Radionuclide Evaluation of Legg-Calvé-Perthes Disease

  • James J. Conway

Abstract

The etiology of Legg-Calvé-Perthes disease (LCP) remains an enigma despite being one of the most frequently studied pediatric orthopedic disorders.3,37,48,95,103 The reasons for the uncertainty surrounding the etiology of LCP are multiple. LCP is a clinically silent disorder during its initial stages, and only with complications such as collapse of the epiphysis or the onset of synovitis do symptoms and signs such as pain and limitation of motion appear. This sequence occurs weeks to months after the onset of the avascular necrosis (AVN) incident. In my experience, the mean duration of symptoms before the appearance of radiographic changes of AVN averages 5 months.20 Importantly, the plain radiographic examination is insensitive and nonspecific for the vascular changes of AVN in bone. To further confound the issue, changes in other disorders, such as steroid osteopathy20 and epiphyseal dysplasia,63 mimic the radiographic changes of LCP in its later stages.

Keywords

Single Photon Emission Compute Tomography Femoral Head Epiphyseal Growth Plate Deep Femoral Artery Transient Osteoporosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Alexander JE, Seibert JJ, Glasier CM, et al. Highresolution hip ultrasound in the limping child. J Clin Ultrasound 1989;17:19–24.PubMedGoogle Scholar
  2. 2.
    Anderson PE Jr, Schantz K, Bollerslev J, Justesen P. Bilateral femoral head dysplasia and osteochondritis: multiple epiphyseal dysplasia tarda, spondyloepiphyseal dysplasia tarda, and bilateral Legg-Perthes disease. Acta Radiol 1988:29:705–709.Google Scholar
  3. 3.
    Barker DJ, Hall AJ. The epidemiology of Perthes’ disease. Clin Orthop 1986;209:89–94.PubMedGoogle Scholar
  4. 4.
    Bensahel H. La scintigraphic dans la maladie de Legg-Calvé-Perthes [Scintigraphy in Legg-Calvé-Perthes disease]. Acta Orthop Belg 1980;46: 371–379.PubMedGoogle Scholar
  5. 5.
    Bensahel H, Bok B, Cavailloles F, Csukonyi Z. Bone scintigraphy in Perthes disease. J Pediatr Orthop 1983; 3:302–305.PubMedGoogle Scholar
  6. 6.
    Bloem JL. Transient osteoporosis of the hip: MR imaging. Radiology 1988; 167:753–755.PubMedGoogle Scholar
  7. 7.
    Bluemm RG, Falke THM, Ziedses des Plantes BG Jr, Steiner RM. Early Legg-Perthes disease (ischemic necrosis of the femoral head) demonstrated by magnetic resonance imaging. Skeletal Radiol 1985; 14:95–98.PubMedGoogle Scholar
  8. 8.
    Bohr H. Densitometry and 18F scintigraphy in the study of the revascularization of the femoral head in coxa plana (C-P). Acta Orthop Scand 1973;44: 417–425.PubMedGoogle Scholar
  9. 9.
    Calvé J. Sur une forme particuliere de pseudo-coxalgie: greffeé sur des deformations caracteristiques de l’extrémité superieure du femur [About a particular form of pseudocoxalgia: thoughts on the characteristic deformations of the superior portion of the femur]. Rev Chir 1910; 42:54–84.Google Scholar
  10. 10.
    Calver R, Venugopal V, Dorgan J, Bentley G, Gimlette T. Radionuclide scanning in the early diagnosis of Perthes’ disease. J Bone Joint Surg [Br] 1981;63:379–382.Google Scholar
  11. 11.
    Carty H, Maxted MB, Fielding JA, Gulliford P, Owen R. Isotope scanning in the “irritable hip syndrome.” Skeletal Radiol 1984;11:32–37.PubMedGoogle Scholar
  12. 12.
    Catterall A. Legg-Calvé-Perthes syndrome. Clin Orthop 1981;158:41–52.PubMedGoogle Scholar
  13. 13.
