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PubMed1995

Radiographic loosening of cementless threaded acetabular cups. No additional diagnostic value of arthrography in 30 patients.

We compared arthrography with plain radiographs in 30 consecutive patients having a clinical diagnosis of loosening of a smooth-threaded acetabular prosthesis (Mecron, Berlin). Leakage of contrast at the interface between the ring and the bone on the medial side of the prosthesis was seen in 21 patients. Loosening of the cup was also visible on the plane radiographs and loosening was confirmed in all these patients at revision surgery. No false positive arthrographies were seen. In one patient, the arthrography was false negative because of a technical failure. We conclude that no additional information was obtained by arthrography.

Acetabulum↗
PubMed1999

Concordance between hip ultrasonography and hip arthrography in the assessment of developmental dysplasia of the hip.

Controversy exists regarding the possibility of predicting hip reducibility in the congenitally dislocated hip, with arthrography still regarded as the gold standard in this situation. This study aims at assessing the degree of concordance between ultrasonography and arthrography in the detection of anatomic elements obstructing hip reduction. Forty-nine hips were studied both by ultrasonography and arthrography. Three anatomic sources of obstruction to reduction were assessed in each hip: ligamentum teres hypertrophy, inverted labrum, and the presence of soft tissue in the acetabulum. For each variable, congruence between ultrasound and arthrography was measured by kappa analysis. Values > 0.40 expressed sufficient concordance, and they were detected with regard to inverted labrum and the presence of soft tissue in the acetabulum. The results of this study suggest that ultrasonography may be considered a reliable technique for the prediction of the main causes of obstruction in the congenitally dislocated hip, such as inverted labrum and soft tissue in the acetabulum.

Arthrography↗
PubMed2001

[Magnetic resonance arthrography of the hip joint in patients with suspected rupture of labrum acetabulare].

INTRODUCTION: MR arthrography by direct joint puncture and instillation of contrast medium is a minimally-invasive diagnostic technique in patients with suspected acetabular labral tear. The joint is distended, and the intraarticular structures are well separated. MATERIAL AND METHODS: 31 patients with chronic hip joint pain underwent MR arthrography by direct joint puncture and instillation of diluted gadolinium to evaluate the glenoid labrum. RESULTS: The glenoid labrum was seen in all patients. Labral tear was found in ten patients. Two of these underwent arthroscopy, and the tears were verified. We also found other causes of hip pain. One patient with villonodular synovitis at MR arthrography was verified at arthroscopy. INTERPRETATION: MR arthrography is a promising diagnostic technique for evaluating the acetabular labrum.

Acetabulum↗
PubMed2001

[Preoperative management of hip osteochondritis: comparison of MRI and arthrography with abduction views].

PURPOSE: Comparison between conventional arthrography and MRI in the preoperative work up of Legg-Calvé-Perthes disease. MATERIAL: ans methods. We studied 17 children (18 hips) who had arthrography and MRI (open-magnet configuration) the same day. Coronal and sagittal T1 weighted were realised with the hip in neutral position. Additional coronal T1 weighted with abduction of the hip were obtained. Two readers analysed individually MRI and arthrographic findings: shape of femoral head, index of Heyman (antero-external covering), came effect, recentering of femoral head and quality of examimation. RESULTS: No statistical difference between MRI and arthrography could be noted-exception made for the index of Heyman. CONCLUSION: MRI can replace arthrography in Legg-Calvé-Perthes disease.

Adolescent↗
PubMed1992

CT arthrography and arthroscopy in chronic glenohumeral joint instability.

The authors evaluate the value of CT arthrography in glenohumeral joint instability. A study was conducted on a group of 16 patients with recurrent dislocation of the shoulder. All patients underwent CT arthrography and arthroscopy. The diagnostic accuracy of CT arthrography was rated for different types of lesions on the basis of arthroscopic confirmation of its findings. Our results, which include a statistical analysis, showed a diagnostic accuracy of 97.3% in Bankart lesions and 100% in Hill-Sachs lesions and loose bodies. Dilation of the subscapular bursa and injury of the glenoid labrum-IGHL complex were often identified, while chondritis and synovitis were less frequently diagnosed. The authors therefore conclude that CT arthrography may be considered an extremely reliable diagnostic test for obtaining an overall picture of injuries due to instability. Arthroscopy, on the other hand, should be reserved for cases in which surgery may be performed in the same stage as diagnosis.

Adult↗
PubMed2003

[Temporomandibular joint disc displacement: diagnosis by arthrography with dental volumetric computerized tomography].

OBJECTIVE: Temporomandibular joint sideways and rotational disc displacement was assessed by arthrography with dental volumetric computerized tomography. METHODS: The study was conducted retrospectively on 119 joints of 109 patients (87 females, 22 males, mean age 31.1 years), who had undergone arthrography with dental volumetric CT in the sagittal and coronal planes. The disc displacements were subdivided into 5 types; condylar abnormalities were subdivided into 4 types. RESULTS: Complete anterior disc displacement was the commonest (70.6%) and medial the rarest (0.8%); anterolateral and anteromedial displacements were 18.5% and 10.1% respectively. The types of disc displacements were not correlated with bone lesions. A higher prevalences of bone lesions were found in the lateral poles of condyles. CONCLUSIONS: Arthrography using dental volume CT can be taken in the sagittal and coronal planes, so the sideways and rotational disc displacements, perforations and bone lesions can be evaluated. It's superior to conventional arthrography.

Adolescent↗
PubMed1991

Arthrography of the hand and wrist.

Arthrography of the wrist and hand is easy to perform, but accurate diagnosis requires meticulous technique and thorough knowledge of anatomy, pathology, and imaging principles. Wrist arthrography is usually performed to assess pain or instability after trauma; a complete examination usually requires injection of the RC, midcarpal, and distal radioulnar joints. Abnormalities that can be detected include interosseous ligament tears, capsular tears, triangular fibrocartilage perforations and separations, cartilaginous defects, loose bodies, and synovial abnormalities including adhesive capsulitis. Arthrography can also be useful in the evaluation of masses and scaphoid nonunion. Finger arthrography can demonstrate capsular injury, ligament tears, tendon derangement, volar plate disruption, cartilage abnormalities, fibrous ankylosis, synovial abnormalities, and ganglia. Tenography is seldom performed; this technique can delineate synovial abnormalities and can be used to evaluate tendon subluxation.

Arthrography↗
PubMed1989

[Diagnostic value of sonography and double contrast arthrography in meniscus lesions].

Using a real time scanner and a 7.5 mHz transducer, the meniscus can bei visualised as a homogeneous triangle. It is clearly distinguishable from the tibial plane und the condyle of the femur. Tears in the meniscus show up as a double contour rich in echoes with an intervening low-echo area, or as a contour rich in echoes with an adjacent low-echo area. The posterior horn area can be visualised most clearly. Assessment of the interior part of the meniscus is somewhat easier than visualising the exterior part. In a clinical study with 107 menisci examined by sonography and controlled by arthroscopy or arthrotomy the rate of accurate diagnoses by sonography of the meniscus is 82%. 42 of these menisci were additionally examined by double contrast arthrography besides sonography. This yielded an accuracy rate of 74% for double contrast arthrography; the latter is superior to sonography only in the anterior horn area. Problems in respect of meniscus sonography occur only in case of transverse ruptures, scars and longitudinal meniscus ruptures presenting as bucket handle tears near the base. The typical longitudinal tear in the area of the posterior horn can be visualised most clearly. Analysis of the results shows that sonography of the meniscus is a noninvasive, painless and randomly reproducible and risk-free examination method which has a diagnostic value especially in the area of the posterior horn that can be compared with double contrast arthrography. Further studies must show whether with an increasing spread of the method it would be possible to replace double contrast arthrography by sonography in diagnosis of menisceal trouble.

Adult↗
PubMed1986

[Rotator cuff ruptures of the shoulder joint. Sonography--arthrography].

47 patients suspected of rupture of the rotator cuff were sonographed and arthrographed. Rupture of the rotator cuff was diagnosed in 12 cases, both diagnostic methods yielding the same result. In 29 patients sonography and arthrography did not reveal any abnormal findings. Six ruptures evident in sonography were not confirmed by arthrography and were considered false positive. Direct pointers towards rupture of the cuff would be: echoless defects, cuff cannot be visualised fully or in part, irregularities of movement during dynamic examination. Echoless "cystic" areas in the periarticular soft parts must be considered an indirect pointer. Echorich focal findings in the echopoor cuff represent a differential diagnostic problem and we cannot give a final assessment as yet. Shoulder sonography is justified as a screening method in suspicion of rotator cuff rupture before initiating arthrography. If sonography reveals no abnormal findings, shoulder arthrography need not be performed.

