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PubMed1987

Potential contrast agents for MR arthrography: in vitro evaluation and practical observations.

In an attempt to identify an ideal contrast agent for MR arthrography, signal behavior as well as T1 and T2 values for articular cartilage, menisci, and ligaments were determined in knees from cadavers and normal volunteers. Comparison was made with similar data derived for intraarticular blood, varying concentrations of an albumin-saline solution (simulating synovial fluid) and Gd-DTPA, 0.9% saline, Renografin 60%, and air. Cadaveric specimens were imaged after intraarticular administration of each substance. A 500-microM volume of Gd-DTPA proved to be an ideal contrast agent for MR arthrography, exhibiting excellent contrast differences with articular structures on T1-weighted images. An albumin concentration of 12%, potentially occurring in severe inflammatory arthritis, also manifested adequate contrast to articular cartilage on T1-weighted images. Renografin and saline provided inadequate contrast on T1-weighted images, and saline necessitated the use of T2-weighted sequences. Air was not found to be an optimal contrast agent. Intraarticular blood exhibited insufficient contrast differences with articular cartilage during the acute hemorrhagic phase. Synovial fluid associated with severe arthritis as compared with fresh intraarticular hemorrhage may thus prove to be a better biological contrast agent for MR arthrography. Saline is currently recommended for use in arthrography, but Gd-DTPA offers significant advantages and should be safety-tested for potential clinical use.

Air↗
PubMed1999

The glenolabral articular disruption lesion: MR arthrography with arthroscopic correlation.

OBJECTIVE: The purpose of this study was to describe the MR arthrography appearance of the glenolabral articular disruption (GLAD) lesion. Proper diagnosis of this lesion is important because it can be a source of persistent shoulder pain that requires surgical repair and because it is often difficult to diagnose clinically. MATERIALS AND METHODS: Findings on MR arthrography were retrospectively correlated with the clinical histories and physical examination findings of six patients in whom we saw the typical appearance of the GLAD lesion. Four of these patients underwent follow-up arthroscopy that included surgical proof of GLAD lesions. RESULTS: Five of the six patients had a documented glenohumeral impaction injury associated with an abducted externally rotated shoulder. All six patients had persistent shoulder pain, but their shoulders were stable during routine examination. In all patients, MR arthrography showed a superficial tear of the anteroinferior labrum with an adjacent articular cartilage injury. The torn labrum remained firmly attached to the anterior scapular periosteum, and contrast material was seen to extend into the labral tear and cartilaginous defect. CONCLUSION: The MR arthrography findings of GLAD lesions include a nondisplaced tear of the anteroinferior labrum with an adjacent chondral injury. The pattern of chondral injury can range from a cartilaginous flap tear to a depressed osteochondral injury of the articular cartilage and underlying bone.

Adult↗
PubMed1999

Superior labral anteroposterior lesions: MR arthrography with arm traction.

OBJECTIVE: The purpose of this study was to investigate the efficacy of arm traction combined with MR arthrography in the evaluation of superior labral anteroposterior (SLAP) lesions. MATERIALS AND METHODS: Cadaveric shoulders were studied with a 1.5-T MR imaging unit with the arm externally rotated. Fifteen milliliters of a gadolinium-containing contrast agent were injected into the glenohumeral joint. Twenty-four sets of images of cadaveric joints were evaluated independently by two observers. These sets consisted of MR arthrographic images obtained with traction (applied to the wrist using 1- to 3-kg weights) and without traction in five shoulders in which SLAP lesions had been excluded arthroscopically or by cadaveric sectioning; and MR arthrographic images obtained with and without traction in seven shoulders in which various types of SLAP lesions had been created arthroscopically and later confirmed by cadaveric sectioning. RESULTS: Analysis of the data indicated that MR arthrography in combination with arm traction and external rotation improved diagnostic accuracy with regard to identification and categorization of SLAP lesions when compared with studies made without traction. CONCLUSION: The combination of MR arthrography and arm traction with the shoulder in external rotation provides a more effective approach for detection of SLAP lesions than does similar MR arthrography performed without arm traction.

