Skip to main content

Imaging of Legg-Calvé-Perthes Disease

  • Chapter
  • First Online:
Joint Imaging in Childhood and Adolescence

Abstract

Legg-Calvé-Perthes disease (LCPD) is an idiopathic form of avascular necrosis of the immature proximal femoral epiphysis. As it occurs in the growing skeleton, there are peculiarities that distinguish it from the adult type of avascular necrosis of the femoral head. It is important to keep in mind that this epiphysis bears a substantial remodeling potential in skeletally immature patients, which can correct architectural changes caused by ischemia; the younger the patient, the greater is this ability. Nevertheless, abnormal epiphyseal development and deformation of the femoral head do occur in cases of poor evolution, and the cascade of phenomena that occur after bone necrosis is paralleled by the evolution of imaging findings. This chapter provides an overview of the role of imaging in the assessment of LCPD.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Recommended Reading

  1. Baunin C, Sanmartin-Viron D, Accadbled F, Sans N, Vial J, Labarre D, et al. Prognosis value of early diffusion MRI in Legg Perthes Calvé disease. Orthop Traumatol Surg Res. 2014;100:317–21.

    Article  CAS  Google Scholar 

  2. Chaudhry S, Phillips D, Feldman D. Legg-Calvé-Perthes disease: an overview with recent literature. Bull Hosp Jt Dis (2013). 2014;72:18–27.

    Google Scholar 

  3. Dillman JR, Hernandez RJ. MRI of Legg-Calve-Perthes disease. AJR Am J Roentgenol. 2009;193:1394–407.

    Article  Google Scholar 

  4. Dillon JE, Connolly SA, Connolly LP, Kim YJ, Jaramillo D. MR imaging of congenital and/or developmental and acquired disorders of the pediatric hip and pelvis. Magn Reson Imaging Clin N Am. 2005;13:783–97.

    Google Scholar 

  5. Doria AS, Cunha FG, Modena M, Maciel R, Molnar LJ, Luzo C, et al. Legg-Calvé-Perthes disease: multipositional power Doppler sonography of the proximal femoral vascularity. Pediatr Radiol. 2008;38:392–402.

    Article  Google Scholar 

  6. Dwek JR. The hip: MR imaging of uniquely pediatric disorders. Magn Reson Imaging Clin N Am. 2009;17:509–20.

    Article  Google Scholar 

  7. Fabry G. Clinical practice: the hip from birth to adolescence. Eur J Pediatr. 2010;169:143–8.

    Article  Google Scholar 

  8. Frick SL. Evaluation of the child who has hip pain. Orthop Clin North Am. 2006;37:133–40.

    Article  Google Scholar 

  9. Heesakkers N, van Kempen R, Feith R, Hendriks J, Schreurs W. The long-term prognosis of Legg-Calvé-Perthes disease: a historical prospective study with a median follow-up of forty one years. Int Orthop. 2015;39:859–63.

    Article  Google Scholar 

  10. Herring JA, Kim HT, Browne R. Legg-Calve-Perthes disease. Part I: classification of radiographs with use of the modified lateral pillar and Stulberg classifications. J Bone Joint Surg Am. 2004;86-A(10):2103–20.

    Article  Google Scholar 

  11. Jaramillo D. What is the optimal imaging of osteonecrosis, Perthes, and bone infarcts? Pediatr Radiol. 2009;39(Suppl 2):S216–9.

    Article  Google Scholar 

  12. Kim HK, Burgess J, Thoveson A, Gudmundsson P, Dempsey M, Jo CH. Assessment of femoral head revascularization in Legg-Calvé-Perthes disease using serial perfusion MRI. J Bone Joint Surg Am. 2016;98:1897–904.

    Article  Google Scholar 

  13. Kim HK, Wiesman KD, Kulkarni V, Burgess J, Chen E, Brabham C, et al. Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: a preliminary study. J Bone Joint Surg Am. 2014;96:1152–60.

    Article  Google Scholar 

  14. Kocher MS, Tucker R. Pediatric athlete hip disorders. Clin Sports Med. 2006;25:241–53.

    Article  Google Scholar 

  15. Laine JC, Martin BD, Novotny SA, Kelly DM. Role of advanced imaging in the diagnosis and management of active Legg-Calvé-Perthes disease. J Am Acad Orthop Surg. 2018;26:526–36.