    Catterall A. The natural history of Perthes’ disease. J Bone Joint Surg [Br] 1971;53:37–53.Google Scholar
  14. 14.
    Catterall A, Pringle J, Byers PD, et al. A review of the morphology of Perthes’ disease. J Bone Joint Surg [Br] 1982;64:269–275.Google Scholar
  15. 15.
    Catterall A, Pringle J, Byers PD, Fulford GE, Kemp HBS. Perthes’ disease: is the epiphysial infarction complete? A study of the morphology in two cases. J Bone Joint Surg [Br] 1982;64:276–281.Google Scholar
  16. 16.
    Cavailloles F, Bok B, Bensahel H. Bone scintigraphy in the diagnosis and follow up of Perthes’ disease. Eur J Nucl Med 1982;7:327–330.PubMedGoogle Scholar
  17. 17.
    Chung SMK. The arterial supply of the developing proximal end of the human femur. J Bone Joint Surg [Am] 1976;58:961–970.Google Scholar
  18. 18.
    Collier BD, Carrera GF, Johnson RP, Isitman AT. Detection of femoral head avascular necrosis in adults by SPECT. J Nucl Med 1985;26;979–987.PubMedGoogle Scholar
  19. 19.
    Colon IN, de Roldan S. Bone scan in Legg-Calvé-Perthes’ disease. Asoc Med Puerto Rico 1984; 76:513–516.Google Scholar
  20. 20.
    Conway JJ. A scintigraphic classification of Legg-Calvé-Perthes disease. Semin Nucl Med 1993; 23:274–295.PubMedGoogle Scholar
  21. 21.
    Conway JJ. Pediatric imaging. In: Syllabus, Categorical Course on Nuclear Medicine. Oak Brook, IL: Radiological Society of North America, 1985:165–171.Google Scholar
  22. 22.
    Conway JJ. Radionuclide bone imaging in pediatrics. Pediatr Clin North Am 1977;24:701–712.PubMedGoogle Scholar
  23. 23.
    Conway JJ. Radionuclide bone scintigraphy is pediatric orthopedics. Pediatr Clin North Am 1986; 33:1313–1334.PubMedGoogle Scholar
  24. 24.
    Conway JJ, Weiss SC, Maldonado V. Scintigraphic patterns in Legg-Calvé-Perthes disease [abstract]. Radiology 1983; 149 (suppl): 102.Google Scholar
  25. Crossan JF, Wynne-Davies R, Fulford GE. Bilateral failure of the capital femoral epiphysis: bilateral Perthes disease, multiple epiphyseal dysplasia, pseudoachondroplasia, and spondyloepiphyseal dysplasia congenita and tarda. J Pediatr Orthop 1983;3:297–301.PubMedGoogle Scholar
  26. 26.
    Daniel WW, Sanders C, Alarcon GS. The early diagnosis of transient osteoporosis by magnetic resonance imaging. J Bone Joint Surg [Am] 1992; 74:1262–1264.Google Scholar
  27. 27.
    Danigelis JA. Pinhole imaging in Legg-Perthes disease: further observations. Semin Nucl Med 1976; 6:69–82.PubMedGoogle Scholar
  28. 28.
    Danigelis JA, Fisher RL, Ozonoff MB, Sziklas JJ. 99mTc -polyphosphate bone imaging in Legg-Perthes disease. Radiology 1975;115:407–413PubMedGoogle Scholar
  29. 29.
    De Camargo FP, De Godoy RM Jr., Tovo R. Angiography in Perthes’ disease. Clin Orthop 1984; 191:216–220.PubMedGoogle Scholar
  30. 30.
    Deutsch SD, Gandsman EJ, Spraragen SC. Quantitative regional blood-flow analysis and its clinical application during routine bone-scanning. J Bone Joint Surg [Am] 1981;63:295–305.Google Scholar
  31. 31.
