Novel three-dimensional MRI technique for study of cartilaginous hip surfaces in Legg-Calvé-Perthes disease

Abstract

Treatment of Legg-Calvé-Perthes disease (LCPD) may improve if new knowledge can be obtained regarding how articular cartilage changes shape during the course of this disorder. A new technique is presented showing how analyses of magnetic resonance images can be used to quantify the three-dimensional changes in the femoral and acetabular articulating cartilage surfaces of children with LCPD. Ten male subjects (8 +/- 1 years) with unilateral LCPD were enrolled in this IRB approved study. Sets of magnetic resonance images of both hips were obtained at three different times. Three-dimensional virtual models of the cartilage were created from these images, and mathematical spheres were fit to the articulating surfaces. Five parameters (size, shape deformity (sphericity error), radial growth rate, joint fit, and joint incongruity) were used to quantify cartilage surface shape. Data were analyzed by using a linear mixed-model. Joint incongruity, i.e., the distance between the centers of the femoral and acetabular spheres, was slightly more than 2.5 times larger (p = 0.001) in LCPD hips than the contralateral normal hips. Cartilage shape deformity was 65% larger in hips with LCPD than in normal hips. Growth rates of the femoral head and the opposing acetabular surface showed that distortion of the femoral surface occurred first and the opposing acetabular surface followed. Mean radial difference (acetabular surface radius minus femoral surface radius) in LCPD hips was less than half (p < 0.01) the value of normal hips. Interobserver variability was approximately 10% of the value attributable to LCPD. This is the first known report presenting a technique that quantifies the three-dimensional size, deformity, growth, fit. and incongruity of the femoral and acetabular articulating cartilaginous surfaces of LCPD and contralateral normal hips. The data obtained support the use of this technique and provide pilot data for a future clinical study of LCPD. Objective assessment of cartilage shape enabled by this technique may aid future diagnoses, enable monitoring of three-dimensional femoral and acetabular remodeling, and permit quantitative assessment of treatment efficacy.