title: US of the painful hip in childhood: diagnostic value of cartilage thickening and muscle atrophy in the detection of Perthes disease.
abstract: OBJECTIVE
  To evaluate the combined use of several ultrasonographic (US) criteria in the detection of Perthes disease.
  
  
  METHODS
  In a prospective study, 144 consecutive children with a painful hip underwent US. The thicknesses of the (a) anterior recess of the joint capsule, (b) cartilage of the femoral head, and (c) quadriceps muscle were assessed. Sixty-eight children with no symptoms, the control group, were also examined.
  
  
  RESULTS
  The final diagnosis was transient synovitis (n = 58), Perthes disease (n = 21), slipped capital femoral epiphysis (SCFE; n = 5), or miscellaneous (n = 6). Fifty-four patients had no US or radiographic abnormalities, and symptoms disappeared during follow-up. The anterior recess in patients with transient synovitis was significantly wider than that in the other patients and control subjects (P < .001). Patients with Perthes disease showed significant cartilage thickening in the symptomatic hip compared with the other patients and control subjects (P < .001). Patients with Perthes disease and patients with SCFE showed significant atrophy of the ipsilateral quadriceps muscle compared with all other groups (P < .001). The combined use of these US criteria for the diagnosis of Perthes disease resulted in a positive predictive value of 95%, a negative predictive value of 95%, a sensitivity of 71%, and a specificity of 99%.
  
  
  CONCLUSIONS
  The combination of several US criteria increases the diagnostic value of US of the painful hip in patients with Perthes disease.
authors.affiliation: Department of Pediatric Radiology, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands.
authors.forename: S G
authors.initials: SG
authors.lastname: Robben
authors.forename: M
authors.initials: M
authors.lastname: Meradji
authors.forename: A F
authors.initials: AF
authors.lastname: Diepstraten
authors.forename: W C
authors.initials: WC
authors.lastname: Hop
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000000981:diagnostic imaging; D002358:Cartilage, Articular / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004839:Epiphyses, Slipped / Q000000981:diagnostic imaging; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D017746:Joint Capsule / Q000000981:diagnostic imaging; D007873:Legg-Calve-Perthes Disease / Q000000981:diagnostic imaging*; D008297:Male; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging; D009133:Muscular Atrophy / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D013585:Synovitis / Q000000981:diagnostic imaging; D013848:Thigh / Q000000981:diagnostic imaging; D014463:Ultrasonography