-Perthes disease by MRI. Part II: pathomorphogenesis and new classification. J Pediatr Orthop 20:463–470PubMedGoogle Scholar
  25. 25.
    Jaramillo D, Kasser JR, Villegas-Medina OL et al (1995) Cartilaginous abnormalities and growth disturbances in Legg-Calvé-Perthes disease: evaluation with MR imaging. Radiology 197:767–773PubMedGoogle Scholar
  26. 26.
    Jaramillo D, Laor T, Zaleske DJ (1993) Indirect trauma to the growth plate: results of MR imaging after epiphyseal and metaphyseal injury in rabbits. Radiology 187:171–178PubMedGoogle Scholar
  27. 27.
    Eckerwall G, Hochbergs P, Simesen K et al (1997) Metaphyseal histology and magnetic resonance imaging in Legg-Calvé-Perthes disease. J Pediatr Orthop 17:659–662PubMedGoogle Scholar
  28. 28.
    Song HR, Dhar S, Na JB et al (2000) Classification of metaphyseal change with magnetic resonance imaging in Legg-Calvé-Perthes disease. J Pediatr Orthop 20:557–561PubMedCrossRefGoogle Scholar
  29. 29.
    Tsuchida Y, Kim WC, Takahashi KA et al (2005) Usefulness of epiphyseal quotient measurement on magnetic resonance images for outcome prediction in patients with early stage Legg-Calve-Perthes disease. J Pediatr Orthop B 14:16–23PubMedCrossRefGoogle Scholar
  30. 30.
    Merlini L, Combescure C, De Rosa V et al (2010) Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study. Pediatr Radiol 40:318–325PubMedCrossRefGoogle Scholar
  31. 31.
    Winzenrieth R, Claude I, Hobatho MC et al (2006) Is there functional vascular information in anatomical MR sequences? A preliminary in vivo study. IEEE Trans Biomed Eng 53:1190–1196PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Harry K. W. Kim
    • 1
    • 2
    Email author
  • Sue Kaste
    • 4
    • 5
    • 6
  • Molly Dempsey
    • 3
  • David Wilkes
    • 3
  1. 1.Center of Excellence in Hip DisordersTexas Scottish Rite Hospital for ChildrenDallasUSA
  2. 2.Department of Orthopedic SurgeryUniversity of Texas SouthwesternDallasUSA
  3. 3.Department of RadiologyTexas Scottish Rite Hospital for ChildrenDallasUSA
  4. 4.Department of Radiological SciencesSt. Jude Children’s Research HospitalMemphisUSA
  5. 5.Department of OncologySt. Jude Children’s Research HospitalMemphisUSA
  6. 6.Department of RadiologyUniversity of Tennessee School of Health SciencesMemphisUSA

Personalised recommendations