Aged↗
PubMed2000

MR imaging and MR arthrography of paraglenoid labral cysts.

OBJECTIVE: We investigated the pathophysiology of paraglenoid labral cysts on the basis of MR imaging, MR arthrography, and cyst aspiration. MATERIALS AND METHODS: From 2211 MR imaging examinations, 51 (2.3%) cysts in 46 patients were identified. MR arthrography (n = 5), cystography (n = 1), arthroscopy (n = 17), percutaneous needle aspiration (n = 4), and medical records were also reviewed (n = 46). RESULTS: On MR imaging and arthrography, cysts were best viewed on T2-weighted images. Mean cyst diameter and volume were 2.2 cm and 2.8 cm3, respectively. Fifty-seven percent of cysts were located adjacent to the posterior labrum. On MR imaging and arthroscopy, a labral tear was identified in 27 (53%) and 15 (88%) patients, respectively. Eight cysts that caused compression neuropathy were large (mean size, 3.1 cm; p = 0.04) and located next to the posterior or inferior labrum. In four of five patients, MR arthrograms showed no intraarticular contrast material in the cyst. Cystograms showed no communication with the glenohumeral joint space, and cyst aspiration resulted in temporary symptom relief; however, cysts recurred in three of four patients. CONCLUSION: Most paralabral cysts are associated with labral tears. Paralabral cysts may be difficult to identify on MR arthrography unless a T2-weighted sequence is performed. Direct communication between a cyst and joint space rarely occurs. A posterior or inferior cyst may cause compression neuropathy of the suprascapular or axillary nerve, respectively. Cyst aspiration may result in temporary relief of symptoms, but an untreated labral tear should be suspected if cysts recur.

Adult↗
PubMed2004

Sublabral sulcus at the posteroinferior acetabulum: a potential pitfall in MR arthrography diagnosis of acetabular labral tears.

OBJECTIVE: Our study correlated findings on hip MRI and MR arthrography with hip arthroscopy to assess the location, prevalence, and potential pitfall of a normal acetabular sublabral sulcus. MATERIALS AND METHODS: We retrospectively collected 58 hip MRI studies along with surgical reports in 58 patients who underwent hip arthroscopy over a 5-year period. Intraoperative photography (n = 23), radiography (n = 56), unenhanced MRI (n = 13), and MR arthrography (n = 54) studies were available for review. Two radiologists described hip anatomy on radiology studies with agreement by consensus. RESULTS: A normal posteroinferior sublabral groove was confirmed on available arthroscopy photographs in four (17.4%) of 23 hips. In each of these four patients, the anatomic sublabral groove correlated with apparent partial labral detachment on MR arthrography. On review of all studies, 13 hips (22.4%) without a posterior labral tear at surgery had imaging findings of a sublabral sulcus. The sulcus was not associated with acetabular dysplasia, which was radiographically noted in 12 cases (21.4%). Preoperatively, the sulcus was misdiagnosed as a tear in two cases. Labral tears were anterior or anterosuperior in 51 patients. CONCLUSION: A posteroinferior sublabral groove is a relatively common normal anatomic hip variation. If not recognized as normal, the sulcus may serve as a diagnostic pitfall on MR arthrography. Its location is distinct from most labral tears. We did not discover a sublabral sulcus at the anterior or anterosuperior acetabulum, the most common sites of labral injury.

Acetabulum↗
PubMed1999

[A Comparative Study of MRI and CT Double-Contrast Arthrography in Diagnosis of Disc Adhesion of TMJ]

OBJECTIVE:To compare the results of CT-assisted double-contrast arthrography and MRI in the diagnosis of adhesion of TMJ. MATERIAL:18 patients with adhesion of TMJ were examined by CT-assisted double-contrast arthrography and MRI, and their results were analysed including position, degree and with or without osseous changes. RESULTS:18 cases of adhesion were demonstrated on CT-assisted double-contrast arthrography, and that only 6 cases of them were diagnosed on MRI.CONCLUSION: CT-assisted double-contrast arthrography is more sensitive and accurate than MRI in demonstrating the disk adhesion of TMJ.

