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Feasibility and safety of perfusion MRI for Legg-Calvé-Perthes disease
Wudbhav N Sankar1, Simon Thomas, Pablo Castañeda
1*Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA †Bristol Royal Hospital for Children, Bristol, UK ‡Shriners Hospitals for Children, Mexico City, Mexico §Texas Scottish Rite Hospital for Children, Dallas, TX ∥Boston Children's Hospital, Boston, MA.
Background:
Recent studies have suggested that perfusion magnetic resonance imaging (pMRI) using gadolinium contrast and a subtraction technique can provide useful prognostic information in Legg-Calvé-Perthes disease (LCPD) and allow earlier stratification for outcome. There are, however, sparse data available regarding the feasibility and safety of these studies in children. The purpose of this study was to collect this information across multiple centers using pMRI for LCPD.
Methods:
We retrospectively reviewed a consecutive series of patients with confirmed or suspected LCPD who had undergone pMRI at 1 of 5 large tertiary-care children's hospitals in the United States, UK, and Mexico. Demographic information, type of contrast administered, and requirement for sedation or anesthesia were noted. Records were scrutinized for adverse events associated with the pMRI protocol.
Results:
Over the study period, 165 patients underwent 298 pMRI studies. The median age at the time of imaging was 8.6 years (range, 2.5to 16.9 y). A total of 252 scans (85%) were performed for a known diagnosis of LCPD, whereas 46 were performed for a suspected diagnosis. Ninety-two of the 298 (31%) pMRIs required sedation, 48 (16%) required general anesthesia, and 122 (41%) were facilitated by video goggles only. The remaining 36 patients (12%) had their studies performed without additional measures. The ages of patients requiring sedation (mean, 7.2±2.4 y) and anesthesia (mean, 7.7±2.3 y) were significantly younger than those patients requiring neither (mean, 10.2±2.3 y, P<0.001). Four patients (1.3%) reported nausea or vomiting as a result of sedation. Two patients (0.7%) had complications from intravenous cannulation (pull out, difficult access). One child (0.3%) had nausea/vomiting as a result of contrast administration. There were no serious adverse events as a result of the pMRI protocol; specifically none of nephrogenic systemic fibrosis, anaphylaxis, or death.
Conclusions:
pMRI is a safe and feasible imaging technique for LCPD. Almost half of our patients required either sedation or general anesthesia to complete the study.
Level Of Evidence:
IV (case series).
Insights
Perfusion MRI (pMRI) is safe and feasible for Legg-Calvé-Perthes disease (LCPD) in children. While nearly half of patients needed sedation or anesthesia, no serious adverse events occurred.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
- Diagnostic Imaging
Background:
- Perfusion magnetic resonance imaging (pMRI) with gadolinium contrast shows prognostic value in Legg-Calvé-Perthes disease (LCPD).
- Limited data exist on the feasibility and safety of pMRI for pediatric LCPD patients.
Purpose of the Study:
- To assess the safety and feasibility of pMRI in children with LCPD across multiple international centers.
Main Methods:
- Retrospective review of 298 pMRI studies in 165 patients with suspected or confirmed LCPD.
- Data collected on patient demographics, contrast type, sedation/anesthesia requirements, and adverse events.
- Studies conducted at five tertiary pediatric hospitals in the US, UK, and Mexico.
Main Results:
- 165 patients underwent 298 pMRI studies; 85% for confirmed LCPD.
- Sedation or anesthesia was required for 47% of studies, with younger patients needing these interventions.
- Minor adverse events included nausea/vomiting (1.3%) and IV cannulation issues (0.7%); no serious events occurred.
Conclusions:
- pMRI is a safe and feasible imaging modality for pediatric LCPD.
- Sedation or general anesthesia is frequently necessary for pediatric patients undergoing pMRI for LCPD.
