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This article explores arthrography of the knee beginning with a brief historical perspective of conventional knee arthrography and culminating in direct and indirect MR arthrography of the knee. This article discusses the advantages of MR arthrography in the radiologic assessment of the postoperative meniscus, abnormalities of articular cartilage, and synovial-based processes.
Forty-nine patients with chronic wrist pain were examined by radiocarpal arthrography, followed by radiocarpal arthroscopy. One patient had bilateral involvement. None of these patients showed deformities or lesions on standard and dynamic radiographs. Not all patients who underwent arthrography underwent radiocarpal arthroscopy. Sensitivity of arthrography was 52%, specificity 50%, positive predictive value 92%, and negative predictive value 8% compared with arthroscopy. In this patient group, a very low negative predictive value was found: in 92% of the negative arthrographic examinations an arthroscopic lesion was found. Arthrography of the radiocarpal joint is a good examination for confirming a clinical suspected lesion, but is of limited value when negative.
BACKGROUND: The purpose of this study was to determine the efficacy of plain magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrography for detecting collateral ligamentous injury of the ankle joint. METHODS: Fifty patients (October 2001 to November 2003) suffering from ankle disability who underwent plain MRI and MR arthrographic studies were enrolled in this study. The diagnostic criteria for ligament disruption on plain MRI included nonvisualization, disruption, waviness of the ligament, or coexistent avulsion fracture. The MR arthrographic findings of ligament disruption were based on leakage of gadolinium contrast medium anterior to the anterior talofibular (ATaF) ligament following ATaF ligament disruption, and the contrast medium filling into the common peroneal tendon sheath after calcaneofibular (CF) ligament disruption. The 2 modalities were interpreted respectively and blindly. RESULTS: Seventeen patients received surgical intervention. There were 14 patients who had a torn ATaF ligament and 6 patients who suffered from CF ligament disruption proved by surgery. Limited detection of preoperative plain MRI survey, which showed 12 patients had torn ATaF and 2 patients had torn CF ligament, was noted. However, most patients with ligamentous injury were correctly diagnosed by MR arthrography preoperatively (only 1 case of CF injury was missed). The plain MRI alone had a higher incidence of false negative and false positive detection. MR arthrography was also valuable for evaluating the coexisting intra-articular pathologies of the ankle joint. CONCLUSION: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.
Arthrography of the second metatarsophalangeal joint is an important diagnostic tool to evaluate the integrity of the plantar plate and to aid in the decision process for surgical intervention. A variety of filling patterns have been identified with lesser metatarsophalangeal joint arthrography and their significance with soft-tissue pathology remains to be completely understood. The purpose of this cadaveric study was to evaluate dye patterns in a series of arthrograms of the second metatarsophalangeal joint and to correlate them with identifiable anatomic lesions or structural variants. Thirty-nine cadaveric specimens (including 28 matched pairs) underwent second metatarsophalangeal joint arthrography with a colored radiopaque dye. Arthrographic findings were observed and recorded. Specimens exhibiting dye extravasation outside of the capsular constraints of the joint were dissected to discover any soft-tissue abnormalities. Twenty-one percent of specimens exhibited abnormal extravasation of dye outside of the joint capsule. A plantar plate tear was identified in 2 of these specimens. Filling of the first intermetatarsophalangeal bursa occurred in 6 specimens. However, because this finding was identified in 2 matched pairs, an anatomic variance is suggested rather than a pathologic entity. This cadaveric study shows that anatomic variances exist concerning the second metatarsophalangeal capsule and that arthrography should be correlated with the clinical scenario.
PURPOSE: To evaluate the accuracy of arthrography, ultrasound and MR imaging in rotator cuff disease. METHODS: 40 patients suffering from subacromial impingement syndrome for at least three months and who were selected for surgery, underwent ultrasound, double-contrast arthrography and MR imaging. Patient preselection focused on partial and small complete tears. RESULTS: 13/26 surgically confirmed tears were partial tears (articular surface: 10, bursal surface: 2, intra-substance tearing: 1). Arthrography, ultrasound and MR imaging yield a sensitivity for complete tears of 91%, 69% and 92% with a specificity of 100%, 93% and 93%. For partial tears sensitivity was 50%, 69% and 69% with a specificity of 100%, 79% and 86%. Concerning evaluation of localisation, extent and correct classification ultrasound was correct in 17/26 cases, MR in 21/26 cases. CONCLUSION: Arthrography is not helpful in detecting partial tears. Ultrasound and MR imaging yield comparable accuracy. MR imaging has advantages concerning better evaluation of extent, location and classification as well as for the detection of associated pathologies.
PURPOSE: To present data on the MR imaging appearance of lumbar intraspinal juxtafacet cysts (JFC) and to assess the importance of additional CT arthrography. MATERIAL AND METHODS: Twenty-eight patients (16 women, 12 men) with a mean age of 64 years (range: 43 - 82), who underwent MR imaging because of radicular pain or spinal claudication, were found to have an intraspinal cyst associated with the facet joint. In 14 patients, additional CT-arthrography was performed to determine whether a communication exists between the cyst and the facet joint and to try to rupture the cyst. RESULTS: In T(2)-weighted images, juxtafacet cysts show a typical pattern consisting of a hyperintense center and hypointense rim. The center is likely to be inhomogeneous because of recurrent hemorrhage in the cyst. In T1-weighted images, the cysts are hypo/isointense. Irregular hyperintensity may indicate subacute hemorrhage, which may aggravate the clinical symptoms. MR allows superior visualization of the cyst in all anatomical planes. It also enables assessment of typical accompanying changes, such as degenerative spondylolisthesis and facet hypertrophy. All patients, who had CT-arthrography, were found to have a direct communication between joint space and cyst. Transarticular rupture of the cyst was possible in five patients. Two of these five patients had good to excellent improvement, and the remaining three patients underwent surgery. CONCLUSION: MR imaging is the method of choice for diagnosing lumbar intraspinal juxtafacet cysts. CT-arthrography of the facet joint is helpful in cases with difficult differential diagnosis, and in the preoperative planning. Furthermore, it assists in the primary interventional treatment.
PATIENTS AND METHODS: 31 patients with clinically diagnosed dysfunction of the temporomandibular joint (TMJ) were examined by magnetic resonance imaging (MRI; 1.5 Tesla, TR/TE 600/30) in closed and open mouth position and functional arthrography with digital image recording. RESULTS: Both methods agreed in the evaluation of the disc position. In 23 joints with displaced disc reposition was found in 11 cases and in 14 cases using MRI or arthrography, respectively. MRI proved to be superior in the diagnosis of sideways disc rotations. Joint hypermobility, eccentric disc displacement (n = 4) and perforation (n = 3) were shown by functional arthrography. Due to the good demonstration of osseous, muscular and discoligamentous structures, MRI as a noninvasive imaging modality is the method of choice for TMJ evaluation. Arthrography can be advantageous in complex functional disturbances or if MRI and clinical findings are inconclusive. The clinical diagnosis of disc displacement was found to be accurate in only 68% of the cases.
The results of plain film radiography and subtraction arthrography in 24 patients prior to revision surgery for a loosened total hip arthroplasty (T.H.A.) were compared with operative findings. Loosening of both the acetabular and the femoral components was evaluated. In plain film radiography the overall accuracy for evidence of loosening in 22 acetabular and 23 femoral components was 58%. The overall accuracy with arthrography was 93%. Three results were false-negatives; arthrography showing no evidence of loosening, while the arthroplasty was found to be loose on surgical evaluation. The results of this study are compared with findings reported in the literature. Arthrography was performed by a lateral puncture technique. There were no complications. The use of the puncture technique has not been described previously. The extent of contrast leakage into the interfaces is described and discussed.
Subtalar arthrography was done in 37 feet of 35 patients in whom recurrent instability of the ankle was diagnosed. There were 16 male and 19 female patients, with a mean age of 29.1 years (range, 11-56 years). The mean interval between the injury and arthrography was 4 years 3 months (range, 6 months-22 years). Anteroposterior, lateral, and oblique radiographs were obtained for all patients. Any leakage during arthrography into the ankle, tendon sheaths, or sinus tarsi was recorded. An oblique view of the microrecess along the interosseous ligament and an anteroposterior view of the lateral recess just under the end of the fibula were examined. At surgery, 13 feet had combined injuries of the anterior talofibular and calcaneofibular ligaments, and 24 feet had isolated injury of the anterior talofibular ligament. The findings of the two groups were significantly different when examined for leakage into the ankle, leakage into the peroneal tendon sheath, and the presence of the lateral recess. Presence of contrast medium in at least two of these three positive arthrographic findings showed 92.3% sensitivity and 87.5% specificity in making the diagnosis of calcaneofibular ligament injury. Subtalar arthrography is valuable in making the diagnosis of calcaneofibular ligament injury in recurrent instability of the ankle.
