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Diagnostic performance of diffusion-weighted imaging (DWI) in Legg-Calvé-Perthes disease: A systematic review and
S Mohebbi1, A Mohebbi2, S Mohammadzadeh2
1Tehran University of Medical Education, Tehran, Iran; Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Diffusion-weighted imaging (DWI) shows increased apparent diffusion coefficient (ADC) values in children with Legg-Calvé-Perthes disease (LCPD). This non-invasive technique aids in early LCPD detection and differentiation from normal femur, improving diagnostic accuracy.
Area of Science:
- Pediatric Radiology
- Orthopedic Imaging
- Biomedical Engineering
Background:
- Legg-Calvé-Perthes disease (LCPD) is avascular necrosis of the femoral head in children, necessitating early diagnosis for optimal outcomes.
- Current diagnostic methods may involve invasive procedures or radiation exposure.
- Diffusion-weighted imaging (DWI) offers a non-invasive, non-radiating alternative for LCPD assessment.
Purpose of the Study:
- To evaluate the diagnostic utility of DWI in detecting Legg-Calvé-Perthes disease (LCPD).
- To compare apparent diffusion coefficient (ADC) values in the femoral epiphysis and metaphysis between affected and unaffected children.
- To assess the potential of DWI as a complementary tool to conventional MRI for LCPD diagnosis.
Main Methods:
- A systematic literature review was conducted using multiple databases (PubMed, Embase, Web of Science, Cochrane Library, MedRxiv) up to October 3, 2024.
- Apparent diffusion coefficient (ADC) values and ADC ratios were compared between normal and pathological femoral epiphysis and metaphysis.
- Six studies involving 150 patients were included for epiphyseal analysis, and five studies with 123 patients for metaphyseal analysis.
Main Results:
- Pathological femoral epiphysis showed a significant mean ADC increase (0.59 × 10-3 mm2/s) and a 2.32-fold increase in ADC ratio compared to normal epiphysis.
- Metaphyseal analysis revealed a mean ADC difference of 0.34 × 10-3 mm2/s and a 1.76-fold increase in ADC ratio in affected femurs.
- All reported differences and ratios were statistically significant (p < 0.001) with high heterogeneity.
Conclusions:
- Diffusion-weighted imaging (DWI) is a promising non-invasive technique for assessing and differentiating Legg-Calvé-Perthes disease (LCPD).
- DWI provides quantitative data (ADC values and ratios) that can enhance diagnostic accuracy when used alongside conventional MRI.
- This systematic review supports the use of DWI in clinical practice for improved evidence-based decision-making in pediatric hip conditions.
Introduction:
Legg-Calvé-Perthes disease (LCPD) is idiopathic avascular necrosis of the femoral head in children. Early diagnosis is essential to optimize management, improve long-term outcomes, and reduce surgical interventions. This study aimed to evaluate the role of diffusion-weighted imaging of the femoral epiphysis and metaphysis in detection of LCPD.
Methods:
The protocol was pre-registered at (https://osf.io/k8xt4/). Using PubMed, Embase, Web of Science, Cochrane Library, and MedRxiv, we found studies available until October 3, 2024. The apparent diffusion coefficient (ADC) values were compared between the normal and pathological femoral epiphysis and metaphysis. We also evaluated a new measurement index for the ADC ratio of the pathological to normal side.
Results:
Six studies comprising 150 patients and 374 epiphyseal ADC measurements were included. Pooled analysis demonstrated that pathological femoral epiphysis exhibited a mean ADC increase of 0.59 × 10-3 mm2/s compared to normal epiphysis (95 % CI: 0.34 to 0.84, p < 0.001, I2 = 97.1 %). Also, ADC ratio analysis showed a 2.32-fold increase (95 % CI: 1.98 to 2.66, p < 0.001, I2 = 88.8 %). Five studies with 123 patients and 282 metaphyseal ADC measurements revealed a mean difference of 0.34 × 10-3 mm2/s (95 % CI: 0.25 to 0.44, p < 0.001, I2 = 74.1 %), and a 1.76-fold ADC ratio increase (95 % CI: 1.49 to 2.03, p < 0.001, I2 = 91.5 %).
Conclusion:
As a non-radiating, non-invasive, and time-saving imaging technique, DWI has the potential to assess and differentiate LCPD from normal femur. It provides quantitative data that can be used in complement to the conventional MRI techniques to enhance diagnostic accuracy.
Implication For Practice:
Through a systematic review of the literature on DWI imaging in LCPD, this study enhances evidence-based clinical decision-making.
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