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1998; 38: 339- 344 Legg-Calve-Perthes : Catterall · · · · · : Legg-Calve-Perthes (LCP) MRI Catterall : LCP Ca- tterall Grade 1 , Grade II , Grade m , Grade 1mm MRI Catterall 4 Catterall : Catterall Catterall : Catterall (1 , 2). (Staging) , 4 MRI l Catterall LCP 28 : Frog leg 1.5-tesla 63SP(Siemens , Erlangen, T1 m

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1998; 38: 339- 344
Legg-Calve-Perthes : Catterall MRI 1
· · · · .2. ·
: Legg-Calve-Perthes (LCP) MRI

Catterall MRI
.
: 1995 2 1996 8 LCP 41
(collapse) 27 28 . Ca­
tterall
0-25% Grade 1 , 25%-50% Grade II , 50%-75% Grade m, 75%-100%
Grade N . MRI 1mm

. MRI Catterall 4 Grade
. Catterall MRI
.
: Catterall MRI
28 24 (85.7% ) . Catterall
MRI 18 (64.3%)
6 (21.4%).
: Catterall MRI
.
3 MRI
.
(1 , 2). LCP
(Staging) , Catterall
(3).
Catterall
.

3 MRI
MRI
l 2 1997 9 1 8 1997 11 1 2
3
Catterall
.

. 28 .
5 16( 9) 21 : 6.
Frog leg
MRI . 1.5-tesla 63SP(Siemens,
Erlangen, Germany) T1
(TR/TE=400 !1 7msec) T2 -(TR/TE=
m
ι
= 3400 / 9Omsec) T1(TR/TE
=400 / 17msec) , (TR / TE=34/2nsec)
T2(TR / TE = 3400 / 9Omsec) . Body coil
FOV 280-32Omm,
3mm 0.3-0.4mm
3-4mm .



Frog leg
Catterall (Fig.
1). Catter all 25%
Grade 1 , 25%-50% Grade II , 50%-
75% grade m 75% grade N (1).
MRI (epiphysis)

T1, T2
. 3 T1
1mm
.

25% Grade 1 , 25%-50%
Grade II , 50%-75% grade m, 75% grade N
(1) .

.
Fig. 1. The measurement of extent of necrotic portion in frog leg view.
Extent of necrotic portion=
28
24 (85.7%) Grade 4
(14.3%) Grade (Table 1)
(Fig. 2).
18 (64.3%)(Fig.
3). 18 7 (25%) Grade m Grade II
Grade N m 6 (21.4%) , Grade
W I 2 (7.1%) Grade N n
Grade m I ~ Grade II I 1
(3.6%) .
6 (21.4%)(Fig.
4). 6 Grade m Grade N 5 (17.
9%) Grade 1 R 1 (3.6%).

3-5 10%
. LCP


(2 3) . LCP


.
rall

(1)
. Catterall I
7 Catterall n
.

Ta ble 1. Comparison of Catterall Classification with Vol­ ume Measurement method in Evaluation of Necrotic Portion in LCP Patients.
Catterall
IV 0 0 5
A B
Fig. 2. A 7-year old boy with LCP disease with an identical grade of conventional radiography and MR. A. Conventional radiography shows a crescent line in the right femoral head, which appears as grade II in Catterall classification . B. Tl-weighted coronal image shows a low signal intensity lesion in the femoral head, and the grade was also disclosed as grade II by MR volume measurement method II
A
c
. Catterall
m N 8 n
8
Fig. 3. A lO-year-old male with LCP disease, the grade of which was overestimated with radiography. A. Radiograph shows collapse and increased density in left femoral head, which was considered as Catterall classifi­ cation grades III. B, C. Tl-weighted coronal image demonstrates the low sig­ nal intensity lesion, being considered as necrotic portion, at central portion of left femoral head(B). However, a cor onal image next to Fig. 2B does not show signal alteration any more. MR volume measurement method indicated grade II.
(2 3) .
MRI

.
Tl T2
- 341 -
I : Legg-Calve-Perthes
A B Fig. 4. A lO-year-old male with LCP disease, the grade of which was underestimated with plain radiography compared to MRI. A. Frog-Ieg radiographic view shows increased density in the collapsed epiphysis of the left femoral head, which was considered as grade III in Catterall classification. B. Tl-weighted coronal image shows decreased signal intensity in the entire epiphysis of the femoral head , thus it was thought to be grade IV.
Tl
T2
Tl T2
Tl T2
(6 11).
LCP
.

.
Koo Tl

(4). Hoch­
berg
30 MRI

MRI
(6). Eyre-Brook (base­
line) 90 epiphyseal index
(8).


.
.
3 MRI

Catterall .
Catterall 85.7%
MRI
. Ca­
tterall MRI
.
MRI
3 MRI 2
. 3
MRI .


Catterall MRI
. MRI


.
3
.

.
MRI
MRI .
Tl, T2

.

MRI 3
Catterall
MRI
.

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J Korean Radiol Soc 1998;38:339-344
Measurement of Necrotic Portion in Legg-Calve-Perthes Disease :
Comparison of MRI Volume Measurement Method and Catterall Classification1
Jae Dong Chung, M.D. , Jae Boem Na, M.D. , Hee Young Jung, M.D. , Il Soon Park M.D. Hae Ryong Song, M.D. 2, Jin Jong Yoo, M.D . .f Sung Hoon Chung, M.D.
1 Department of Diagnostic Radiology, Gyeongsang National Universit)ι College of Medicine
2Department of Orthopedics, Gyeongsang National University, College of Medicine
Purpose: The purpose of this study was to evaluate the extent of necrosis of the femoral head in Legg-Calve-Perthes (LCP) disease. This involved the use of MR1, followed by volume measurement and the use of the Catterall classification system; the difference between the grade obtained using each of these approaches was then determined.
Materials and Methods: We retrospectively reviewed 28 hip-joint MR images on which a diag­ nosis of LCP disease had been based. According to the necrotic portion of femoral head, and on the basis of the catterall classification, LCP was graded 1 to 4, as follows: Grade 1=O~ (25%; II=25~ (50%;III=50~(75%;1V=75-100%. Using a transparent paper on which 1mm squares had been drawn, the necrotic area of each MR image was measured; the following equation was then used to calculate the volume of the necrotic portion: volume=necrotic area x slice thickness. On the basis of this measurement, each femoral head was graded and the results were compared with those obtained using the Catterall classification.
Results: 1n 24 joints(85.7%), grades according to the Catterall classification and MR1 volume measurement were not the same. As compared with the volume measurement method, use of the Catterall classification led to grade overestimation in 18 joints (64.3%) and underestimation in six (21 .4 %)
Conclusion: The grade according to the Catterall classification was different from that obtained using the volume measurement method. This study thus indicates the need for a new system of classifying LCP disease based on the volume measurement method and using MR imaging.
Index words: Femur, necrosis Children, skeletal system Hip, MRI Hip, necrosis
Address reprint requests to : Jae Boem Na, M.D., Department of Diagnostic Radiology, Gyeongsang National University Hospital # 90 Chil-Dong Chinju, 660-702, Korea . Tel. 0591-50-8212 Fax. 0591-758-1568
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