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PubMed2006

MR-imaging of anterior tibiotalar impingement syndrome: agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography.

OBJECTIVE: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. MATERIALS AND METHODS: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. RESULTS: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). CONCLUSION: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.

Adolescent↗
PubMed2005

MR arthrography of the knee: how, why, when.

MR arthrography combines the techniques of arthrography with MR imaging to benefit from the added imaging information afforded by intra-articular distention. This article reviews technical considerations for MR arthrography, potential complications, indications, pitfalls in imaging diagnosis, and commonly encountered pathology. It is an elegant study that can offer precise diagnostic information in the appropriate clinical setting.

Anterior Cruciate Ligament↗
PubMed2005

Wrist MR arthrography: how, why, when.

MR imaging of the wrist frequently represents a diagnostic challenge for radiologists because of the complex anatomy of this joint, small size of its components, and little known pathologic conditions. MR arthrography combines the advantages of conventional MR imaging and arthrography by improving the visualization of small intra-articular abnormalities. This article reviews the current role of MR arthrography in the evaluation of wrist joint disorders considering the relevant aspects of anatomy, techniques, and applications.

Bone Diseases↗
PubMed1993

[The diagnostic value of arthrography of the wrist in the evaluation of carpal ligament injuries: radio-surgical correlations. Apropos of 20 cases].

Intra-carpal ligament tears lead to radiocarpal arthritis early diagnosis allows early treatment. Standard and dynamic X rays are not always able to make the diagnosis. In these cases, arthrography of the wrist may give the diagnosis. To establish the specificity of this examination we tried to correlate surgical findings with arthrographic suspicions. Exact diagnosis was established in 12 out of 13 cases of suspected scapholunate ligament tears in 5 out of 6 cases of suspected luno-triquetral ligament tear suspicion and none of the 3 cases of suspected T.F.C.C. rupture suspicion. Wrist arthrography appears to have a good specificity for first row intra-carpal ligament tears. The indication arthrography must be discussed with wrist arthroscopy for the diagnosis of long term wrist pain after clinical examination and standard and dynamic X rays.

Adolescent↗
PubMed1990

[CT arthrography in the diagnosis of shoulder instability].

In the course of a prospective study, CT arthrography was carried out on 40 patients with shoulder instability. In 35 of these patients a lesion of the capsule and labrum was demonstrated, indicating glenohumeral instability; in three patients this was shown primarily by CT arthrography. In three patients, multidirectional instability was demonstrated. In four patients there was an isolated lesion of the labrum, whereas in one patient all the findings were normal. Compared with the capsulo-labral lesions, bone changes involving the head of the humerus and the glenoid were of lesser importance, although their severity affected the choice of operative treatment in four patients. Fifteen of the 40 patients have undergone surgery so far and in all cases the findings on CT arthrography could be confirmed.

Adolescent↗
PubMed1981

Arthrography, talar tilt and surgical findings after inversion trauma of the ankle.

Both inversion stress examination under general anesthesia and arthrography are sensitive indicators of lateral ankle ligament pathology (91%, 96% resp.). Arthrography is significantly superior to inversion stress examination done under local anesthesia (96%, 70% resp.). Peroneus tendon sheath filling is always pathological, but although this does not always indicate calcaneo-fibular ligament rupture, such rupture cannot be excluded in its absence. Talar tilt difference cannot be correlated with the extent of ligamentous rupture and therefore inversion stress examination, while providing valuable additional information, must be regarded as a secondary technique to ankle arthrography.

Ankle Injuries↗
PubMed1998

Complications of Arthrography.

Serious reactions to intra-articular contrast media are exceedingly rare, and arthrography is considered to be a very safe procedure. To assess the safety of arthrography, a questionnaire was sent to 180 radiologists experienced in arthrography. The 134 respondents had performed approximately 262,000 arthrograms throughout their career. Their experience included 45 cases of infection, eight cases of anaphylaxis, and five cases of vascular complications; no deaths were reported. Most of the reactions reported were minor and included pain, vasovagal reactions, and urticaria. In addition, the respondents reported approximately 13,300 magnetic resonance (MR) arthrograms, which had been performed with intra-articular gadolinium. Of these, there were only six cases of reported reactions, all of which were minor, including vasovagal reactions, pain, and headaches.

