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PubMed1995

Glenohumeral ligaments and shoulder capsular mechanism: evaluation with MR arthrography.

PURPOSE: To evaluate the efficacy of magnetic resonance (MR) arthrography in identification of the glenohumeral ligaments (GHLs) and to determine the location of abnormalities of the GHL, joint capsule, and labrum. MATERIALS AND METHODS: MR arthrograms were evaluated retrospectively in 46 patients with a history of shoulder instability, impingement syndrome, or pain of unknown cause. Imaging findings were correlated with surgical observations. RESULTS: The superior, middle, and inferior GHLs were identified on MR arthrograms in 39 (85%), 39 (85%), and 42 (91%) of the 46 patients, respectively. In diagnosis of tears of the superior, middle, and inferior GHLs, MR arthrography had a sensitivity of 100%, 89%, and 88% and a specificity of 94%, 88%, and 100%, respectively. CONCLUSION: Findings at MR arthrography can help accurate identification and demonstration of the integrity of the GHL and labrum and can help in staging of abnormalities. The large number of abnormalities depicted in the middle and inferior GHLs suggests that both might be important in the maintenance of glenohumeral joint congruity.

Adult↗
PubMed1996

Acetabular labral tears: evaluation with MR arthrography.

PURPOSE: To determine the usefulness of magnetic resonance (MR) arthrography in the diagnosis of acetabular labral tears. MATERIALS AND METHODS: MR arthrography of the hip was performed in 10 patients who underwent subsequent surgical evaluation. Eight arthrograms were obtained with intraarticular administration of gadolinium solution and two with intraarticular administration of normal saline. T1-weighted spin-echo (intraarticular gadolinium) or T2-weighted gradient-echo (intraarticular normal saline) images were obtained in the axial, sagittal, and coronal planes with use of a surface coil. Criteria for labral tears included labral blunting, absence, displacement, intrasubstance contrast material, and contrast material at the acetabular-labral junction. Labra with enlargement, intrasubstance intermediate signal intensity, or irregular margins were interpreted as degenerative. RESULTS: Labral tears were diagnosed in eight hips. Tears included six labra with contrast material that tracked at the acetabular-labral junction, one of which had associated intrasubstance extension. One tear was confined to the labral substance. The other tear exhibited absent labral tissue and an irregular remnant. One degenerative labrum and one normal labrum were identified. All MR arthrographic findings were confirmed at surgery. Extension of one anterosuperior tear into the posterosuperior labrum was not prospectively appreciated. CONCLUSION: In this preliminary study, MR arthrography appears to be a promising imaging modality for accurate diagnosis of acetabular labral tears.

Acetabulum↗
PubMed1996

Sublabral recess of the superior glenoid labrum: study of cadavers with conventional nonenhanced MR imaging, MR arthrography, anatomic dissection, and limited histologic examination.

PURPOSE: To evaluate size, location, and appearance of the sublabral recess of the superior glenoid labrum, which mimics a superior labral tear oriented in the anterior to posterior direction (SLAP) lesion with conventional magnetic resonance (MR) imaging, MR arthrography, gross dissection, and limited histologic evaluation. MATERIALS AND METHODS: Twenty-six cadaveric shoulder specimens that were freshly frozen were examined with nonenhanced MR imaging and with MR arthrography after intraarticular injection of dilute contrast material with gadolinium. In all specimens, the appearance of the superior glenolabral junction was categorized and was correlated to that seen at gross anatomic dissection. Histologic sections were obtained of two shoulders with large sublabral recesses in the plane of the MR sections. RESULTS: A sublabral recess was present in 19 (73%) shoulders and was deeper than 2 mm in 10 (39%). MR arthrography better demonstrated the sublabral recess than nonenhanced MR imaging. In 16 of 19 shoulders, the sublabral recess was located in the most anterior section obtained through the superior labrum. There was no definite correlation between subject age and sex and glenolabral junction type. At histologic examination of the two shoulders, a synovial lining of the sublabral recess was seen and there was no evidence of fibrosis to suggest a traumatic cause. CONCLUSION: A sublabral recess is common in cadaveric shoulders and has an appearance similar to that of published examples of SLAP lesions. Histologic findings were consistent with normal anatomic structure rather than with acquired, posttraumatic lesions.

Cadaver↗
PubMed2000

Direct MR arthrography of the shoulder: is exercise prior to imaging beneficial or detrimental?

PURPOSE: To define the beneficial and detrimental effects of adding exercise to direct magnetic resonance (MR) shoulder arthrography. MATERIALS AND METHODS: Direct, intraarticular, gadolinium arthrography of the shoulder was performed in 41 patients, who underwent 1.5-T MR imaging before and after 1 minute of arm swinging. Fourteen milliliters of dilute gadolinium solution was injected. Two readers blinded to exercise independently graded the randomly distributed images with a five-point scale for capsular contrast material resorption; extraarticular contrast material leakage; rotator cuff, glenoid labrum, and anterior capsule conspicuity; and partial-thickness or full-thickness rotator cuff tear and labral tear detectability. The sign test was performed to evaluate the significance of differences between preexercise and postexercise grading for each reader. A second review was performed, with direct side-by-side comparison of preexercise and postexercise images. RESULTS: There was evidence of increased capsular resorption after exercise but no alteration in the depiction of the rotator cuff tendons or glenoid labrum. There was no significant extraarticular contrast material leakage after exercise and no alteration in depiction of the anterior capsule. There was no difference in the detectability of rotator cuff or labral tears. CONCLUSION: Exercise with direct shoulder MR arthrography has no beneficial or detrimental effect on image quality or on the depiction of rotator cuff or labral tears.