The value of arthrography in children's fractures is well established, but the accuracy of this technique has not been reported. We assessed the usefulness of arthrography by performing this test on a series of lateral humeral condyle fractures and, when possible, compared the arthrographic findings with the findings at operation to assess the accuracy of the test. Twenty-four consecutive patients were evaluated, and 13 patients underwent both arthrography and open reduction. We conclude that arthrography is a useful and accurate test when performed on children with lateral humeral condyle fractures and have provided guidelines for its use in managing this problem.
A total of 266 patients with injuries to the knee sustained during sports activities were managed by arthroscopy and/or arthrotomy. All of them received systemic examination and a standard battery of knee stability tests. Fifty-three were examined by arthrography and all underwent arthrotomy for surgical correction of the lesion diagnosed by both clinical examination and arthrography. Our study showed that clinical examination could give an accurate clinical diagnosis in 88.35% of cases and arthrography in 76.89%. No complication from arthrography was found. Injury occurred most commonly between 21 and 30 years of age and was more common to the right knee than the left. The sport in which most injuries occurred was football.
PURPOSE: To assess dual-detector spiral computed tomographic (CT) arthrography of the knee in the evaluation of anterior cruciate ligament (ACL) tears and associated meniscal lesions. MATERIALS AND METHODS: ACL and meniscal abnormalities in 125 consecutive patients who underwent dual-detector spiral CT arthrography of the knee were evaluated on the basis of both initial interpretations and retrospective review of CT images and were compared with arthroscopic findings. The sensitivity and specificity of CT arthrography for the detection of ACL tears and meniscal lesions in knees with abnormal ACLs were determined. RESULTS: The sensitivities and specificities for the detection of ACL tears were 90% and 96%, respectively, at initial interpretation and 95% and 99%, respectively, at retrospective interpretation. The sensitivities and specificities for the detection of meniscal tears in knees with abnormal ACLs were 92% and 88%, respectively, at initial interpretation and 96% and 94%, respectively, at retrospective interpretation. CONCLUSION: Dual-detector spiral CT arthrography of the knee is an accurate method for detecting ACL tears and associated meniscal lesions.
Shoulder arthrography is a reliable technique for use in the diagnosis of tears of the rotator cuff, although delineation of the precise site and size of tears requires meticulous double-contrast technique and considerable examiner expertise. The authors initiated a prospective evaluation of digital arthrography of the glenohumeral joint in 28 patients with clinical manifestations suggesting rotator cuff tear because they believed that examination with this technique would allow more accurate definition of the precise status of the cuff. Fifteen patients had normal studies. Ten complete and three partial rotator cuff tears were demonstrated with digital technique, and the precise site of the tear was demonstrated in all of these cases. The results indicate that digital arthrography of the glenohumeral joint may have some advantages over standard arthrography in the delineation of complete and partial tears of the rotator cuff, particularly in defining the exact site of tears.
This prospective study correlated the results of magnetic resonance (MR) imaging, arthrography, and arthroscopy in 27 patients with clinically suspected temporomandibular joint (TMJ) dysfunction. Open surgical confirmation was available in 12 TMJs. The variables assessed with each modality were disk position and morphology, disk perforation, joint adhesions, and degenerative joint disease. MR imaging was superior to dual joint arthrography with arthrotomography in delineation of the disk position. MR imaging accurately demonstrated the disk position in 11 joints (92%); arthrography was accurate in nine of the 12 joints (75%) with surgically confirmed dysfunction. Disk perforations and joint adhesions were not demonstrated with MR imaging. Arthroscopy was superior to arthrography and MR imaging in the detection of disk perforations, joint adhesions, and early degenerative changes along the articular eminence and glenoid fossa. The authors believe MR imaging should constitute the first line of imaging because it provides accurate information about disk position in a noninvasive manner. In most cases, information obtained with MR imaging is adequate in deciding whether to institute conservative or surgical management; in difficult cases, triple correlation may be needed.