Journal Article↗
PubMed1988

Cutaneous fistula communicating with the hip in a patient with a painful total hip prosthesis. Demonstration by radionuclide arthrography.

Radionuclide arthrography is becoming increasingly useful in the evaluation of femoral component loosening in patients with a painful total hip prosthesis. Additional potential advantages of radionuclide arthrography include detection of abnormal communications with the hip, such as bursae, abscess cavities, and fistulas. A case of cutaneous fistula communicating with the hip in a patient with loosening and infection of the femoral component of the total hip prosthesis that is clearly demonstrated by radionuclide arthrography is presented.

Aged↗
PubMed1975

Upper extremity arthrography.

Arthrography is a proven and well-established diagnostic aid in the evaluation and treatment of lesions in several joints; it provides useful information in the treatment of shoulder and wrist lesions. The procedure can be used whenever the cause of shoulder pain is in doubt. Arthrography of the shoulder can aid in the diagnosis of a variety of lesions: rotator cuff tear, subluxation of the shoulder, recurrent dislocation, subluxation and tear of the biceps tendon, the frozen shoulder, anterior capsular derangements, and combinations of these abnormalities. Arthrography has occasional, but definite use in the wrist, particularly in recurrent ganglion, painful ganglion on the flexor aspect of the wrist, and in the evaluation of the post-traumatic wrist with unexplained pain.

Adult↗
PubMed1977

A study of ankle instability utilizing ankle arthrography.

A preclinical and clinical study of ankle arthrography for chronic ankle instability was performed. In the first study, ankle arthrograms were done on 50 cadaver ankles to demonstrate the limits of the normal ankle joint, and it was demonstrated that contrast in tendon sheaths is not a sign of a torn ankle ligament. The second study consisted of investigating ten cases of chronic ankle instability utilizing ankle arthrography. It was concluded that ankle arthrography is helpful in diagnosing torn ankle ligaments if all remaining investigative procedures are negative. A positive ankle arthrogram is proof that a torn capsule and ligament has occurred. However, in this small series a negative a negative arthrogram and a normal talar tilt was still associated with a torn ligament of the ankle.

Adolescent↗
PubMed1980

Semiopaque arthrography of the temporomandibular joint.

Arthrography was performed in 166 temporomandibular joints with known disorders. The results reflected the pathology expected in each disorder. Clicking and locking were characterized by an increased inferior synovial cavity. The superior cavity was either normal or with irregularity of the articular space. In degenerative diseases, the most frequent finding was perforation of the disc. Rheumatoid arthritis was characterized by reduced extent and irregular outline of the synovial cavities. A late effect from contusion of the temporomandibular joint was a slight reduction in the extent of the synovial cavity. Late effects from intracapsular fracture of the mandibular condyle were considerable irregularity of the articular space and perforation of the disc. As a rule, the arthrographs were highly characteristic, and it seems possible to distinguish between the current disorders by means of arthrography. The arthrographs of 15 intact joints are described. The features of unsuccessful arthrography based on 32 instances of extrasynovial injection are described.

Arthritis, Rheumatoid↗
PubMed1994

Labrocapsular ligamentous complex of the shoulder: normal anatomy, anatomic variation, and pitfalls of MR imaging and MR arthrography.

Magnetic resonance (MR) imaging is a useful modality for evaluating the labrocapsular ligamentous complex (LCLC) of the shoulder. MR arthrography is an important and occasionally indispensable supplementary modality for accurate differentiation between normal and deranged glenohumeral joints. Because of the joint distention that occurs during MR arthrography, it is especially helpful in detecting subtle capsular derangement, as occurs in patients with atraumatic instability. Also, some of the pitfalls associated with MR imaging of the LCLC are less likely to occur with MR arthrography. Radiologists should look for several key abnormalities when evaluating MR images of the shoulder: an anterior or posterior Bankart lesion; a Hill-Sachs defect; a tear of the rotator cuff, glenoid labrum, or superior labrum-biceps tendon attachment; and loose bodies. Knowledge of normal anatomy, normal variations, and pitfalls in image interpretation related to evaluation of the LCLC will help the radiologist accurately detect debilitating derangements associated with glenohumeral instability.

