MR perfusion index as a quantitative method of evaluating epiphyseal perfusion in legg-calve-perthes disease and correlation with short-term radiographic outcome: A preliminary study

Jerry Du, Amanda Lu, Molly Dempsey, John A. Herring, Harry K W Kim

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Abstract

BACKGROUND: Current radiographic prognosticators of the outcome of Perthes disease can only be applied after femoral head deformity has occurred. Quantification of femoral head perfusion using the gadolinium-enhanced subtraction magnetic resonance imaging (MRI) technique may serve as an early prognosticator of outcome. The purposes of this study were 2-fold: (1) to develop a reliable method to quantify femoral head perfusion using this MRI technique; and (2) to determine whether the perfusion at early stages of Perthes disease correlates with radiographic deformity after a 2-year follow-up. METHODS: A total of 20 patients meeting the following inclusion criteria were studied: radiographs and MRI obtained of femoral heads predeformity, age between 5 and 13 years, and unilateral disease. MR perfusion index, a measure of perfusion in the epiphysis, was obtained using digital image analysis of subtraction gadolinium-enhanced MRI. Intraobserver and interobserver agreement of this index was assessed by 2 independent observers. MR perfusion index was correlated with a radiographic deformity index (a measure of femoral head deformity) obtained after a minimum of 2 years. RESULTS: The intraobserver agreement assessed by the intraclass correlation coefficient was 0.96 for observer 1 and 0.97 for observer 2. The interobserver agreement of the MR perfusion index was 0.90 for trials 1 and 2. MR perfusion index in the early stages of Perthes disease was highly variable, ranging from 0 to 0.70. After a minimum of 2 years following MRI acquisition, radiographs were obtained and evaluated using the deformity index, a continuous measure of femoral head deformity, by 2 blinded observers. Deformity index at 2-year follow-up showed moderate correlation with predeformity MR perfusion index (r=-0.56, P=0.01, R=0.31). In those patients who were treated nonoperatively, the correlation was stronger (r=-0.79, P=0.006, R=0.63). CONCLUSIONS: MR perfusion index obtained from gadolinium-enhanced subtraction MR images showed a high interobserver agreement. MR perfusion index is highly variable at early stages of Perthes disease, and a lower MR perfusion index correlated with greater radiographic deformity at the 2-year follow-up. This pilot study shows the promise of predeformity MR perfusion index as a possible early prognosticator of outcome in Perthes disease.

Original languageEnglish (US)
Pages (from-to)707-713
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume33
Issue number7
DOIs
StatePublished - Oct 2013

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Legg-Calve-Perthes Disease
Perfusion
Gadolinium
Thigh
Magnetic Resonance Imaging
Epiphyses
Magnetic Resonance Angiography

Keywords

  • avascular necrosis
  • contrast MRI
  • gadolinium
  • hip
  • Legg-Calve-Perthes disease
  • osteonecrosis
  • perfusion MRI
  • subtraction MRI

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

@article{4e7d4c592b7245b69db8a271897b38b7,
title = "MR perfusion index as a quantitative method of evaluating epiphyseal perfusion in legg-calve-perthes disease and correlation with short-term radiographic outcome: A preliminary study",
abstract = "BACKGROUND: Current radiographic prognosticators of the outcome of Perthes disease can only be applied after femoral head deformity has occurred. Quantification of femoral head perfusion using the gadolinium-enhanced subtraction magnetic resonance imaging (MRI) technique may serve as an early prognosticator of outcome. The purposes of this study were 2-fold: (1) to develop a reliable method to quantify femoral head perfusion using this MRI technique; and (2) to determine whether the perfusion at early stages of Perthes disease correlates with radiographic deformity after a 2-year follow-up. METHODS: A total of 20 patients meeting the following inclusion criteria were studied: radiographs and MRI obtained of femoral heads predeformity, age between 5 and 13 years, and unilateral disease. MR perfusion index, a measure of perfusion in the epiphysis, was obtained using digital image analysis of subtraction gadolinium-enhanced MRI. Intraobserver and interobserver agreement of this index was assessed by 2 independent observers. MR perfusion index was correlated with a radiographic deformity index (a measure of femoral head deformity) obtained after a minimum of 2 years. RESULTS: The intraobserver agreement assessed by the intraclass correlation coefficient was 0.96 for observer 1 and 0.97 for observer 2. The interobserver agreement of the MR perfusion index was 0.90 for trials 1 and 2. MR perfusion index in the early stages of Perthes disease was highly variable, ranging from 0 to 0.70. After a minimum of 2 years following MRI acquisition, radiographs were obtained and evaluated using the deformity index, a continuous measure of femoral head deformity, by 2 blinded observers. Deformity index at 2-year follow-up showed moderate correlation with predeformity MR perfusion index (r=-0.56, P=0.01, R=0.31). In those patients who were treated nonoperatively, the correlation was stronger (r=-0.79, P=0.006, R=0.63). CONCLUSIONS: MR perfusion index obtained from gadolinium-enhanced subtraction MR images showed a high interobserver agreement. MR perfusion index is highly variable at early stages of Perthes disease, and a lower MR perfusion index correlated with greater radiographic deformity at the 2-year follow-up. This pilot study shows the promise of predeformity MR perfusion index as a possible early prognosticator of outcome in Perthes disease.",
keywords = "avascular necrosis, contrast MRI, gadolinium, hip, Legg-Calve-Perthes disease, osteonecrosis, perfusion MRI, subtraction MRI",
author = "Jerry Du and Amanda Lu and Molly Dempsey and Herring, {John A.} and Kim, {Harry K W}",
year = "2013",
month = "10",
doi = "10.1097/BPO.0b013e3182a05dc1",
language = "English (US)",
volume = "33",
pages = "707--713",
journal = "Journal of Pediatric Orthopaedics",
issn = "0271-6798",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - MR perfusion index as a quantitative method of evaluating epiphyseal perfusion in legg-calve-perthes disease and correlation with short-term radiographic outcome

T2 - A preliminary study

AU - Du, Jerry

AU - Lu, Amanda

AU - Dempsey, Molly

AU - Herring, John A.

