Objective <p>To investigate femoral head epiphysis perfusion via dynamic contrast-enhanced MRI (DCE-MRI) in children with developmental dysplasia of the hip (DDH) after closed reduction, assessing correlations between perfusion parameters and enhancement grades, and their utility in identifying post-reduction ischemia.</p> Materials and methods <p>Children with DDH undergoing closed reduction and plaster fixation were evaluated with MRI (conventional sequences, T1 mapping, and DCE-MRI) within 3&#xa0;days post-procedure. Femoral head perfusion was evaluated using DCE-MRI subtraction, graded as 0 (normal), 1 (asymmetric decrease), 2 (focal decrease), or 3 (complete decrease). Perfusion parameters (K^trans, K_ep, V_e) were quantified in the epiphyseal ROI. The correlation with perfusion grades and diagnostic value for ischemia was analyzed.</p> Results <p>The study included 58 DDH patients (116 hips; 68 dislocated, 48 normal). Among the dislocated side of DDH, although a marginal age difference was observed among the groups (<i>P</i> = 0.053), no significant differences were found in sex distribution or Tönnis grade (<i>P</i> &gt; 0.05). Significant perfusion parameter differences were observed across enhancement grades (all <i>P</i> &lt; 0.05), with K^trans showing greatest discrimination (H = 89.769). K^trans and K_ep correlated negatively with enhancement grade (<i>r</i> = −0.883 and −0.608, respectively; both <i>P</i> &lt; 0.001). For ischemia detection (grade ≥ 2), K^trans demonstrated superior diagnostic accuracy (AUC = 0.959, cutoff = 0.028&#xa0;min⁻¹) versus K_ep (AUC = 0.811) and V_e (AUC = 0.628). Performance further improved for grade 3 ischemia (K^trans AUC = 0.992, cutoff = 0.010&#xa0;min⁻¹).</p> Conclusion <p>K^trans &lt; 0.010&#xa0;min⁻¹ on DCE-MRI signals post-reduction ischemia in dislocated femoral heads, inversely correlating with enhancement grade. This threshold may help identify high-risk patients requiring close monitoring or intervention.</p>