Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: A preliminary study

Harry K W Kim, Kathryn D. Wiesman, Vedant Kulkarni, Jamie Burgess, Elena Chen, Case Brabham, Haseeb Ikram, Jerry Du, Amanda Lu, Ashok V. Kulkarni, Molly Dempsey, J. Anthony Herring

Research output: Contribution to journalArticle

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Abstract

Background: Current radiographic classifications for Legg-Calvé- Perthes disease cannot be applied at the early stages of the disease. The purpose of this study was to quantify the perfusion of the femoral epiphysis in the early stages of Legg- Calvé-Perthes disease with use of perfusion magnetic resonance imaging (MRI) and to determine if the extent of epiphyseal perfusion can predict the lateral pillar involvement at the mid-fragmentation stage. Methods: Twenty-nine patients had gadolinium-enhanced perfusion MRI at the initial stage or early fragmentation stage of Legg-Calvé-Perthes disease and were followed prospectively. The percent perfusion of the whole epiphysis and its lateral third was measured by four independent observers using image analysis software. The radiographs obtained at the mid-fragmentation stage were used for the lateral pillar classification. Intraclass correlation coefficient (ICC) and logistic regression analyses were performed. Results: The mean age (and standard deviation) at diagnosis was 7.7 ± 1.7 years (range, 5.3 to 11.3 years). The mean interval between the MRI and the time of maximum fragmentation was 8.2 ± 5.5 months. The interobserver ICC for the percent perfusion of the lateral third of the epiphysis was 0.90 (95% confidence interval [CI]: 0.83 to 0.95). The mean percent perfusion of the lateral third of the epiphysis was 92% ± 2%, 68% ± 18%, and 46% ± 12% for the hips in which the lateral pillar was later classified as A, B, and C, respectively (p = 0.001). When the perfusion level was ≥90% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group A, as opposed to B or C, was 72.0 (CI: 3.5 to 1476). With a perfusion level of ≤55% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group C, as opposed to A or B, was 33.3 (CI: 2.8 to 392). Similar results were obtained for the whole epiphysis. Conclusions: Perfusion MRI measurements of the total epiphysis and its lateral third obtained at the early stages of Legg-Calvé-Perthes disease were predictive of lateral pillar involvement at the mid-fragmentation stage of the disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1152-1160
Number of pages9
JournalJournal of Bone and Joint Surgery - American Volume
Volume96
Issue number14
DOIs
StatePublished - Jul 16 2014

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Legg-Calve-Perthes Disease
Epiphyses
Magnetic Resonance Angiography
Perfusion
Confidence Intervals
Odds Ratio
Gadolinium
Thigh
Hip
Software
Logistic Models
Regression Analysis
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement : A preliminary study. / Kim, Harry K W; Wiesman, Kathryn D.; Kulkarni, Vedant; Burgess, Jamie; Chen, Elena; Brabham, Case; Ikram, Haseeb; Du, Jerry; Lu, Amanda; Kulkarni, Ashok V.; Dempsey, Molly; Herring, J. Anthony.

In: Journal of Bone and Joint Surgery - American Volume, Vol. 96, No. 14, 16.07.2014, p. 1152-1160.

Research output: Contribution to journalArticle

Kim, HKW, Wiesman, KD, Kulkarni, V, Burgess, J, Chen, E, Brabham, C, Ikram, H, Du, J, Lu, A, Kulkarni, AV, Dempsey, M & Herring, JA 2014, 'Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement: A preliminary study', Journal of Bone and Joint Surgery - American Volume, vol. 96, no. 14, pp. 1152-1160. https://doi.org/10.2106/JBJS.M.01221
Kim, Harry K W ; Wiesman, Kathryn D. ; Kulkarni, Vedant ; Burgess, Jamie ; Chen, Elena ; Brabham, Case ; Ikram, Haseeb ; Du, Jerry ; Lu, Amanda ; Kulkarni, Ashok V. ; Dempsey, Molly ; Herring, J. Anthony. / Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement : A preliminary study. In: Journal of Bone and Joint Surgery - American Volume. 2014 ; Vol. 96, No. 14. pp. 1152-1160.
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abstract = "Background: Current radiographic classifications for Legg-Calv{\'e}- Perthes disease cannot be applied at the early stages of the disease. The purpose of this study was to quantify the perfusion of the femoral epiphysis in the early stages of Legg- Calv{\'e}-Perthes disease with use of perfusion magnetic resonance imaging (MRI) and to determine if the extent of epiphyseal perfusion can predict the lateral pillar involvement at the mid-fragmentation stage. Methods: Twenty-nine patients had gadolinium-enhanced perfusion MRI at the initial stage or early fragmentation stage of Legg-Calv{\'e}-Perthes disease and were followed prospectively. The percent perfusion of the whole epiphysis and its lateral third was measured by four independent observers using image analysis software. The radiographs obtained at the mid-fragmentation stage were used for the lateral pillar classification. Intraclass correlation coefficient (ICC) and logistic regression analyses were performed. Results: The mean age (and standard deviation) at diagnosis was 7.7 ± 1.7 years (range, 5.3 to 11.3 years). The mean interval between the MRI and the time of maximum fragmentation was 8.2 ± 5.5 months. The interobserver ICC for the percent perfusion of the lateral third of the epiphysis was 0.90 (95{\%} confidence interval [CI]: 0.83 to 0.95). The mean percent perfusion of the lateral third of the epiphysis was 92{\%} ± 2{\%}, 68{\%} ± 18{\%}, and 46{\%} ± 12{\%} for the hips in which the lateral pillar was later classified as A, B, and C, respectively (p = 0.001). When the perfusion level was ≥90{\%} in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group A, as opposed to B or C, was 72.0 (CI: 3.5 to 1476). With a perfusion level of ≤55{\%} in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group C, as opposed to A or B, was 33.3 (CI: 2.8 to 392). Similar results were obtained for the whole epiphysis. Conclusions: Perfusion MRI measurements of the total epiphysis and its lateral third obtained at the early stages of Legg-Calv{\'e}-Perthes disease were predictive of lateral pillar involvement at the mid-fragmentation stage of the disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.",
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T1 - Perfusion MRI in early stage of Legg-Calvé-Perthes disease to predict lateral pillar involvement

