Evaluation of Hip Containment in Legg-Calvé-Perthes Disease: A Comparison of Ultrasound and Magnetic Resonance Imaging

Zusammenfassung

Ziel: Das Ziel der Studie war es festzustellen, ob die Ultraschalluntersuchung (US) im Vergleich zur Magnetresonanztomographie (MRT) für die Containmentdiagnostik beim M. Perthes einsetzbar ist. Methode: Bei 26 Patienten (Alter: 5,7 ± 1,9 Jahre) mit M. Perthes der Catterall-Gruppe III/IV wurden jeweils bei Diagnosestellung und im Verlauf sowohl US nach den DEGUM-Richtlinien (lateraler Longitudinalschnitt) als auch MRT der Hüftgelenke durchgeführt (insgesamt 63 Einzeluntersuchungen). Die Auswertung erfolgte unabhängig von 2 verschiedenen Untersuchern. Die Containmentbestimmung erfolgte kernspintomographisch mit dem knorpeligen Acetabulum-Kopf-Index (kAKI) und sonographisch durch die Messung der knorpeligen Hüftkopfprotrusion nach Terjesen (LCD: „Lateral Cartilage Distance”). Die Zustimmung der Ethikkommission zur Veröffentlichung der Studie wurde eingeholt. Ergebnisse: Zwischen den zwei verschiedenen Untersuchern kann bei der Messung der Hüftkopfbreite bzw. Acetabulumbreite und der LCD-Messung bei allen Hüftgelenken eine hohe Übereinstimmung (Pearson-Test: > 0,70) ermittelt werden. Der kAKI und die LCD sind bei Perthesgelenken gegenüber der gesunden Seite signifikant unterschiedlich (gepaarter t-Test: < 0,001). Unter Berücksichtigung der gesunden Seite ist der Grenzwert für das Containment beim M. Perthes bei einem kAKI < 73 % und einer LCD von > 6,5 mm. Schlussfolgerung: Die Hüftsonographie erscheint zur Containmentdiagnostik - insbesondere zur Verlaufskontrolle - beim M. Perthes sinnvoll zu sein.

Abstract

Background: To compare the performance of magnetic resonance imaging (MRI) and ultrasound (US) in the determination of head containment in hips with Legg-Calvé-Perthes disease (LCPD). Methods: In 26 children (22males, 4 females; age range 2.75 - 11.5 years; median 5.7 years) with LCPD classified as Catterall group III/IV, MRI and US were compared to assess the containment of the femoral head. A total of 63 individual examinations of LCPD and the healthy contralateral hip were evaluated and analyzed objectively by two independent observers. The containment was quantified by MRI with the “cartilage acetabulum-head-index” (CAHI) and by sonography with the “lateral cartilage distance” (LCD). For analyzing MRI and US data, the Pearson correlation coefficient was used and a probability value of less than 0.05 was assigned to indicate statistical significance. Results: US correlated well with MRI in the objective evaluation of the lateralization of the femoral head (CAHI: p = 0.01; LCD: p = 0.01). All hips showed a high agreement between the observers for the width of the femoral head/roof (Pearson: > 0.70) and for the LCD (Pearson: > 0.70). In comparison with the unaffected side, the loss of containment should be considered if CAHI is less than 73 % and LCD higher than 6.5 mm. Conclusion: Hip sonography seems to be a reliable method for monitoring the containment of the femoral head in LCPD.

