Diagnostic Performance of Diffusion-Weighted Imaging (Dwi) in Legg-Calve-Perthes Disease: A Systematic Review and Meta-Analysis Publisher Pubmed



Mohebbi S ; Mohebbi A ; Mohammadzadeh S ; Mohammadi A ; Nabian MH
Source: Radiography Published:2026

Abstract

Introduction: Legg-Calve-Perthes disease (LCPD) is idiopathic avascular necrosis of the femoral head in children. Early diagnosis is essential to optimize management, improve long-term outcomes, and reduce surgical interventions. This study aimed to evaluate the role of diffusion-weighted imaging of the femoral epiphysis and metaphysis in detection of LCPD. Methods: The protocol was pre-registered at (https://osf.io/k8xt4/). Using PubMed, Embase, Web of Science, Cochrane Library, and MedRxiv, we found studies available until October 3, 2024. The apparent diffusion coefficient (ADC) values were compared between the normal and pathological femoral epiphysis and metaphysis. We also evaluated a new measurement index for the ADC ratio of the pathological to normal side. Results: Six studies comprising 150 patients and 374 epiphyseal ADC measurements were included. Pooled analysis demonstrated that pathological femoral epiphysis exhibited a mean ADC increase of 0.59 × 10−3 mm2/s compared to normal epiphysis (95 % CI: 0.34 to 0.84, p < 0.001, I2 = 97.1 %). Also, ADC ratio analysis showed a 2.32-fold increase (95 % CI: 1.98 to 2.66, p < 0.001, I2 = 88.8 %). Five studies with 123 patients and 282 metaphyseal ADC measurements revealed a mean difference of 0.34 × 10−3 mm2/s (95 % CI: 0.25 to 0.44, p < 0.001, I2 = 74.1 %), and a 1.76-fold ADC ratio increase (95 % CI: 1.49 to 2.03, p < 0.001, I2 = 91.5 %). Conclusion: As a non-radiating, non-invasive, and time-saving imaging technique, DWI has the potential to assess and differentiate LCPD from normal femur. It provides quantitative data that can be used in complement to the conventional MRI techniques to enhance diagnostic accuracy. Implication for practice: Through a systematic review of the literature on DWI imaging in LCPD, this study enhances evidence-based clinical decision-making. © 2025 The College of Radiographers