Humans↗
PubMed2002

MR arthrography of shoulders after suture-anchor Bankart repair.

PURPOSE: To determine the ability of magnetic resonance (MR) arthrography to depict the anatomic reestablishment of the capsulolabral complex after suture-anchor Bankart repair. MATERIALS AND METHODS: Thirty patients (25 men, five women; mean age, 28 years) who had undergone suture-anchor Bankart repair of one shoulder underwent MR arthrography before second-look arthroscopy. Ninety-eight anchors were used for the sutures. MR arthrographic diagnosis of anatomic reestablishment of the capsulolabral complex was correlated with arthroscopic findings. Contingency table analysis was performed to determine the relationship between MR arthrographic findings and arthroscopic findings. RESULTS: MR findings of reattachment of the capsulolabral complex were in agreement with arthroscopic findings in 93 anchor points (accuracy, 93 of 98 anchor points; 95%). In 28 shoulders, oblique transverse images obtained with the shoulder in the abduction and external rotation position showed that the anterior band of the inferior glenohumeral ligament (AIGHL) abutted the humeral head and that reattachment of the AIGHL to the glenoid rim was seamless. Arthroscopy revealed satisfactory reestablishment of the capsulolabral complex in these shoulders. In the remaining two shoulders, a pool of contrast material was seen between the AIGHL and humeral head and a "divot" was detected at the point of reattachment of the AIGHL to the glenoid rim. Arthroscopy revealed unsatisfactory reestablishment of the capsulolabral complex. MR arthrographic findings of reattachment of the AIGHL were significantly associated with arthroscopic findings of reestablishment of the capsulolabral complex (P <.01). CONCLUSION: MR arthrography can be reliably used for the postoperative assessment of suture-anchor Bankart repair.

Adolescent↗
PubMed2006

Association between extrinsic and intrinsic carpal ligament injuries at MR arthrography and carpal instability at radiography: initial observations.

PURPOSE: To retrospectively compare the presence or absence of carpal instability on radiographs with the findings of magnetic resonance (MR) arthrographic evaluation of intrinsic and extrinsic ligament tears in patients with chronic wrist pain. MATERIALS AND METHODS: The institutional review board approved this study and did not require informed consent. Signs of carpal instability were assessed on static and dynamic radiographs of the wrist obtained in 72 patients (24 female, 48 male; mean age, 36 years; age range, 14-59 years) with posttraumatic wrist pain. MR arthrography was subsequently performed. Two musculoskeletal radiologists independently analyzed the radiographs and MR images. Each intrinsic and extrinsic ligament was individually evaluated for the presence of a ligament tear. The extent of the tear also was recorded. Interobserver agreement regarding MR arthrographic findings was tested by calculating kappa statistics. Statistical comparison between radiography and MR arthrography was performed by using the Fisher exact test. RESULTS: Twenty-five triangular fibrocartilage complex, 18 (five partial, 13 complete) scapholunate ligament, and 25 (10 partial, 15 complete) lunotriquetral ligament tears were visualized. Twenty-two (all complete) extrinsic ligament tears were detected: two radial collateral ligament, 10 radioscaphocapitate ligament, and 10 radiolunotriquetral ligament tears. Interobserver agreement regarding intrinsic and extrinsic ligament tear detection at MR arthrography was excellent (kappa = 0.80). Nineteen patients had evidence of carpal instability on radiographs. Fourteen (52%) of 27 patients with at least one complete intrinsic lesion had no sign of carpal instability. On the other hand, the association of scapholunate ligament and/or lunotriquetral ligament and extrinsic ligament tears was significantly correlated (P < .001) with carpal instability at radiography. CONCLUSION: The presence or absence of carpal instability on radiographs depends on the association between intrinsic and extrinsic ligament tears-even partial ones-rather than on the presence of intrinsic ligament tears alone, even when the tears are complete.

