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LEGGCALVPERTHES DISEASE
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Title: LEGGCALVPERTHES DISEASE
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RADIOGRAPHIC AND MRI DISSOCIATION IN
LEGG-CALVÉ-PERTHES DISEASE
UNIFESP - Federal University of São Paulo BRAZIL
Júlio César Di Sicco Eiffel T. Dobashi Patrícia
Corey Yamane Akira Ishida Carlo Milani
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INTRODUCTION
- Diagnosis, in most institutions ? X-ray
- Catterall (1971)
- Kaniklides et al. (1995)
- Early radiographic signs ? late phases of the
disease - X-ray ? Limited value
- Cartilaginous structures ? are not visualized
- Gershuni (1980), Bluemm et al. (1985), Pinto et
al. (1989), Bos et al. (1991), Cardinal White
(1992) - X-Rays do not provide these information ? MRI /
PAG - Kaniklides et al. (1995), Laredo (1992), Laredo
Ishida (1992)
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PURPOSE Compare the obtained results of the
acetabulum-femoral head index and extrusion in 60
hips of 60 children with LCP disease to
demonstrate if there is correlation or not of the
calculated index between these two different
methods. DISSOCIATION DISSIMILARITY (LAREDO,
1992)
- MATERIAL AND METHODS
- 60 patients - unilateral LCPD (Milani, 2000)
- 46M (76,67) 14F (23,33)
- 46W (76,67) 14NW (23,33)
- 34R (56,67) 26L (43,33)
- 34N (56,67) / 13F (21,67) / 9R (15,00) / 4D
(6,67) - Uninvolved opposite side as normal
- Rush et al. (1988) Beauty (1989) Mastantuono
(1997) Sales de Gauzy et al. (1997) Song et al.
(1998) - X-rays and MRI ? respectively
- Femoral Head Coverage
- HEYMAN HERDON (1950), SALES DE GAUZY et al.
(1997) - Extrusion of the FH
- DICKENS MENELAUS (1978)
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X-RAY
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MRI
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X-RAY
Measurements 8.93 2.80
wwwTesseract.com.br
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MRI
Measurement 24.47
wwwTesseract.com.br
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FH EXTRUSION
- Averages and SD of the values of all extrusion
measures of the FH of the 60 pathologic hips
(X-ray and MRI) of the 58 normal contralateral
hips(X-rays), and of the 54 normal contralateral
hips (MRI), with regard to the four Laredo
classes we defined. Laredo types I and II and the
results of the Wilcoxon and Kruskal-Wallis tests
were grouped in a single group.
Ppathological N normal W Wilcoxon A
average SD standard deviation No significant
differences were found with MRI and radiographs
for normal hips among the four groups
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- RESULTS (DISCORDANCE ? DISSOCIATION) ? 23 hips
(38,33) - Disagreement in the information concerned to the
femoral head coverage - sufficient according to plain x-ray
- insufficient according to MRI images
- SALES DE GAUZY et al. (1997)
- 26 patients
- IAC ? MRI and x-ray
- Similar results
- Ishida (1991) / Laredo (1992)
- Disagreement 50 of the patients
- IAC ? PAG and x-ray
- X-Ray does not represent the anatomical reality
of the FH affected by LCPD. (Harrison
Blakemore, 1980 Bluemm et al., 1985 Beauty,
1989 Pinto et al., 1989 Kamegaya et al., 1989
Bos et al., 1991 Cardinal White, 1992
Kaniklides et al., 1995 Jaramillo et al., 1999) - Laredo type III ? FH protrudes from the
acetabular brim. - Not covered ? FH deformed (Eyre-Brook, 1936
Strange, 1965 Catterall, 1971 Sommerville,
1971 Dickens Menelaus, 1978 Beauty, 1989
Ishida, 1991 Fulford et al., 1993 Eckerwall et
al., 1997 Ismail Macnicol, 1998 Roy, 1999) - ? EXTRUSION ? ? prognosis (Catterall, 1971,
1977 Dickens Menelaus, 1978 Sulberg et al.
1981 Sales de Gauzy et al., 1997) - Favorable results ? early coverage
- However, it was not determine the precise time
when FH coverage should be performed
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FH EXTRUSION x STAGE x LAREDO
- We observed
- high percentage of extruded hips
- necrosis and fragmentation ? 71.67
- in group III, IV and V
- Similar results were obtained by Ishida (1991)
- Precocious diagnosis
- Better anatomical details
- FH involvement
- Prognosis
- ? Morbidity
- Scoles et al. (1984), Bluemm et al. (1985), Pinto
et al. (1989), Kaniklides et al. (1995)
The results suggest that MRI provides trustworthy
information to conduct the treatment of LCP
disease, independent of the chosen method of
treatment.
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