Journal Article↗
PubMed1991

[MRI and arthrography in the evaluation of TMJ disorders].

Arthrosis of the temporomandibular joint (TMJ) is a noninfectious, noninflammatory condition characterized by joint pain, noise (clicking) and abnormal motion. It contains various disease processes, such as abnormalities in the menisci or masticating muscles, subluxation of the condyle and degenerative joint disease. Analysis of the morphology and dynamics of TMJ by means of imaging modalities has become highly advanced since the development of arthrography in the late 1970s. Magnetic resonance imaging (MRI) has become the modality of choice in the evaluation of TMJ owing to the development of surface coils. We retrospectively studied MRI and inferior joint compartment arthrography in the evaluation of TMJ disorders. Nineteen joints of 14 patients included 15 with internal derangement, two with osteoarthrosis and two normal joints. Sagittal MR images were routinely obtained in a resting position and in positions with the mouth half open, and also with the mouth fully open on balanced images. Although perforation of the menisci was difficult to evaluate, MRI and arthrography were equally useful in identifying the shape and position of the meniscus. However, MRI was more reliable in depicting TMJ abnormalities than arthrography. MR is considered to be the modality of choice in screening arthrosis of TMJ, making the definitive diagnosis of internal derangement and monitoring conservative therapy for arthrosis.

Adult↗
PubMed1990

[Clinical uses of digital subtraction arthrography of the temporomandibular joint].

In the present study, digital subtraction arthrography of TMJ upper cavity was performed in 20 cases with TMJ dysfunction syndrome. It was found that digital subtraction arthrography of TMJ can eliminate various overlapping imaging interference of skull components and has great diagnostic value for TMJ dysfunction syndrome, especially for the diagnosis of small meniscus perforation and the location of meniscus perforation. If this technique can be combined with dynamic observation of TMJ arthrography, the diagnoses for various displacement of meniscus can be made more exactly. However, it is impossible to carry out dynamic observation for TMJ when we use this technique only. This is its disadvantage. Therefore, the best way is to combine arthrographic dynamic observation or arthrographic fluoroscopic observation with digital subtraction arthrography.

Adult↗
PubMed1979

[Arthrography of the wrist: procedures and normal results (author's transl)].

The results of 31 opaque arthrographies of the wrist carried out under two different circumstances are reported. --In a first group the investigation was made immediately after or within a longer period following injury to the wrist or forearm. The results supply information to the surgeon on the condition of the triangular ligament in dislocation and partial dislocations of the inferior radioulnar joint, caused by an architectural fault in the radius after trauma (fracture of the head, diaphysis, or lower extremity). Simple reduction of the radius, without intervention on the inferior radio-ulnar joint, provides an excellent functional result when the triangular ligament is simply stretched. When it is torn (sprains, dislocation locally or at a distance) results are not very convincing in spite of the many possible procedures available. Arthrography easily reveals the presence of a reflex dystrophy complicating the injury. Both the radiological and clinical signs give characteristic pictures of the condition. --This examination is still only used infrequently for the diagnosis of chronic inflammatory rheumatic diseases. The arthrographic images appear very early, however, and are characteristic of an inflammatory synovial lesion. Examinations were carried out mainly for evaluation before therapy, surgical in the case of a synovectomy, medical for a chemical or isotopic synovial treatment. Arthrography in a acutely inflammed joint is followed by an injection of corticoid, sometimes associated with a local antibiotic. This rapidly relieves the patient and prevents worsening of the acute inflammatory process. Arthrography of the wrist is a simple, painless, rapidly performed examination. There has never been a failure, any incident, or accident. It appears to be the only direct exploratory procedure for this joint. A precise anatomical evaluation can be made from the image which gives a true picture of the different anatomical structures.

Adrenal Cortex Hormones↗
PubMed1979

Correlations of arthrography with arthroscopy.