T2 - A preliminary study

AU - Kim, Harry K W

AU - Wiesman, Kathryn D.

AU - Kulkarni, Vedant

AU - Burgess, Jamie

AU - Chen, Elena

AU - Brabham, Case

AU - Ikram, Haseeb

AU - Du, Jerry

AU - Lu, Amanda

AU - Kulkarni, Ashok V.

AU - Dempsey, Molly

AU - Herring, J. Anthony

PY - 2014/7/16

Y1 - 2014/7/16

N2 - Background: Current radiographic classifications for Legg-Calvé- Perthes disease cannot be applied at the early stages of the disease. The purpose of this study was to quantify the perfusion of the femoral epiphysis in the early stages of Legg- Calvé-Perthes disease with use of perfusion magnetic resonance imaging (MRI) and to determine if the extent of epiphyseal perfusion can predict the lateral pillar involvement at the mid-fragmentation stage. Methods: Twenty-nine patients had gadolinium-enhanced perfusion MRI at the initial stage or early fragmentation stage of Legg-Calvé-Perthes disease and were followed prospectively. The percent perfusion of the whole epiphysis and its lateral third was measured by four independent observers using image analysis software. The radiographs obtained at the mid-fragmentation stage were used for the lateral pillar classification. Intraclass correlation coefficient (ICC) and logistic regression analyses were performed. Results: The mean age (and standard deviation) at diagnosis was 7.7 ± 1.7 years (range, 5.3 to 11.3 years). The mean interval between the MRI and the time of maximum fragmentation was 8.2 ± 5.5 months. The interobserver ICC for the percent perfusion of the lateral third of the epiphysis was 0.90 (95% confidence interval [CI]: 0.83 to 0.95). The mean percent perfusion of the lateral third of the epiphysis was 92% ± 2%, 68% ± 18%, and 46% ± 12% for the hips in which the lateral pillar was later classified as A, B, and C, respectively (p = 0.001). When the perfusion level was ≥90% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group A, as opposed to B or C, was 72.0 (CI: 3.5 to 1476). With a perfusion level of ≤55% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group C, as opposed to A or B, was 33.3 (CI: 2.8 to 392). Similar results were obtained for the whole epiphysis. Conclusions: Perfusion MRI measurements of the total epiphysis and its lateral third obtained at the early stages of Legg-Calvé-Perthes disease were predictive of lateral pillar involvement at the mid-fragmentation stage of the disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Current radiographic classifications for Legg-Calvé- Perthes disease cannot be applied at the early stages of the disease. The purpose of this study was to quantify the perfusion of the femoral epiphysis in the early stages of Legg- Calvé-Perthes disease with use of perfusion magnetic resonance imaging (MRI) and to determine if the extent of epiphyseal perfusion can predict the lateral pillar involvement at the mid-fragmentation stage. Methods: Twenty-nine patients had gadolinium-enhanced perfusion MRI at the initial stage or early fragmentation stage of Legg-Calvé-Perthes disease and were followed prospectively. The percent perfusion of the whole epiphysis and its lateral third was measured by four independent observers using image analysis software. The radiographs obtained at the mid-fragmentation stage were used for the lateral pillar classification. Intraclass correlation coefficient (ICC) and logistic regression analyses were performed. Results: The mean age (and standard deviation) at diagnosis was 7.7 ± 1.7 years (range, 5.3 to 11.3 years). The mean interval between the MRI and the time of maximum fragmentation was 8.2 ± 5.5 months. The interobserver ICC for the percent perfusion of the lateral third of the epiphysis was 0.90 (95% confidence interval [CI]: 0.83 to 0.95). The mean percent perfusion of the lateral third of the epiphysis was 92% ± 2%, 68% ± 18%, and 46% ± 12% for the hips in which the lateral pillar was later classified as A, B, and C, respectively (p = 0.001). When the perfusion level was ≥90% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group A, as opposed to B or C, was 72.0 (CI: 3.5 to 1476). With a perfusion level of ≤55% in the lateral third of the epiphysis, the odds ratio of the lateral pillar being later classified as group C, as opposed to A or B, was 33.3 (CI: 2.8 to 392). Similar results were obtained for the whole epiphysis. Conclusions: Perfusion MRI measurements of the total epiphysis and its lateral third obtained at the early stages of Legg-Calvé-Perthes disease were predictive of lateral pillar involvement at the mid-fragmentation stage of the disease. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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