The accuracy of T1-, proton-density-, and T2-weighted magnetic resonance (MR) imaging sequences and gadolinium-enhanced MR arthrography in evaluation of the triangular fibro-cartilage complex (TFCC) and the scapholunate (SL) and lunotriquetral (LT) ligaments was studied in 15 patients with chronic wrist pain. Arthrography and arthroscopy were used as standards of reference. Twelve patients also underwent imaging with short tau inversion recovery (STIR) sequences. MR imaging was more reliable in evaluation of the morphology of the TFCC and SL ligament than in that of the LT ligament. With arthrography as the standard, sensitivity was 0.721, specificity was 0.947, and accuracy was 0.887 for the TFCC; these values were 0.500, 0.864, and 0.765 for the SL ligament and 0.519, 0.455, and 0.490 for the LT ligament. No visualization of the SL ligament indicated a tear, but this sign was not helpful in evaluation of the LT ligament. Fluid in the distal radioulnar joint had a high association with TFCC tears. Accuracy with MR arthrography was higher than with the other sequences. STIR images were effective in evaluation of the TFCC. The combination of proton-density-and T2-weighted images appears to be useful because morphologic characteristics and the presence of fluid can be evaluated.
CT arthrography and arthroscopy were used to assess tears of the rotator cuff in 259 shoulders. Tear size was determined in the frontal and sagittal planes according to the classification of the French Arthroscopy Society. CT arthrography had a sensitivity of 99% and a specificity of 100% for the diagnosis of tears of supraspinatus. For infraspinatus these figures were 97.44% and 99.52%, respectively and, for subscapularis, 64.71% and 98.17%. For lesions of the long head of the biceps, the sensitivity was 45.76% and the specificity was 99.57%. Our study showed an excellent correlation between CT arthrography and arthroscopy when assessing the extent of a rotator cuff tear. CT arthrography should, therefore, be an indispensable part of pre-operative assessment. It allows determination of whether a tear is reparable (retraction of the tendon and fatty degeneration of the corresponding muscle) and whether this is possible by arthroscopy (degree of tendon retraction and extension to subscapularis).
OBJECTIVE: The purpose of our study was to determine the accuracy of two signs for superior labrum anterior to posterior (SLAP) tears: increased width of high signal between the superior labrum and glenoid, and high signal posterior to the biceps tendon. MATERIALS AND METHODS: Forty-one patients with SLAP tears and 40 patients without a tear at surgery who had undergone MRI or MR arthrography were retrospectively evaluated. The MR studies were combined and interpreted in a blinded manner. The reviewers measured the width of high signal that extended to the articular surface on oblique coronal images and determined whether the high signal extended posterior to the biceps. A Student's t test was used to determine statistical significance between the means of the signal width. RESULTS: High-signal width was greater in patients with a SLAP tear than in the control group on both MRI and MR arthrography (both p = 0.003). The sensitivity and specificity of at least 2.0 mm on MRI are 39% (11/28) and 89% (24/27) and at least 2.5 mm on MR arthrography are 46% (6/13) and 85% (11/13). The sensitivity and specificity of high signal posterior to the biceps are 54% (15/28) and 74% (20/27) on MRI and 69% (9/13) and 54% (7/13) on MR arthrography. CONCLUSION: Increased width of high signal has a moderate specificity but a poor positive predictive value for distinguishing a SLAP tear from a normal recess. In addition, labral signal posterior to the biceps tendon is not rare in patients with no SLAP tear.
Twenty-three patients underwent both conventional MR imaging of the shoulder and MR shoulder arthrography for clinically suspected labral or rotator cuff abnormalities. Images obtained before and after contrast administration were studied independently, and without knowledge of clinical findings, by two radiologists for the presence of abnormalities of the glenoid labrum or rotator cuff. Results were correlated with surgical findings in all patients. Nine patients had surgically proved labral tears. MR arthrography detected all nine labral abnormalities, while six of the nine were missed on conventional MR imaging. Fourteen patients had surgically proved rotator cuff tears. MR arthrography detected 11 of the 14 tears and missed three partial tears on the bursal surface. Conventional MR imaging detected nine cuff tears and missed five tears; two of these were complete rotator cuff tears and three were partial tears of the undersurface of the rotator cuff. Our results suggest that MR arthrography enhances the accuracy of MR in the evaluation of the glenoid labrum and rotator cuff tendon.