As a rule, radiographic changes in Perthe's disease are usually firmly established before symptoms develop although few changes are apparent in very early disease (1):
Waldenström has divided radiological stages which all children with Perthes disease pass through into initial, condensation, fragmentation, repair, and healing stages (1)
MRI can detect avascular areas before there is collapse. MRI is therefore indicated in cases of recurrent irritable hip (3).
Bone scans are useful in early disease when diagnosis can be prompted by demonstration of decreased uptake in the avascular phase and increased uptake in the healing phase.
Reference:
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