Schlüsselwörter

Hüfte - M. Perthes - Containment - Sonographie - MRT

Key words

Hip - Legg-Calvé-Perthes disease - head containment - ultrasound - MRI

References

• 1 Kramer J, Hofmann S, Scheurecker A. et al . Perthes disease.  Radiologe. 2002;  42 (6) 432-439. Review. German. PMID: 12149903 [PubMed - indexed for MEDLINE]
• 2 Herring J A, Neustadt J B, Williams J J. et al . The lateral pillar classification of Legg-Calve-Perthes disease.  J Pediatr Orthop. 1992;  12 (2) 143-150. PMID: 1552014 [PubMed - indexed for MEDLINE]
• 3 Catterall A. The natural history of Perthes’ disease.  J Bone Joint Surg Br. 1971;  53 (1) 37-53. No abstract available. PMID: 5578 764 [PubMed - indexed for MEDLINE]
• 4 Rush B H, Bramson R T, Ogden J A. Legg-Calve-Perthes disease: detection of cartilaginous and synovial change with MR imaging.  Radiology. 1988;  167 (2) 473-476. PMID: 3357958 [PubMed - indexed for MEDLINE]
• 5 Terjesen T. Ultrasonography in the primary evaluation of patients with Perthes disease.  J Pediatr Orthop. 1993;  13 (4) 437-443. PMID: 8370776 [PubMed - indexed for MEDLINE]
• 6 Wirth T, LeQuesne G W, Paterson D C. Ultrasonography in Legg-Calve-Perthes disease.  Pediatr Radiol. 1992;  22 (7) 498-504. Erratum in: Pediatr Radiol 1993; 23 (4): 331 - 332. PMID: 1491906 [PubMed - indexed for MEDLINE]
• 7 Konermann W, Gruber G, Gaa J. Standardized sonographic examination of the hip joint.  Ultraschall Med. 2000;  21 (3) 137-141. German. PMID: 10929601 [PubMed - indexed for MEDLINE]
• 8 Graf R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment.  Arch Orthop Trauma Surg. 1980;  97 (2) 117-133. PMID: 7458597 [PubMed - indexed for MEDLINE]
• 9 Graf R. Ultrasound examination of the hip. An update.  Orthopade. 2002;  31 (2) 181-189. Review. German. PMID: 11963485 [PubMed - indexed for MEDLINE]
• 10 de Sales G auzy J, Kerdiles N, Baunin C. et al . Imaging evaluation of subluxation in Legg-Calve-Perthes disease: magnetic resonance imaging compared with the plain radiograph.  J Pediatr Orthop B. 1997;  6 (4) 235-238. PMID: 9343780 [PubMed - indexed for MEDLINE]
• 11 Moberg A, Hansson G, Kaniklides C. Acetabulum-head index measured on arthrograms in children with Legg-Calve-Perthes disease.  J Pediatr Orthop B. 2000;  9 (4) 252-256. PMID: 11143468 [PubMed - indexed for MEDLINE]
• 12 Bennett J T, Stuecker R, Smith E. et al . Arthrographic findings in Legg-Calve-Perthes disease.  J Pediatr Orthop B. 2002;  11 (2) 110-116. Review. PMID: 11943983 [PubMed - indexed for MEDLINE]
• 13 Hochbergs P, Eckerwall G, Egund N. et al . Femoral head shape in Legg-Calve-Perthes disease. Correlation between conventional radiography, arthrography and MR imaging.  Acta Radiol. 1994;  35 (6) 545-548. PMID: 7946675 [PubMed - indexed for MEDLINE]
• 14 Egund N, Wingstrand H. Legg-Calve-Perthes disease: imaging with MR.  Radiology. 1991;  179 (1) 89-92. PMID: 2006309 [PubMed - indexed for MEDLINE]
• 15 Jaramillo D, Kasser J R, Villegas-Medina O L. et al . Cartilaginous abnormalities and growth disturbances in Legg-Calve-Perthes disease: evaluation with MR imaging.  Radiology. 1995;  197 (3) 767-773. PMID: 7480754 [PubMed - indexed for MEDLINE]
• 16 Jaramillo D, Galen T A, Winalski C S. et al . Legg-Calve-Perthes disease: MR imaging evaluation during manual positioning of the hip - comparison with conventional arthrography.  Radiology. 1999;  212 (2) 519-525. PMID: 10429712 [PubMed - indexed for MEDLINE]
• 17 Meiss A L. MRT zur Diagnostik des Containment-Verlustes beim M. Perthes.  Med Orth Tech. 2001;  121 47-54
• 18 Kaniklides C, Lonnerholm T, Moberg A. et al . Legg-Calve-Perthes disease. Comparison of conventional radiography, MR imaging, bone scintigraphy and arthrography.  Acta Radiol. 1995;  36 (4) 434-439. PMID: 7619626 [PubMed - indexed for MEDLINE]