    Article  Google Scholar 

  16. Lamer S, Dorgeret S, Khairouni A, Mazda K, Brillet PY, Bacheville E, et al. Femoral head vascularisation in Legg-Calvé-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy. Pediatr Radiol. 2002;32:580–5.

    Article  Google Scholar 

  17. Merlini L, Combescure C, De Rosa V, Anooshiravani M, Hanquinet S. Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation. Pediatr Radiol. 2010;40:318–25.

    Article  Google Scholar 

  18. Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics. 2014;34:1003–28.

    Article  Google Scholar 

  19. Murphey MD, Roberts CC, Bencardino JT, Appel M, Arnold E, Chang EY, et al. ACR appropriateness criteria osteonecrosis of the hip. J Am Coll Radiol. 2016;13(2):147–55.

    Article  Google Scholar 

  20. Nelitz M, Lippacher S, Krauspe R, Reichel H. Perthes disease: current principles of diagnosis and treatment. Dtsch Arztebl Int. 2009;106:517–23.

    PubMed  PubMed Central  Google Scholar 

  21. Ozel BD, Ozel D, Ozkan F, Halefoglu AM. Diffusion-weighted magnetic resonance imaging of femoral head osteonecrosis in two groups of patients: Legg-Perthes-Calve and avascular necrosis. Radiol Med. 2016;121:206–13.

    Article  Google Scholar 

  22. Park KW, Rejuso CA, Cho WT, Song HR. Timing of premature physeal closure in Legg-Calve-Perthes Disease. Int Orthop. 2014;38:2137–42.

    Article  Google Scholar 

  23. Sheikh A, Koujok K, Sampaio ML, Schweitzer ME. MR imaging of osseous lesions of the hip. Magn Reson Imaging Clin N Am. 2013;21:111–25.

    Article  Google Scholar 

  24. Shirai Y, Wakabayashi K, Wada I, Tsuboi Y, Ha M, Otsuka T. MRI appearance in the early stage of Legg-Calvé-Perthes disease to predict lateral pillar classification: a retrospective analysis of the labral horizontalization. J Orthop Sci. 2018;23:161–7.

    Article  Google Scholar 

  25. Sujlana P, Skrok J, Fayad LM. Review of dynamic contrast-enhanced MRI: technical aspects and applications in the musculoskeletal system. J Magn Reson Imaging. 2018;47:875–90.

    Article  Google Scholar 

  26. Tiwari V, Gamanagatti S, Mittal R, Nag H, Khan SA. Correlation between MRI and hip arthroscopy in children with Legg-Calve-Perthes disease. Musculoskelet Surg. 2018;102:153–7.

    Article  CAS  Google Scholar 

  27. Weishaupt D, Exner GU, Hilfiker PR, Hodler J. Dynamic MR imaging of the hip in Legg-Calvé-Perthes disease: comparison with arthrography. AJR Am J Roentgenol. 2000;174:1635–7.

    Article  CAS  Google Scholar 

  28. Yao K, Troupis JM. Diffusion-weighted imaging and the skeletal system: a literature review. Clin Radiol. 2016;71:1071–82.

    Article  CAS  Google Scholar 

  29. Yazici M, Aydingöz U, Aksoy MC, Akgün RC. Bipositional MR imaging vs arthrography for the evaluation of femoral head sphericity and containment in Legg-Calvé-Perthes disease. Clin Imaging. 2002;26:342–6.

    Article  Google Scholar 

  30. Yoo WJ, Choi IH, Cho TJ, Jang W, Chung CY, Park MS, et al. Risk factors for femoral head deformity in the early stage of Legg-Calvé-Perthes disease: MR contrast enhancement and diffusion indexes. Radiology. 2016;279:562–70.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Viana, S.L., Machado Ribeiro, M.C., Beber Machado, B. (2019). Imaging of Legg-Calvé-Perthes Disease. In: Joint Imaging in Childhood and Adolescence. Springer, Cham. https://doi.org/10.1007/978-3-030-11342-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-11342-1_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-11341-4

  • Online ISBN: 978-3-030-11342-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics