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Updated: Jul 21, 2026
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
A comparison of subtraction MRI with the standard contrast-enhanced imaging in Perthes' disease
K Jamil1,2,3, T Walker4, E Onikul4
1Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.
Purpose:
Perthes' disease (PD) results from loss of blood supply to the hip and can progress to femoral head deformity. MRI in the early course of the disease can provide data on the initial extent of infarct. Vascularity of the femoral head is assessed by gadolinium-enhanced MRI (contrast MRI), which may be improved by the digital subtraction technique (subtraction MRI). We hypothesized that gadolinium-enhanced MRI without subtraction was comparable with subtraction MRI in depicting the femoral head perfusion.
Methods:
In all, 34 patients (34 hips) with unilateral PD had gadolinium-enhanced MRI as part of a prospectively randomized study. Nine patients had three MRIs, 15 had two and ten had a single MRI. Measurement of perfusion of the femoral head (MRI perfusion index) was obtained using digital image analysis on all the MRIs, including both before and after subtraction. A paired sample t-test was performed to compare the measurements.
Results:
The mean age of the patients was 8.9 years (sd 1.6). At the time of diagnosis, the subtraction MRI did not elicit a statistically significant difference in MRI perfusion index measurements when compared with the contrast MRI (p = 0.19). The same findings were found when including all patients at various stages of the disease (p = 0.30). Qualitatively, although some subtraction MRI images showed superior delineation of epiphysis, there are no significant differences throughout the whole series.
Conclusion:
Although the current literature supports the increasing role of the subtraction MRI for PD management, our study proposed that the contrast MRI without subtraction technique appears adequate in assessing femoral head perfusion.
Level Of Evidence:
Level I - Diagnostic study.
Insights
Gadolinium-enhanced MRI without subtraction is adequate for assessing femoral head perfusion in Perthes' disease (PD). This contrast MRI technique provides comparable results to subtraction MRI, simplifying early diagnosis and management of PD.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Medical Imaging
Background:
- Perthes' disease (PD) involves hip blood supply loss, potentially causing femoral head deformity.
- Early MRI is crucial for assessing infarct extent and guiding treatment.
- Gadolinium-enhanced MRI (contrast MRI) evaluates femoral head vascularity, with subtraction MRI potentially improving visualization.
Purpose of the Study:
- To compare the efficacy of standard contrast MRI versus subtraction MRI in assessing femoral head perfusion in pediatric patients with Perthes' disease.
- To determine if gadolinium-enhanced MRI without subtraction is a sufficient method for evaluating femoral head vascularity in PD.
Main Methods:
- A prospective randomized study involving 34 pediatric patients (34 hips) with unilateral Perthes' disease.
- Gadolinium-enhanced MRI scans were performed, with perfusion measurements (MRI perfusion index) obtained using digital image analysis, both before and after subtraction.
- Paired sample t-tests were used to compare perfusion measurements between the two MRI techniques.
Main Results:
- No statistically significant difference was found in MRI perfusion index measurements between contrast MRI and subtraction MRI at diagnosis (p = 0.19).
- Similar non-significant findings were observed when analyzing all patients across various disease stages (p = 0.30).
- Qualitative assessment showed no significant overall differences, although subtraction MRI occasionally offered superior epiphyseal delineation.
Conclusions:
- Contrast MRI without subtraction is adequate for assessing femoral head perfusion in Perthes' disease.
- Despite literature supporting subtraction MRI, standard contrast MRI offers comparable diagnostic value for PD management.
- This finding may simplify imaging protocols for evaluating femoral head vascularity in pediatric patients with PD.
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