Can We Solve Legg-Calvé-Perthes Disease with Better Imaging Technology?

A better understanding of the revascularization process during Legg-Calve-Perthes disease has been desired for decades by many pediatric orthopaedic surgeons who have been seeking to improve on the natural history of the disease but have been limited in their ability to determine the prognosis of the disease on the basis of the initial radiographic appearance. Contrast-enhanced magnetic resonance imaging (MRI) in the initial stage of Legg-Calve-Perthes disease has shown promise as a prognostic indicator of outcome. This interesting paper by Kim et al. focuses on the rate and patterns of revascularization of femoral heads in the active stage of Legg-Calve-Perthes disease using serial perfusion MRI, shedding light on this important topic. Serial perfusion MRI is a relatively new tool with which to better understand the process of revascularization after osteonecrosis in Legg-Calve-Perthes disease. Building upon previous findings is the best way to arrive at a better understanding of any process. Although bone scintigraphy has been used previously to determine different revascularization patterns1,2, perfusion …