Arthrography↗
PubMed1981

[The significance of arthrography and arthroscopy in the diagnosis of meniscus injury--a comparative study (author's transl)].

The article reports on 364 double-contrast arthrographics and 185 arthroscopies. The results obtained in 126 patients in whom both arthrography and arthroscopy had been conducted, were compared. It became evident that arthrography is of high informative value in the diagnosis of lesions of the meniscus, so that preference may well be given to this method in non-specific knee-joint complaints where meniscopathy is suspected. Arthroscopies are indicated in cases of clinico-arthrographic doubt. Trial arthrotomy for clarifying doubtful meniscus lesions without previous exploitation of all arthrographic/arthroscopic possibilities is no longer justified and should be abandoned. Arthroscopy is definitely superior to arthrography in the diagnosis of, in particular, cartilage structures, of the synovia and of the retropatellar space. It is here where arthrography has its narrow limitations--now and in the future--for methodical reasons.

Adolescent↗
PubMed1993

Radiographic anatomy and technique for arthrography of the cubital joint in clinically normal dogs.

A technique for arthrography of the cubital joint in clinically normal large-breed dogs was developed with the objective of improving visualization of the articular margin of the medial coronoid process. A lateral approach to the cubital joint for injection of contrast medium was selected. Arthrography of 24 cubital joints was performed by using 14 dogs. Twelve combinations of iodinated contrast medium, consisting of various concentrations (3) and volumes (4), were used. Two sets of arthrograms for each of the 12 combinations of contrast medium were obtained. Five radiographic views were used for each set. All arthrograms were examined by 3 evaluators, and each articular surface received a numerical rating for how well it could be seen in each view. Results of the evaluation indicated that low volumes of contrast medium were preferable to high volumes, with 2 ml providing the best visualization. Concentration of iodine seemed less important than did volume. The numerical ratings also indicated that the articular margin of the coronoid process was clearly observed a maximum of only 24% of the time on a slightly supinated mediolateral projection. The articular margins of the head of the radius, trochlea humeri, and trochlear notch were well visualized > 90% of the time. Arthrography of the cubital joint was technically easy to perform, and complications were not encountered, but arthrographic anatomy of the cubital joint is complex. Potential uses for arthrography of the cubital joint include diagnosis of osteochondrosis, intraarticular fragments, and joint capsule ruptures.

Animals↗
PubMed1996

[Arthrography of the wrist joint in acute trauma].

At least 20-25% of the patients with distal radius fractures show concomitant lesions of the intrinsic ligaments of the proximal carpal row and lesions of the triangular fibrocartilage complex. A high number of these lesions cause persistent pain and discomfort, even if there is a good radiological result. Wrist arthrography as a screening method can identify these lesions and help to select the patients in whom further diagnostic and therapeutic procedures (diagnostic arthroscopy, arthroscopical refixation of the discus or SL stabilization) should be performed. Wrist arthrography also allows cartilage lesions to be detected, as well as associated fractures or lesions of the capsular ligaments. The technique of wrist arthrography in the acute traumatized wrist, which is different from wrist arthrography in patients suffering from chronic post-traumatic pain, is described in this paper.

Arthrography↗
PubMed1998

[Significance of three-compartment digitalized arthrography in the diagnosis of post-traumatic instability of the radiocarpal complex].

