Modern Imaging Methods for the Diagnosis of Legg–Calvé–Perthes Disease in Children: A Comparative Evaluation of the Diagnostic Capabilities of Radiography and Magnetic Resonance Imaging in Early Detection

Abstract

Background. Legg–Calvé–Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head in children. Its estimated incidence is approximately 1 case per 10,000 children, accounting for 0.25–0.5% of all pediatric orthopedic disorders [1, 2]. The disease most commonly affects children between 4 and 8 years of age, although it may occur between the ages of 2 and 15 years. It is significantly more common in boys than in girls, with a male-to-female ratio of approximately 4–5:1 [1, 2].Despite its relatively low incidence, delayed diagnosis and the absence of appropriate treatment may result in severe complications, including progressive deformity of the hip joint, functional impairment of the affected limb, and long-term disability. Therefore, early detection of the disease using modern imaging techniques, particularly radiography and magnetic resonance imaging (MRI), is of paramount importance for selecting the optimal treatment strategy and improving clinical outcomes.

Objective. To comparatively evaluate the diagnostic capabilities of radiography and magnetic resonance imaging (MRI) in the early diagnosis of Legg–Calvé–Perthes disease in children.

Objectives of the Study:

1. To review the fundamental principles of imaging diagnosis of Legg–Calvé–Perthes disease.
2. To analyze the diagnostic value of radiography for detecting Legg–Calvé–Perthes disease at different stages of the disease.
3. To investigate the role of magnetic resonance imaging in the early diagnosis of Legg–Calvé–Perthes disease and in assessing the extent of femoral head involvement.
4. To compare the diagnostic performance of radiography and magnetic resonance imaging in the early detection of Legg–Calvé–Perthes disease.
5. To identify the advantages and limitations of each imaging modality and to formulate recommendations for their rational use in clinical practice.

Materials and Methods

A comprehensive analysis, systematization, and synthesis of data from national and international scientific literature on contemporary imaging modalities for the diagnosis of Legg–Calvé–Perthes disease in children were performed. A comparative evaluation of the diagnostic capabilities of radiography and magnetic resonance imaging (MRI) for the early detection of the disease was conducted, together with an analysis of their respective advantages, limitations, and clinical significance.

Results

Radiography remains the primary diagnostic imaging modality due to its wide availability, low cost, and suitability for dynamic follow-up assessment. However, the sensitivity of radiography in the early stages of the disease is limited because pronounced structural changes are often absent.

Magnetic resonance imaging (MRI) enables the detection of early ischemic changes in the bone marrow, bone marrow edema, and impaired vascular supply of the femoral head before the appearance of radiographic signs of the disease. This significantly improves the effectiveness of early diagnosis.

Conclusion

The most rational approach is a comprehensive diagnostic strategy in which radiography is used as the first-line imaging modality, while magnetic resonance imaging (MRI) is performed in cases of persistent clinical suspicion of Legg–Calvé–Perthes disease despite the absence of radiographic abnormalities.