LEGG CALV PERTHES DISEASE by MikeJenny

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    RADIOGRAPHIC AND MRI DISSOCIATION
                   IN
       LEGG-CALVÉ-PERTHES DISEASE

     UNIFESP - Federal University of São Paulo
                    BRAZIL

                Júlio César Di Sicco
                Eiffel T. Dobashi
                Patrícia Corey Yamane
                Akira Ishida
                Carlo Milani
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                            INTRODUCTION
     Diagnosis, in most institutions  X-ray
                  » Catterall (1971)
                  » Kaniklides et al. (1995)

     Early radiographic signs  late phases of the disease
     X-ray  Limited value
     • Cartilaginous structures  are not visualized
                  » Gershuni (1980), Bluemm et al. (1985), Pinto et al. (1989), Bos et al. (1991), Cardinal
                    & White (1992)

     X-Rays do not provide these information  MRI / PAG
                  » Kaniklides et al. (1995), Laredo (1992), Laredo & Ishida (1992)
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                                     PURPOSE
    Compare the obtained results of the acetabulum-femoral head index and
  extrusion in 60 hips of 60 children with LCP disease to demonstrate if there is
 correlation or not of the calculated index between these two different methods.
                DISSOCIATION – DISSIMILARITY (LAREDO, 1992)

                             MATERIAL AND METHODS
  60 patients - unilateral LCPD (Milani, 2000)
  • 46M (76,67%) 14F (23,33%)
  • 46W (76,67%) 14NW (23,33%)
  • 34R (56,67%) 26L (43,33%)
  • 34N (56,67%) / 13F (21,67%) / 9R (15,00%) / 4D (6,67%)
  Uninvolved opposite side as normal
                 » Rush et al. (1988); Beauty (1989); Mastantuono (1997); Sales de Gauzy et al. (1997);
                   Song et al. (1998)
  • X-rays and MRI  respectively
  • Femoral Head Coverage
                 » HEYMAN & HERDON (1950), SALES DE GAUZY et al. (1997)
  • Extrusion of the FH
                 » DICKENS & MENELAUS (1978)
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 X-RAY
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    MRI
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 X-RAY
          Measurements:
          8.93
          2.80




www:Tesseract.com.br
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    MRI
  Measurement:
  24.47




www:Tesseract.com.br
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                                             FH EXTRUSION
          Averages and SD of the values of all extrusion measures of the FH of the 60
            pathologic hips (X-ray and MRI); of the 58 normal contralateral hips(X-rays),
            and of the 54 normal contralateral hips (MRI), with regard to the four Laredo
            classes we defined. Laredo types I and II and the results of the Wilcoxon
            and Kruskal-Wallis tests were grouped in a single group.
                               Laredo I/II         Laredo III       Laredo IV           Laredo V        Kruskal-
  Exam         Side        A         SD        A           SD     A          SD     A              D     Wallis

  X-ray          P       5,15        6,38     8,06        7,95   13,84      9,75   16,42      16,37     p=0,035*

                 N       2,34        7,15     4,20        6,09   4,26       4,80   0,30       7,08      p=0,364

                 W              p=0,333            p=0,169            p=0,001*          p=0,018*
   MRI          P        17,45        7,94    21,39       7,03   25,05      8,69   42,92      20,36     p<0,001*

                N        15,43        8,10    13,13       5,42   12,69      4,76   13,20      4,56      p=0,620
                W               p=0,721            p=0,017*           p=0,001*          p=0,043*


 P=pathological; N= normal; W= Wilcoxon; A= average; SD= standard deviation
 No significant differences were found with MRI and radiographs for normal hips among the four groups
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        RESULTS (DISCORDANCE  DISSOCIATION)  23 hips (38,33%)
• Disagreement in the information concerned to the femoral head coverage
     – sufficient according to plain x-ray
     – insufficient according to MRI images
•   SALES DE GAUZY et al. (1997)
     – 26 patients
     – IAC  MRI and x-ray
     – Similar results
•   Ishida (1991) / Laredo (1992)
     – Disagreement = 50% of the patients
     – IAC  PAG and x-ray
•   X-Ray does not represent the anatomical reality of the FH affected by LCPD. (Harrison & Blakemore,
    1980; Bluemm et al., 1985; Beauty, 1989; Pinto et al., 1989; Kamegaya et al., 1989; Bos et al., 1991; Cardinal & White, 1992; Kaniklides et al., 1995; Jaramillo et
    al., 1999)

•   Laredo type III  FH protrudes from the acetabular brim.
•   Not covered  FH deformed (Eyre-Brook, 1936; Strange, 1965; Catterall, 1971; Sommerville, 1971; Dickens & Menelaus, 1978; Beauty,
    1989; Ishida, 1991; Fulford et al., 1993; Eckerwall et al., 1997; Ismail & Macnicol, 1998; Roy, 1999)

•   ↑ EXTRUSION  ↓ prognosis (Catterall, 1971, 1977; Dickens & Menelaus, 1978; Sulberg et al. 1981; Sales de Gauzy et al., 1997)
•   Favorable results  early coverage
•   However, it was not determine the precise time when FH coverage should be performed
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             FH EXTRUSION x STAGE x LAREDO

We observed:
• high percentage of extruded hips
• necrosis and fragmentation  71.67%
• in group III, IV and V
     – Similar results were obtained by Ishida (1991)
•   Precocious diagnosis
•   Better anatomical details
•   FH involvement
•   Prognosis
•   ↓ Morbidity
                 » Scoles et al. (1984), Bluemm et al. (1985), Pinto et al. (1989), Kaniklides et al. (1995)



The results suggest that MRI provides trustworthy information to conduct
  the treatment of LCP disease, independent of the chosen method of
                               treatment.

								
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