Unit of Pediatric Radiology, Geneva University Hospital, rue Willy-Donzé 6, Geneva, Switzerland.
Pediatr Radiol. 2010 Mar;40(3):318-25. doi: 10.1007/s00247-009-1468-2. Epub 2010 Jan 6.
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.
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 病（LCP）是一种起源于血管的股骨头骨骺缺血性坏死。LCP 疾病的临床病程和结局在不同患者之间差异很大。需要有比传统放射学提供的更早的预后标准来识别需要及时手术治疗的儿童。
评估弥散加权磁共振成像（DWI MR）在 LCP 中的信号改变的意义。
12 名单侧 LCP 疾病（Catterall 2 级和 3 级）的男孩，处于初始硬化阶段和早期碎裂阶段，接受了动态钆增强减影（DGS）和 DWI MR 检查。对于 DGS MR，记录外侧柱增强情况。对于 DWI 成像，我们测量了病变和未受影响的骨骺和干骺端的 ADC 值。进行了受试者工作特征曲线分析，以分析 DWI 在与 DGS MR 结果（预后的金标准）建立一致性方面的性能。
在所有病例中，受累髋关节的股骨骨骺弥散性增加。在所有 DGS MR 无外侧柱增强的情况下，患侧的骺端弥散性增加。
DWI 似乎是一种区分预后良好和不良的 Perthes 病的非侵入性方法。