    Dickens DRV, Menelaus MB. The assessment of prognosis in Perthes’ disease. J Bone Joint Surg [Br] 1978;60:189–194.Google Scholar
  32. 32.
    Dorr U, Zieger M. Perthes’ disease: accuracy potentials and the value of sonography. Radiologe 1989; 29:182–186.PubMedGoogle Scholar
  33. 33.
    Egund N, Wingstrand H. Legg-Calvé-Perthes disease: imaging with MR. Radiology 1991; 179: 89–92.PubMedGoogle Scholar
  34. 34.
    Elsig JP, Exner GU, von Schulthess GK, Weitzel M. False-negative magnetic resonance imaging in early stage of Legg-Calvé-Perthes disease. J Pediatr Orthop 1989;9:231–235.PubMedGoogle Scholar
  35. 35.
    Fasting OJ, Langeland N, Bjerkreim I, Hertzenberg L, Nakken K. Bone scintigraphy in early diagnosis of Perthes’ disease. Acta Orthop Scand 1978;49: 169–174.PubMedGoogle Scholar
  36. 36.
    Fasting OJ, Bjerkreim I, Langeland N, Hertzenberg L, Nakken K. Scintigraphic evaluation of the severity of Perthes’ disease in the initial stage. Acta Orthop Scand 1980;51:655–660.PubMedGoogle Scholar
  37. 37.
    Ferguson AB Jr. Pathophysiology of Legg-Perthes disease. Hip 1985;7:3–11.Google Scholar
  38. 38.
    Fisher RL, Roderique JW, Brown DC, et al. The relationship of isotopic bone imaging findings to prognosis in Legg-Perthes disease. Clin Orthop 1980;150:23–29.PubMedGoogle Scholar
  39. 39.
    Fotter R, Fueger GF, Ritter G: The value of scintigraphy and osteoscintimetry for the early detection of Legg-Calvé-Perthes disease. Rontgenblatter 1979; 32:79–86.PubMedGoogle Scholar
  40. 40.
    Fotter R, Lammer J, Ritter G. 5-Year scintigraphic study of children with Perthes disease: diagnostic evaluation and therapeutic consequences. Fortschr Geb Rontgenstr Nuklearmed Erganzungsb 1982; 137:141–146.Google Scholar
  41. 41.
    Gandsman EJ, Deutsch SD, Tyson IB. Atlas of computerized blood flow analysis in bone disease. Clin Nucl Med 1983;8:558–563.PubMedGoogle Scholar
  42. 42.
    Gelfand MJ, Ball WS, Oestreich AE, et al. Transient loss of femoral head Tc-99m diphosphonate uptake with prolonged maintenance of femoral head architecture. Clin Nucl Med 1983;8:347–354.Google Scholar
  43. 43.
    Gershuni DH. Preliminary evaluation and prognosis in Legg-Calvé-Perthes disease. Clin Orthop 1980; 150:16–22.PubMedGoogle Scholar
  44. 44.
    Goertzen M, Schulitz KP, Assheuer J. Significance of imaging techniques (roentgen, scintigraphy, MRI) in the diagnosis and therapy planning of Perthes disease. Z Orthop 1991;129:500–506.PubMedGoogle Scholar
  45. 45.
    Gordon I, Peters AM, Nunn R. The symptomatic hip in childhood: scintigraphic findings in the presence of a normal radiograph. Skeletal Radiol 1987; 16:383–386.PubMedGoogle Scholar
  46. 46.
    Green NE, Beauchamp RD, Griffin PP. Epiphyseal extrusion as a prognostic index in Legg-Calvé-Perthes disease. J Bone Joint Surg [Am] 1981; 63:900–905.Google Scholar
  47. 47.
    Green NE, Griffin PP. Intra-osseous venous pressure in Legg-Perthes disease. J Bone Joint Surg [Am] 1982;64:666–671.Google Scholar
  48. 48.