Adolescent↗
PubMed1985

Temporomandibular joint arthrography of normal subjects: prevalence of pain with ionic versus nonionic contrast agents.

Bilateral temporomandibular joint (TMI) arthrography was performed in 31 healthy subjects to determine the prevalence and degree of postprocedural pain and to establish if morbidity could be decreased by use of a nonionic contrast agent. Ionic contrast material (Hypaque 60%) was injected on one side and nonionic contrast material (Amipaque) on the other side. The pain experienced in the 5 days following arthrography was graded and recorded. Discomfort, when present, was described as mild or moderate and usually lasted for 2 days after the procedure. In no instance was the pain considered severe. There was significantly less pain on the side that was injected with nonionic contrast material. The invasiveness of the examination should not be a deterrent since discomfort from TMJ arthrography is minimal when performed by an experienced arthrographer; use of a nonionic contrast agent can further decrease the pain.

Adult↗
PubMed1987

MR arthrography: anatomic-pathologic investigation.

To enhance the efficacy of magnetic resonance (MR) imaging in evaluating articular soft-tissue structures, arthrography was performed before imaging 45 fresh cadaveric specimens. Contrast agents used were gadolinium-DTPA, 0.9% saline, diatrizoate, and air. MR imaging was performed with and without intraarticular contrast material, and specimens were subsequently sectioned in the same plane. Gd-DTPA was the most effective agent. Saline and diatrizoate exhibited equivalent signal behavior and necessitated T2-weighted sequences, while air was not useful. Depiction of normal anatomy was enhanced with MR arthrography. After surgical creation of lesions in selected specimens, subtle tears were delineated exclusively with MR arthrography, and major tears were diagnosed more confidently. Intraarticular contrast material may enhance the diagnostic capabilities of MR imaging in the setting of joint disease.

Air↗
PubMed1993

Rotator cuff: evaluation with fat-suppressed MR arthrography.

Thirty-seven shoulders with rotator cuff diagnoses proved at arthrography, arthroscopy, or open surgery were examined prospectively with magnetic resonance (MR) arthrography. T1-weighted MR images were obtained with and without fat suppression after intraarticular injection of gadopentetate dimeglumine. Without fat suppression, overall accuracy was 84%. False-positive full-thickness tears were diagnosed in three patients who were proved to have partial tears. False-negative normal tendons were diagnosed in two patients who had partial tears. The corresponding sensitivity and specificity were 90% and 75%, respectively. With the aid of fat-suppressed imaging, full-thickness and partial cuff tears were identified with 100% sensitivity and specificity. Fat-suppressed images also showed intratendinous contrast material imbibition in three torn cuffs with frayed, friable tendon margins. Fat suppression in MR arthrography is valuable in the differentiation of partial from full-thickness cuff tears and in the detection of small partial tears of the inferior tendon surface.

Adolescent↗
PubMed1994

Labral-ligamentous complex of the shoulder: evaluation with MR arthrography.

PURPOSE: To determine the usefulness of magnetic resonance (MR) arthrography in assessment of the labral-ligamentous complex and test the hypothesis that the inferior glenohumeral ligament (IGHL) is an important anatomic feature of clinical instability. MATERIALS AND METHODS: Forty-eight shoulders with labral diagnoses proved with arthroscopy or open surgery were prospectively examined with MR arthrography after intraarticular injection of gadopentetate dimeglumine. RESULTS: Surgical findings showed that 14 labra were normal, 29 were torn, and six were deficient. (One labrum was torn and deficient in separate locations.) MR arthrographic findings had a diagnostic sensitivity of 91% and specificity of 93%. In 32 patients with proved labral abnormalities, 30 lesions involved the labral-bicipital junction, origins of the glenohumeral ligaments, or both. In 22 of 23 shoulders considered clinically unstable, a labral abnormality involved the origin of the IGHL. CONCLUSION: MR arthrography accurately shows the relationship of labral lesions to the origins of the glenohumeral ligaments and helps in distinction between stable and unstable lesions.

Adult↗