| Objective To study the advantages of non-enhanced MRI in the evaluation of the early femoral head protrusion index relative to X-ray film and the advantage of enhanced nuclear magnetic resonance in assessing the extent of femoral head involvement.To explore application of plain magnetic resonance and enhanced nuclear magnetic resonance in evaluating the prognosis of Perthes disease.Materials Retrospective analysis of children with Perthes’ disease who were admitted between January 2005 and February 2018,of whom Perthes’ s disease was non-enhanced MRI data from January 2005 to October 2016,a total of 181 patients with Perthes’ disease,38 The children with Perthes disease were in the stage of modified Waldenstr?m necrosis and fragmentation,with 35 males and 3 females;21 cases on the left side and 17 cases on the right side;all had unilateral onset.Among them,there were 14 cases with necrosis,with an average age of(6.9±1.5)years;24 cases with fragmentation,and an average age of(7.4±1.4)years.Between October 2016 and February 2018,Perthes’ disease children had enhanced magnetic resonance data.A total of 37 children with Perthes disease were treated.Among them,21 children with Perthes disease were in the stage of modified Waldenstr?m necrosis,fragmentation and repair,and the data of children.complete.The early stage of modified Waldenstr?m stage was 17 cases and late stage was 8 cases.In 17 cases of early-stage children,there were 16 males and 1 female;the age ranged from 6.2 to 9.5 years,with an average of(7.4±1.3)years;the left side was in 9 cases and the right side was in 4 cases.8 cases of late-stage children,8 males and 0 females;aged 6.1 to 10.5 years old,an average of(7.2 ± 1.5)years;4 cases on the left,4 cases on the right.Methods To assess femoral head protrusion index simultaneously by two pediatric orthopedic clinicians individually measuring the contralateral and ipsilateral X-rays and MRI,ie,femoral head protrusion of all parts of the acetabular(cartilage)margin/femoral skull(cartilage)Maximum lateral diameter × 100%.The extent of femoral head involvement was evaluated and measured by two pediatric orthopedic clinicians.1.Visual observation: The observer assessed the extent of femoral head involvement by visual inspection: 2.The software measured: Measurement of femoral heads at different NMR levels using PS software.Degree of involvement.Results The femoral head protrusion index was measured on the healthy side X-ray.The results showed that the average was 11.6%±8.2%(range,0~26.3%),and the affected side was 19.3%±9.8%(range,0~36.7%).The difference was statistically significant(t=11.550,P=0.000).The femoral head protrusion index was measured on the contralateral MRI.The results showed that the average was 20.1%±5.5%(range,8.9%~32.2%),and the affected side was 27.8%±5.8%(range,0~36.7%).The difference was statistically significant(t = 5.172,P = 0.000).The index of femoral head protrusion was measured on the ipsilateral MRI.The results showed an average of 27.9%±19.6%(range,16.5%~31.4%),compared with the contralateral [21.6%±1.4%(range,0~26.3%)].Statistically significant(t=2.651,P=0.018).The prominence index of the femoral head was measured by X-ray film in 24 patients with fragmentation.The results showed that the average was 21.3% ± 8.8%(range,6.5% ~ 36.7%),and the contralateral [10.8% ± 1.6%(range,0 ~ 19.8 %)]Compared,the difference was statistically significant(t=4.756,P=0.000);ipsilateral femoral head protrusion index was measured on MRI,and the results showed an average of 27.8%±5.4%(range,19.7%~36.8%),with There was a statistically significant difference between the unaffected side [19.6%±1.1%(range,10.7%~26.3%)](t=4.622,P=0.000).Among the 14 children with necrosis,X-ray showed 3 cases with positive signs(21.4%),and 12 cases with MRI(85.7%)had positive signs.There was a statistically significant difference between the two groups(P=0.018).Among 24 patients with fragmentation,X-ray showed 17 cases with positive signs(70.8%),and MRI showed 22 cases(91.7%)with prominent signs.There was no significant difference between the two groups(P=0.137).The average of Catterall 3 and 4 femoral head prominence index was 21.1±10.2%,which was significantly different from that of the healthy side(t=-3.462,P=0.002).MRI measurement of Catterall type 1 and type 2 femoral head prominence index averaged 27.2±6.5%,which was statistically significant compared with the healthy side(t=-3.364,P=0.005);Catterall type 3 and 4 femoral head prominence index averaged 28.0 ± 5.7%,compared with the healthy side,the difference was statistically significant(t=-5.611,P=0.000).The degree of involvement of the femoral head was visually measured: the degree of involvement of the early non-enhancing T1 WI sequence was 31.6%±20.4%(range: 5-65%),and the mean value of the enhanced MRI was 81.8%±12.0%(range: 52-95%).Significance(t=7.546,P=0.000).Late stage: the mean level of non-enhancing T1 WI sequence involvement was 65.1%±16.3%(range: 35-80%),mean value of enhanced MRI was 31.4%±15.6%(range: 9-50%),and the difference was statistically significant(t=5.344,P=0.001).PS: The mean level of involvement of early non-enhancing T1 WI sequence was 41.3%±17.9%(range: 9.7-58.5%),and the mean value of enhanced MRI was 78.9%±16.1%(range: 41.7-95.6%).The difference was statistically significant.(t=6.473,P=0.000).Late Stage: The mean level of femoral head involvement in non-enhanced T1 WI sequence was 62.6%±21.9%(range: 23.4 to 92.7%),mean value of enhanced MRI was 30.6%±19.6%(range: 2.3 to 66%),and the difference was statistically significant Significance(t=5.750,P=0.001).Conclusion The femoral head protrusion was not observed on the X-ray film in the stage of necrosis in Perthes disease.On the MRI,it was observed that the femoral head protruded prominently on the outer edge of the acetabulum.MRI evaluation of Perthes disease early femoral head protrusion index has better clinical guidance.Strengthen NMR in the early assessment of Perthes disease femoral head involvement is better than non-enhanced MRI,enhanced MRI can be estimated by visual assessment of the degree of femoral head involvement is more convenient clinical application;Perthes disease assessment of late femoral head blood supply recovery enhanced NMR significantly better than non-enhanced NMR. |
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