    Gregosiewicz A, Okonski M, Stolecka D, Kandzierski G, Szponar M. Ischemia of the femoral head in Perthes’ disease: is the cause intra- or extravascular? J Pediatr Orthop 1989;9:160–162.PubMedGoogle Scholar
  49. 49.
    Grimm J, Haist J, Higer HP. Diagnosis of Perthes disease using magnetic resonance tomography. Z Orthop 1991;129:151–155.PubMedGoogle Scholar
  50. 50.
    Hajek MR, Dias LS, Carroll N. A scintigraphic classification of Legg-Calvé-Perthes disease. Orthop Trans 1988;12:569.Google Scholar
  51. 51.
    Hardcastle PH, Ross R, Hamalainen M, Mata A. Catterall grouping of Perthes’ disease: an assessment of observer error and prognosis using Catterall classification. J Bone Joint Surg [Br] 1980;62: 428–431.Google Scholar
  52. 52.
    Hegge FN. Femoral head activity in Perthes’ disease [letter]. J Nucl Med 1979;20:170.PubMedGoogle Scholar
  53. 53.
    Henard DC, Calandruccio RA. Experimental production of roentgenographic and histological changes in the capital femoral epiphysis following abduction, extension, and internal rotation of the hip. Surg Forum 1971;22:442–444.PubMedGoogle Scholar
  54. 54.
    Herring JA, Hotchkiss BL. Legg-Perthes disease versus multiple epiphyseal dysplasia. J Pediatr Orthop 1987;7:341–343.PubMedGoogle Scholar
  55. 55.
    Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop 1992; 12:143–150.PubMedGoogle Scholar
  56. 56.
    Heyman CH, Herndon CH. A method for the measurement of the roentgenographic result. J Bone Joint Surg [Am] 1950;32:767–778.Google Scholar
  57. 57.
    Jensen OM, Lauritzen J. Legg-Calvé-Perthes’ disease: morphological studies in two cases examined at necropsy. J Bone Joint Surg [Br] 1976;58: 332–338.Google Scholar
  58. 58.
    Kumasaka Y, Harada K, Watanabe H, et al. Modified epiphyseal index for MRI in Legg-Calvé-Perthes disease (LCPD). Pediatr Radiol 1991 ;21:208–210.PubMedGoogle Scholar
  59. 59.
    LaMont RL, Muz J, Heilbrunner D, Bouwhuis JA. Quantitative assessment of femoral head involvement in Legg-Calve-Perthes disease. J Bone Joint Surg 1981;63:746–752.PubMedGoogle Scholar
  60. 60.
    Lauritzen J. The arterial supply to the femoral head in children. Acta Orthop Scand 1974;45:724–736.PubMedGoogle Scholar
  61. 61.
    Legg AT. An obscure affection of the hip-joint. Boston Med Surg J 1910;162:202–204.Google Scholar
  62. 62.
    Linnenbaum FJ, Woltering H, Karbowski A, Harle A. Ultrasonography of the hip for Perthes’ disease. Arch Orthop Trauma Surg 1989; 108:166–172.PubMedGoogle Scholar
  63. 63.
    Mandell GA, MacKenzie WG, Scott CI Jr, et al. Identification of avascular necrosis in the dysplastic proximal femoral epiphysis. Skeletal Radiol 1989; 18:273–281.PubMedGoogle Scholar
  64. 64.
    McKibbin B, Ralis Z. Pathological changes in a case of Perthes’ disease. J Bone Joint Surg [Br] 1974; 56:438–447.Google Scholar
  65. 65.
    Minikel J, Sty J, Simons G. Sequential radionuclide bone imaging in avascular pediatric hip conditions. Clin Orthop 1983;175:202–208.PubMedGoogle Scholar
  66. 66.
    Morley TR, Short MD, Dowsett DJ. Femoral head activity in Perthes disease: clinical evaluation of a quantitative technique for estimating tracer uptake. JNuclMed 1978;19:884–890.Google Scholar
  67. 67.