Arthrography and arthroscopy were compared on a prospective basis in 100 consecutive and unselected knees, all in patients who underwent arthrography, arthroscopy, and surgery. Arthroscopy was found to be more accurate than arthrography in the diagnosis of medial and lateral meniscus and anterior cruciate ligament lesions. Because of its easy availability and relatively low cost, arthrography continues to be a useful extension of the physical examination of the knee, serving as a further diagnostic screening technique. However, arthroscopy is recommended in all patients prior to surgery because it provides more complete and more accurate delineation of intra-articular lesions.

Cartilage, Articular↗
PubMed1979

Arthrography of the hip in the diagnosis of postoperative painful conditions after total hip replacement.

Arthrography of the artificial hip joint was performed postoperatively in 29 patients with pain after total hip replacement. In 23 cases the arthrographic findings were checked by operation and corresponded in 91%. In two arthrographies which did not give reliable results sinuses outside the thigh or a large pseudocapsule prevented a satisfactory performance of the arthrography. The unoperated patients had only mild discomfort or were considered a high risk for reoperation; they were treated with physiotherapy and medication. As a result of this investigation arthrography can be regarded as a highly reliable method of diagnosing the various causes of pains in the hip after total hip replacement.

Hip Joint↗
PubMed1984

The significance of preoperative shoulder arthrography in painful arc patients.

Preoperative shoulder arthrography was performed on 34 patients with painful arc syndromes. Rotator cuff rupture was diagnosed in 20 cases. Out of these the arthrography correctly showed rupture in 17 cases, while in one case rupture was not seen and two examinations were unsuccessful. Rotator cuff rupture was not found in 14 cases at operation. Of these, arthrography had been negative in eight cases and in six cases the rupture had merely been suspected. Sensitivity of shoulder arthrography in showing rotator cuff rupture was thus 85%, specificity 57% and accuracy 74%. The biceps tendon was intact in all cases with rotator cuff rupture. So-called "bicipital leakage" was seen in four cases, but its significance remains unclear.

Adult↗
PubMed1984

Single and double contrast arthrography in lesions of the glenohumeral joint.

One hundred and forty-five arthrograms from single and double contrast arthrography were compared with respect to their accuracy in revealing lesions of the glenohumeral joint. Total and partial rotator cuff tears were accurately delineated by both single and double contrast arthrography. The size of the tear did not correlate with surgical findings with either technique. The volume of the injected contrast medium was larger in full-thickness rotator cuff tears than in normal arthrograms (p less than 0.001; t test). As expected, this volume was not correlated with the size of the tear. Dislocation of the biceps tendon was well imaged if the biceps sheath was filled with contrast medium. The sheath became filled less frequently in total rotator cuff tears than in cases with an intact cuff (p less than 0.001; X2 test). No difference in filling frequency of the sheath could be observed between single and double contrast arthrography. This study did not reveal any major advantages of double contrast arthrography over single contrast examinations in lesions of the rotator cuff and those of the tendon of the long head of the biceps brachii.

Adult↗
PubMed1984

Arthrography in the investigation of persistent pain after meniscectomy.

The authors report 62 patients in whom arthrography of the knee had been performed because of persistent pain after menisectomy. In about 60% of the cases the interval between operation and arthrography was less than 18 months. The causes of residual pain identified by arthrography were divided into meniscal and extra meniscal. The most frequent findings were remnants of pathological meniscal tissue; lesions of the anterior cruciate ligament; synovial and chondral pathology. Thirty patients were checked by arthroscopy and were subjected to further operation. In 80% of these cases the arthrographic findings corresponded exactly with the operative findings. The writers confirm that arthrography is still a valid method of investigation in patients affected by persisting pain after meniscectomy.

Adolescent↗
PubMed1981

Shoulder arthrography.