INTRODUCTION: The radiocarpal complex is the structure formed by the distal radioulnar, radiocarpal and midcarpal joints; these joints are compartments, each anatomically separated from the other. An appropriate arthrographic study with three-compartment injection better demonstrates the capsuloligamentous structures than conventional radiography. The diagnosis of any condition in this complex may therefore be easier to make. MATERIAL AND METHODS: From January 1993 to December 1996, twenty-six patients with mild to moderate wrist and carpal sprain and previously examined with radiography, were submitted to digital three-compartment arthrography at the Imaging Diagnostic Service of the Rizzoli Orthopedic Institute. Of 17 patients with previous radiographic diagnosis of scapholunar diastasis, 1 patient had a negative radiographic picture, 15 had an incomplete tear of the scapholunar ligament and 1 a double injury of the scapholunar and triquetro-lunar ligaments. Of 10 patients with mild to moderate triquetro-lunar diastasis, 8 had and arthrographic picture of pyramido-lunar ligament injury, 1 had a double injury of the triquetro-lunar and scapholunar ligaments and another one of triangular fibrocartilage complex injury. RESULTS: Three-compartment contrast agent injection permitted the diagnosis of interruptions between the different compartments and more injuries of scapholunar and triquetro-lunar ligaments than single compartment injection. We examined 27 patients with small arch injuries with three-compartment digital arthrography and found scapholunar diastasis in 17 (63%) and triquetro-lunar diastasis in 10 (37%). In the first group of 17 patients, three-compartment arthography demonstrated more scapholunar ligament injuries (13 cases) than single compartment injection; image subtraction, allowed by the digital technique, showed 2 injuries not visible otherwise. Injuries of the scapholunar and triquetro-lunar ligaments were demonstrated with and without digital subtraction. One patient had no ligament injury. In the other group of 10 patients, three-compartment arthrography showed more triquetro-lunar ligament injuries (6 cases) than single compartment injection; image subtraction demonstrated 2 injuries not visible otherwise in this group too. Injuries of the scapholunar and triquetro-lunar ligaments were demonstrated with and without digital subtraction. The injury of triangular fibrocartilage and contrast agent leak into soft tissues were shown in one patient with the injection of the distal radioulnar compartment alone, regardless of image subtraction. CONCLUSIONS: Arthrography, combined with conventional static and dynamic radiography, increases the detection rate of capsuloligament joint defects in the wrist-carpal complex. The three-compartment digital technique combines the advantages of fluoroscopic monitoring and videorecording and allows real time imaging of the contrast agent flow during injection in different compartments. Moreover, the digital technique permits the complete study of all joints in a single session, while image subtraction reveals even minimal ligament changes. This technique becomes therefore a fundamental tool for surgical planning.

Adult↗
PubMed1996

Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty.

OBJECTIVE: The objective of this clinical study was to define the diagnostic value of plain radiography, digital subtraction arthrography and two-phase bone scintigraphy in patients with clinically loose or infected hip prostheses. DESIGN: Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. RESULTS: Digital subtraction arthrography was best (P < 0.001) for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs (P = 0.24) and scintigraphy (P = 0.27). Digital subtraction arthrography was also the most important modality for predicting a loose femoral component (P = 0.001), while the plain radiograph was of significant (P = 0.04) additional value and scintigraphy was of no additional value (P = 0.13) on multivariate analysis. CONCLUSION: Digital subtraction arthrography gives the best results in the prediction of loosening of acetabular and femoral components. Plain radiographs give additional information on loosening of the femoral component, but scintigraphy offers no additional advantage.

Adult↗
PubMed2001

Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation.

The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then examined with MR arthrography. This technique involved free-hand injection of contrast medium into the shoulder joint. At surgery 20 incomplete and 24 complete tears were observed. Ultrasound offered good results for the large tears, but its sensitivity decreased proportionally with the size of the tears. Magnetic resonance arthrography correctly diagnosed 43 tears, whereas only one false-negative diagnosis of tendinosis was made for a partial tear on the bursal side. Since it improves the diagnosis of small tears, MR arthrography must be performed on all patients for whom surgical repair is necessary in order to restore normal functions.

Adult↗
PubMed1998

Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging.

The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions.

Adolescent↗
PubMed1981

The value or arthrography in the management of internal derangements of the knee: the first 1000 are the worst.

The acceptance of arthrography of the knee as an accurate diagnostic procedure by both radiologists and orthopaedic surgeons in the United Kingdom has been slow compared to many other parts of the world. The value of arthrography in the diagnosis of meniscal lesions is discussed with reference to the first 1000 documented cases in the authors' series. It is considered that the results obtained from such early experience is more relevant to those about to start as an arthrographic service. Problems in clinical, arthrographic and arthroscopic diagnosis are discussed. Arthrography constitutes an accurate method of diagnosing such lesions and should be employed whenever clinical doubt about the diagnosis of an internal derangement of the knee is encountered. In a selected group of 137 patients, in whom both arthrography and arthroscopy was performed, the two investigations showed a comparable accuracy of 89.8 and 88.3% respectively.

Adolescent↗
PubMed1997

Indirect MR arthrography: techniques and applications.

Indirect MR arthrography is a simple noninvasive alternative to direct MR arthrography and can potentially alter the diagnostic work-up of several diseases. Based on current knowledge, these diseases include rotator cuff tears. glenoid labrum tears, recurrent tears of the menisci and classification of osteochondritis dissecans. The technique is recommended for inclusion in the MRI diagnostic array, and may obviate the need for invasive direct MR arthrography. The technique and applications of indirect MR arthrography are summarized in this article, based on our own experiences and that described in the current literature.

Adipose Tissue↗