    Mose K. Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. Clin Orthop 1980;150:103–109.PubMedGoogle Scholar
  68. 68.
    Mukherjee A, Fabry G. Evaluation of the prognostic indices in Legg-Calvé-Perthes disease: statistical analysis of 116 hips. J Pediatr Orthop 1990; 10:153–158.PubMedGoogle Scholar
  69. 69.
    Murray IPC, Dixon J. The role of single photon emission computed tomography in bone scintigraphy. Skeletal Radiol 1989;18:493–505.PubMedGoogle Scholar
  70. 70.
    Ogden JA. Changing patterns of proximal femoral vascularity. J Bone Joint Surg [Am] 1974; 56:941–950.Google Scholar
  71. 71.
    Paterson D, Savage JP. The nuclide bone scan in the diagnosis of Perthes’ disease. Clin Orthop 1986; 209:23–29.PubMedGoogle Scholar
  72. 72.
    Paul DJ, Gilday DL, Gurd A. A better method of imaging abnormal hips. Radiology 1974;113: 466–467.PubMedGoogle Scholar
  73. 73.
    Perthes: Uber arthritis deformans juvenilis [About juvenile deforming arthritis]. Dtsch Z Chir 1910; 107:111–159.Google Scholar
  74. 74.
    Pinto MR, Peterson HA, Berquist TH. Magnetic resonance imaging in early diagnosis of Legg-Calvé-Perthes disease. J Pediatr Orthop 1989; 9:19–22.PubMedGoogle Scholar
  75. 75.
    Ranner G. Osteochondrosis deformans coxae juvenilis (Legg-Calvé-Perthes disease) in the MR tomogram: diagnosis and follow-up assessment correlated with x-rays and skeletal scintigraphy. Fortschr Geb Rontgenstr Nuklearmed Erganzungsbd 1990;153:124–130.Google Scholar
  76. 76.
    Reinker KA, Larsen IJ. Patterns of progression in Legg-Perthes disease. J Pediatr Orthop 1983;3: 455–460.PubMedGoogle Scholar
  77. 77.
    Ritter G. Perthes’ disease in scintigraphy—early diagnosis, course and therapeutic consequences. Z Orthop 1982;120:850–859.PubMedGoogle Scholar
  78. 78.
    Ritterbusch JF, Shantharam SS, Gelinas C. Comparison of lateral pillar classification and Catterall classification of Legg-Calvé-Perthes’ disease. J Pediatr Orthop 1993;12:200–202.Google Scholar
  79. 79.
    Royle SG, Galasko CS. The irritable hip: scintigraphy in 192 children. Acta Orthop Scand 1992;63:25–28.PubMedGoogle Scholar
  80. 80.
    Rush BH, Bramson RT, Ogden JA. Legg-Clavé-Perthes disease: detection of cartilaginous and synovial changes with MR imaging. Radiology 1988;167:473–476.PubMedGoogle Scholar
  81. 81.
    Salter RB. Legg-Perthes disease: the scientific basis for the methods of treatment and their indications. Clin Orthop 1980;150:8–11.PubMedGoogle Scholar
  82. 82.
    Salter RB, Thompson GH. Legg-Clavé-Perthes disease. J Bone Joint Surg [Am] 1984,66:479–489.Google Scholar
  83. 83.
    Sanchis M, Zahir A, Freeman MAR. The experimental simulation of Perthes disease in consecutive interruptions of the blood supply to the capital femoral epiphysis in the puppy. J Bone Joint Surg [Am] 1973;53:335–342.Google Scholar
  84. 84.
    Schlesinger I, Crider RL Gage’s sign—revisited! J Pediatr Orthop 1988;8:201–202.PubMedGoogle Scholar
  85. 85.
    Schuind F, Hoekman P. Legg-Perthes-Calvé disease: a new method for measurement of roentgenographic results of bilateral cases. J Pediatr Orthop 1984;4:431–435.PubMedGoogle Scholar
  86. 86.
