The role of NMR imaging in the diagnosis of juvenile Legg-Perthes disease as compared to bone scintiscanning and conventional radiography

For 13 out of 50 juvenile patients complaining about acute pain in the hip, the diagnosis was Legg-Perthes disease, in two of these cases both hip joints were affected. The diagnostic examinations were done within a period of a few days, covering conventional radiography, bone scinntiscanning, and NMR imaging of the pelvis. In 8 of the 13 patients, re-examinations were done once or several times at time intervals of three to six months after first diagnosis. NMR imaging proved to be as sensitive as bone scintiscanning for early diagnosis of Legg-Perthes disease, and thus was clearly better than conventional radiography, but was not so good for detection of beginning revascularisation of necroses. For this purpose, scintiscanning together with osteoscintiscanning was superior over NMR imaging. Magnetic resonance imaging should be applied for early diagnosis as well as for follow-up examinations, in addition to scintiscanning and as a complemtary tool to conventional radiography. Bone scintiscanning is the best method of detecting the onset of revitalisation, which is a decisive criteria for therapy planning. Pre-surgery arthrography is expected to be replaced in future by magnetic resonance imaging. (orig./MG)