Arthrography of the glenohumeral joint is an important diagnostic tool. The procedure is easy to perform and can be accomplished without significant complications in most individuals. If care is exercised in performing the arthrogram, inadvertent injection of the subacromial (subdeltoid) bursa and soft tissue extravasation of contrast material can be avoided. Mild patient discomfort following the procedure may be diminished if small amounts of xylocaine are added to the injection material. Double-contrast or single-contrast examination can be utilized, depending upon the nature of the suspected underlying process. Arthrography of the glenohumeral joint is most useful in delineating the presence of a complete tear of the rotator cuff. It is also valuable in investigating patients with partial (inner) tears of the cuff, adhesive capsulitis, previous anterior dislocations of the joint, and articular diseases. The procedure can define subtle abnormalities of the bicipital tendon and sheath, and can demonstrate the nature of periarticular soft tissue masses. Although it is expected that additional procedures, such as subacromial bursography and arthrography of the acromioclavicular joint will be advocated in the years to come, arthrography of the glenohumeral joint will remain the most important contrast examination of the abnormal shoulder.

Acromioclavicular Joint↗
PubMed1981

Ankle arthrography.

Ankle arthrography allows radiologists to assess accurately the degree of damage caused by ankle sprains. Ankle sprains are a significant problem to a large number of people, particularly those who participate in sports. Proper care of these ankle injuries requires the combined expertise of many disciplines. Radiologists should be aware of the significance of these lesions and utilize all modalities, including plain films, stress films, and ankle arthrograms, when indicated, to obtain the exact pathologic diagnosis of severe sprains. The primary role of arthrography is to separate those patients who have moderate or severe sprains that may require surgery from those who will respond to more conservative therapy. Many orthopedists believe that combined lateral ligament tears, or any tear involving the deltoid ligament and perhaps the interosseous ligament, may require surgery. At the other end of the spectrum of ankle sprains, occasionally, one may not be able to distinguish between a very slight sprain and a more severe sprain with rupture of the ankle ligament. This is an important distinction, particularly in young athletes who would like to continue to play a competitive sport despite their injury. Utilizing arthrography, the orthopedic surgeon can suggest a more accurate prognosis as to whether the patient might be able to participate with proper taping. Obviously, if the patient has ruptured a ligament, it is not in the best interest of the patient to participate in a competitive sport without allowing a proper interval for healing. I heartily recommend arthrography of the ankle to any radiologist who is not yet utilizing this procedure. I believe that it can add significantly to the care of those patients who sustain ankle sprains.

Ankle Injuries↗
PubMed1997

Imaging of articular pathology: MRI, CT, arthrography.

The purpose of this review article is to present the advantages and limitations of magnetic resonance imaging (MRI), computed tomography (CT) and arthrography for evaluating articular pathology. Techniques, patient selection, indications and contraindications for each modality are reviewed. MRI provides superior soft tissue contrast and image plane selection, making it the ideal technique for most articular abnormalities. However, obese patients and patients with certain electrical or metallic implants cannot be examined with MRI. CT provides superior detail for fine cortical bone and subtle calcifications, but lacks the soft tissue contrast provided by MRI. Arthrography is an invasive technique with minimal risk of allergy to contrast material or infection. This technique permits accurate measurement of capsular volume, allows for fluid aspiration for laboratory studies and permits injection of anesthetic and/or steroid compounds for purposes of treatment or confirming the site of the patient's pain. Magnetic resonance imaging, computed tomography and arthrography are useful techniques for evaluating articular pathology. Careful review of the clinical symptoms and patient's condition is necessary to select the most appropriate technique.

Arthrography↗
PubMed1992

Shoulder impingement syndrome: impingement view and arthrography study based on 100 cases.

A prospective evaluation combining the shoulder impingement view and arthrography was made in patients presenting with chronic shoulder pain. Five hundred and twenty-three patients with chronic shoulder pain were X-rayed using conventional views and impingement views. One hundred of these patients (mean age 62 years) had subacromial bony spurs on the impingement view; these underwent arthrography. They were divided into two groups according to the degree of spur formation--whether or not the size of the spur exceeded one half of the acromial width as measured from the outer margin to the acromioclavicular joint. Of the 100 subacromial spurs demonstrated on the impingement view, only 18 were visible on the conventional view as assessed by an independent radiologist. Arthrography showed 35 cases of rotator cuff tear. The size of the bony spur was strongly associated with the incidence of rotator cuff tear (P < 0.02).

Acromion↗