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Radionuclide scanning in the early diagnosis of Perthes' disease
Insights
Radioisotope scans can identify early signs of avascular necrosis in children with irritable hip. This condition, if detected, may progress to Legg-Calvé-Perthes disease within six months.
Area of Science:
- Pediatric Orthopedics
- Radiology
- Pediatric Imaging
Background:
- Irritable hip is a common cause of hip pain in children.
- Early diagnosis is crucial for appropriate management and prognosis.
- Distinguishing transient synovitis from early avascular necrosis is clinically important.
Purpose of the Study:
- To evaluate the utility of radioisotope scanning in identifying early avascular necrosis in children with irritable hip.
- To determine the correlation between scan findings and the subsequent development of Legg-Calvé-Perthes disease.
Main Methods:
- Prospective survey of children presenting with irritable hip at a children's hospital.
- All participants underwent hip radioisotope scanning.
- Serial radiography and one-year follow-up were conducted for all children.
Main Results:
- Five out of 50 children (10%) showed areas of ischemia in the capital femoral epiphysis on radioisotope scans.
- All five children with scan abnormalities developed radiological signs of Perthes' disease within six months.
- The remaining 45 children (90%) had radiographically normal hips at one-year follow-up.
Conclusions:
- Radioisotope scanning is a valuable tool for detecting early avascular necrosis in the capital femoral epiphysis in children with irritable hip.
- Scan-identified ischemia is a strong predictor of subsequent Legg-Calvé-Perthes disease development.
- Negative scan findings in irritable hip suggest a favorable prognosis with normal radiological outcomes at one year.
Abstract:
A prospective survey was carried out on all cases of irritable hip presenting at the Royal Liverpool Children's Hospital over a period of one year. All children had a radioisotope scan of the hips and were then followed for one year by serial radiography. Five of the 50 children seen during the one year had areas of ischaemia in the capital femoral epiphysis demonstrated on the scan. all five developed radiological signs of Perthes' disease within sic months. The remaining 45 had radiographically normal hips at one year.