    Scoles PV, Yoon YS, Makley JT, Kalamchi A. Nuclear magnetic resonance imaging in Legg-Calvé-Perthes disease. J Bone Joint Surg [Am] 1984;66:1357–1363.Google Scholar
  87. 87.
    Simmons ED, Graham HK, Szalai JP. Interobserver variability in grading Perthes’ disease. J Bone Joint Surg [Br] 1990;72:202–204.Google Scholar
  88. 88.
    Stansberry SD, Swischuk LE, Barr LL. Legg-Perthes disease: incidence of the subchondral fracture. Appl Radiol 1990;19(4):30–33.Google Scholar
  89. 89.
    Sutherland AD, Savage JP, Paterson DC, Foster BK. The nuclide bone-scan in the diagnosis and management of Perthes’ disease. J Bone Joint Surg [Br] 1980;62:300–306.Google Scholar
  90. 90.
    Sziklas JJ. Femoral head activity in Perthes disease [letter]. J Nucl Med 1979;20:458–459.PubMedGoogle Scholar
  91. 91.
    Tachdjian M. 99m Technetium diphosphonate bone imaging in Legg-Calvé-Perthes’ disease. Acta Orthop Belg 1980;46:366–370.PubMedGoogle Scholar
  92. 92.
    Tachdjian MO, Grana L. Response of the hip joint to increased intra-articular hydrostatic pressure. Clin Orthop 1968;61:199–212.PubMedGoogle Scholar
  93. 93.
    Theissen P, Rutt J, Linden A, et al. The early diagnosis of Perthes disease: the value of bone scintigraphy and magnetic resonance imaging in comparison with x-ray findings. Nuklearmedizin 1991;30: 265–271.PubMedGoogle Scholar
  94. 94.
    Theron J. Angiography in Legg-Calvé-Perthes disease. Radiology 1980;135:81–92.PubMedGoogle Scholar
  95. 95.
    Thompson GH, Salter RB. Legg-Calvé-Perthes disease: current concepts and controversies. Orthop Clin North Am 1987;18:617–635.PubMedGoogle Scholar
  96. 96.
    Toby EB, Koman LA, Bechtold RE. Magnetic resonance imaging of pediatric hip disease. J Pediatr Orthop 1985;5:665–671.PubMedGoogle Scholar
  97. 97.
    Tsao AK, Dias LS, Conway JJ, Straka P. The prognostic value and significance of serial bone scintigraphy in Legg-Calvé-Perthes disease. Unpublished dataGoogle Scholar
  98. 98.
    Vegter J. The influence of joint posture on intraarticular pressure: a study of transient synovitis and Perthes’ disease. J Bone Joint Surg [Br] 1987;69: 71–74.Google Scholar
  99. 99.
    Waldenström H. On coxa plana. Acta Clin Scand 1923;55:577–590.Google Scholar
  100. 100.
    Waldenström H. The definite form of the coxa plana. Acta Radiol 1922;1:384–394.Google Scholar
  101. 101.
    Waldenström H. The first stage of coxa plana. Acta Orthop Scand 1934;5:1–34.Google Scholar
  102. 102.
    Waldenström H. The first stage of coxa plana. J Bone Joint Surg 1938;20:559–566.Google Scholar
  103. 103.
    Wenger DR, Ward WT, Herring JA. Current concepts review: Legg-Calvé-Perthes disease. J Bone Joint Surg [Am] 1991;73:778–788.Google Scholar
  104. 104.
    Wilson AJ, Murphy WA, Hardy DC, Totty WG. Transient osteoporosis: transient bone marrow edema? Radiology 1988;167:757–760.PubMedGoogle Scholar
  105. 105.
    Wingstrand H, Bauer GCH, Brismar J, et al. Transient ischaemia of the proximal femoral epiphysis in the child. Acta Orthop Scand 1985;56: 197–203.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • James J. Conway

There are no affiliations available

Personalised recommendations