Purpose or Case Report: Legg-Calvé-Perthes disease (LCPD) is juvenile idiopathic osteonecrosis of the femoral head, which can lead to permanent hip deformity and painful early-onset osteoarthritis. An issue in clinical practice is that there is wide variation in imaging and management of patients with LCPD. In our institution, we have created a rapid access pathway, so those with clinically suspected LCPD are imaged with a pelvic radiograph, seen by an orthopedic specialist in a dedicated LCPD clinic and subsequently a contrast MRI perfusion of the hips is expedited. This rapid pathway ensures imaging and management is not delayed. High quality MRI of the hips is important to prognosticate and guide orthopedic intervention. It was therefore important to standardise how the MRI hips is performed and reported.
Methods & Materials: Optimising care for those with LCPD required creating a standardised imaging protocol for contrast MRI perfusion of the hips. The protocol includes multiplanar axial and coronal imaging with T2W, STIR and T1W fat saturation pre and post contrast sequences with post processing subtraction. Once the MR sequences were standardised, it was then essential to create a formal reporting template for the MR study. This was created in collaboration with radiology and orthopedics. The reporting template ensures that the formal report contains all relevant information the orthopedic team require. The reporting template includes quantitative analysis of the relevant zones of the epiphysis of the femoral head. The volume of affected epiphysis is calculated.
Results: The standardised protocol for performing the MRI ensures that all relevant sequences are acquired. The structured reporting template allows the orthopaedic team to standardise their intervention. Standardised MRIs and reports enable optimal management. The full imaging protocol and the standardised reporting template will be described.
Conclusions: We have introduced a rapid access pathway for Legg-Calvé-Perthes disease with standardised imaging. Standardising how the contrast MRI perfusion of the hips is performed and reported facilitates a structured approach to orthopedic management. This structure enables formalised research into outcomes. Ideally, this standardised approach will be utilized by other institutions. This approach can be further modified to create an evidence based collaborative approach between radiology and orthopaedic teams to manage Legg-Calvé-Perthes disease.