AU - Kim, Harry K W

PY - 2013/10

Y1 - 2013/10

N2 - BACKGROUND: Current radiographic prognosticators of the outcome of Perthes disease can only be applied after femoral head deformity has occurred. Quantification of femoral head perfusion using the gadolinium-enhanced subtraction magnetic resonance imaging (MRI) technique may serve as an early prognosticator of outcome. The purposes of this study were 2-fold: (1) to develop a reliable method to quantify femoral head perfusion using this MRI technique; and (2) to determine whether the perfusion at early stages of Perthes disease correlates with radiographic deformity after a 2-year follow-up. METHODS: A total of 20 patients meeting the following inclusion criteria were studied: radiographs and MRI obtained of femoral heads predeformity, age between 5 and 13 years, and unilateral disease. MR perfusion index, a measure of perfusion in the epiphysis, was obtained using digital image analysis of subtraction gadolinium-enhanced MRI. Intraobserver and interobserver agreement of this index was assessed by 2 independent observers. MR perfusion index was correlated with a radiographic deformity index (a measure of femoral head deformity) obtained after a minimum of 2 years. RESULTS: The intraobserver agreement assessed by the intraclass correlation coefficient was 0.96 for observer 1 and 0.97 for observer 2. The interobserver agreement of the MR perfusion index was 0.90 for trials 1 and 2. MR perfusion index in the early stages of Perthes disease was highly variable, ranging from 0 to 0.70. After a minimum of 2 years following MRI acquisition, radiographs were obtained and evaluated using the deformity index, a continuous measure of femoral head deformity, by 2 blinded observers. Deformity index at 2-year follow-up showed moderate correlation with predeformity MR perfusion index (r=-0.56, P=0.01, R=0.31). In those patients who were treated nonoperatively, the correlation was stronger (r=-0.79, P=0.006, R=0.63). CONCLUSIONS: MR perfusion index obtained from gadolinium-enhanced subtraction MR images showed a high interobserver agreement. MR perfusion index is highly variable at early stages of Perthes disease, and a lower MR perfusion index correlated with greater radiographic deformity at the 2-year follow-up. This pilot study shows the promise of predeformity MR perfusion index as a possible early prognosticator of outcome in Perthes disease.

AB - BACKGROUND: Current radiographic prognosticators of the outcome of Perthes disease can only be applied after femoral head deformity has occurred. Quantification of femoral head perfusion using the gadolinium-enhanced subtraction magnetic resonance imaging (MRI) technique may serve as an early prognosticator of outcome. The purposes of this study were 2-fold: (1) to develop a reliable method to quantify femoral head perfusion using this MRI technique; and (2) to determine whether the perfusion at early stages of Perthes disease correlates with radiographic deformity after a 2-year follow-up. METHODS: A total of 20 patients meeting the following inclusion criteria were studied: radiographs and MRI obtained of femoral heads predeformity, age between 5 and 13 years, and unilateral disease. MR perfusion index, a measure of perfusion in the epiphysis, was obtained using digital image analysis of subtraction gadolinium-enhanced MRI. Intraobserver and interobserver agreement of this index was assessed by 2 independent observers. MR perfusion index was correlated with a radiographic deformity index (a measure of femoral head deformity) obtained after a minimum of 2 years. RESULTS: The intraobserver agreement assessed by the intraclass correlation coefficient was 0.96 for observer 1 and 0.97 for observer 2. The interobserver agreement of the MR perfusion index was 0.90 for trials 1 and 2. MR perfusion index in the early stages of Perthes disease was highly variable, ranging from 0 to 0.70. After a minimum of 2 years following MRI acquisition, radiographs were obtained and evaluated using the deformity index, a continuous measure of femoral head deformity, by 2 blinded observers. Deformity index at 2-year follow-up showed moderate correlation with predeformity MR perfusion index (r=-0.56, P=0.01, R=0.31). In those patients who were treated nonoperatively, the correlation was stronger (r=-0.79, P=0.006, R=0.63). CONCLUSIONS: MR perfusion index obtained from gadolinium-enhanced subtraction MR images showed a high interobserver agreement. MR perfusion index is highly variable at early stages of Perthes disease, and a lower MR perfusion index correlated with greater radiographic deformity at the 2-year follow-up. This pilot study shows the promise of predeformity MR perfusion index as a possible early prognosticator of outcome in Perthes disease.

KW - avascular necrosis

KW - contrast MRI

KW - gadolinium

KW - hip

KW - Legg-Calve-Perthes disease

KW - osteonecrosis

KW - perfusion MRI

KW - subtraction MRI

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U2 - 10.1097/BPO.0b013e3182a05dc1

DO - 10.1097/BPO.0b013e3182a05dc1

M3 - Article

C2 - 23872796

AN - SCOPUS:84884670207

VL - 33

SP - 707

EP - 713

JO - Journal of Pediatric Orthopaedics

JF - Journal of Pediatric Orthopaedics

SN - 0271-6798

IS - 7

ER -