title: Diffusion-weighted imaging findings in Perthes disease with dynamic gadolinium-enhanced subtracted (DGS) MR correlation: a preliminary study.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To assess the significance of signal alteration on diffusion-weighted MR imaging (DWI MR) in LCP.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  DWI seems to be a noninvasive means of distinguishing between Perthes disease with favourable and unfavourable prognosis.
authors.affiliation: Unit of Pediatric Radiology, Geneva University Hospital, rue Willy-Donzé 6, Geneva, Switzerland. laura.merlini@hcuge.ch
authors.forename: Laura
authors.initials: L
authors.lastname: Merlini
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.forename: Vincenzo
authors.initials: V
authors.lastname: De Rosa
authors.forename: Mehrak
authors.initials: M
authors.lastname: Anooshiravani
authors.forename: Sylviane
authors.initials: S
authors.lastname: Hanquinet
mesh_terms: D002675:Child, Preschool; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005269:Femur / Q000473:pathology*; D005271:Femur Head Necrosis / Q000150:complications / Q000473:pathology*; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000150:complications / Q000473:pathology*; D008297:Male; D008536:Meglumine; D009942:Organometallic Compounds; D010865:Pilot Projects; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013382:Subtraction Technique
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; C072417:gadoterate meglumine