Adolescent↗
PubMedDate not supplied

Iohexol and meglumine iothalamate in shoulder arthrography. A double-blind investigation.

The first clinical experience with the new contrast medium, iohexol, in shoulder arthrography is reported. A double-blind comparison of iohexol and meglumine iothalamate, a conventional medium in standard use for arthrography, was carried out in a consecutive series of 60 adult patients forming two groups of 30 subjects each. No difference in the radiographic quality was seen immediately after contrast injection but in exposures at 20 min iohexol gave a significantly better arthrographic quality. Practically no adverse effects occurred during the examinations. Although minor side effects were numerous in both groups during the two days following arthrography, they were somewhat more frequent in patients given iothalamate.

Adult↗
PubMed1996

MR arthrography in the diagnosis of rotator cuff tears. Standard spin-echo alone or with fat suppression?

PURPOSE: To examine the value of fat-suppressed images in MR arthrography of the shoulder in patients with rotator cuff tears. MATERIAL AND METHODS: MR arthrography was performed in 25 patients (9 women, 16 men) ranging from 19 to 64 years. Standard T1-weighted spin-echo images (sSE) and fat-suppressed images (FS) were obtained after intraarticular injection of contrast material. The MR studies were analyzed according to contrast, image quality and conspicuity of pathology. A diagnosis was established without knowledge of the conventional arthrographic findings on the basis of sSE versus FS techniques. RESULTS: The contrast between the intraarticular fluid and the adjacent structures in FS images was increased compared to sSE images in all patients. The conspicuity of anatomical structures was improved in 8 patients. Without fat suppression, 2 false-negative and one false-positive full-thickness tears were diagnosed. With the FS technique, 14 full-thickness tears and 4 partial-thickness tears of the cuff were correctly classified. CONCLUSION: The results suggest that, if MR arthrography is chosen for a diagnosis of rotator cuff disorders, a fat suppression sequence should be included.

Adult↗
PubMed1990

Degeneration of the lumbar facet joints. Arthrography and pathology.

The reproduction of symptoms on arthrography of the lumbar facet joint has been accepted as a screening procedure before localised spinal fusion. We studied the histology of 127 facet joints removed at operation from 84 patients, who had previously had facet arthrography. The specificity of the arthrographic results for degenerative joint disease was 75% but their sensitivity was only 59%. This gave a positive predictive value of 85%, but a negative predictive value of only 43%. We conclude that the production of symptoms during facet arthrography is of little value as a screening procedure.

Back Pain↗
PubMed1994

Ultrasonography and arthrography in the diagnosis of tears of the rotator cuff.

The accuracy of ultrasonography and arthrography in the prediction of lesions of the rotator cuff was evaluated and compared with the operative findings in a retrospective study of forty-nine patients (forty-nine shoulders). In the detection of full-thickness (stage-III) tears of the rotator cuff, ultrasonography had an over-all sensitivity of 74 per cent, a specificity of 95 per cent, an accuracy of 84 per cent, a predictive value of a positive test of 95 per cent, and a predictive value of a negative test of 75 per cent. In contrast, arthrography demonstrated a sensitivity of 93 per cent, a specificity of 95 per cent, an accuracy of 94 per cent, a predictive value of a positive test of 96 per cent, and a predictive value of a negative test of 91 per cent. Ultrasonography could not reliably differentiate between partial (stage-II) and full-thickness (stage-III) tears. Lesions of the long head of the biceps brachii tendon were recorded by ultrasonography for twenty-two patients (45 per cent) and by arthrography for eleven patients (22 per cent). The ultrasonographic finding of fluid in the sheath of this tendon is not a reliable sign of a lesion in the tendon.

Adult↗
PubMed1984

Digital arthrography of the wrist: a radiographic-pathologic investigation.

An analysis of digital arthrography of the wrist was accomplished in 10 cadaveric specimens. In each case, images were obtained during a 30-sec period in which a small amount of contrast material was introduced into the radiocarpal compartment; films were reviewed with and without subtraction technique. Pathologic examination of the sectioned specimens documented the accuracy of this arthrographic method. The sequence of contrast opacification of the various compartments of the wrist and the location and size of the defects within ligamentous and cartilaginous structures were ideally seen with digital arthrography. A previously unemphasized pattern of communication, that between the midcarpal and pisiform-triquetral compartments, was seen in two instances. Digital wrist arthrography seems to represent an excellent method to evaluate the patient with suspected soft-tissue injury.

Fluoroscopy↗
PubMed1984

Arthrography in the posttraumatic elbow in children.

Radiographic interpretation of children's elbows after trauma can be perplexing because of the large proportion of unossified cartilage relative to bone. The numbers of ossification centers appearing at different ages also complicate the interpretation. This study summarizes arthrographic experience in 10 children who sustained elbow trauma. Nine children had arthrography performed 5-24 months after injury. Seven patients had supracondylar or condylar fractures, one patient had a proximal radial fracture, and two patients had suspected osteochondritis dissecans. Arthrography was useful in delineating the integrity of the joint surfaces and in identifying healed rotated fracture components, cartilaginous spurs, nonunion of unossified fragments, and the normal physis. A small scarred joint and intraarticular loose bodies also were demonstrated. Elbow arthrography, though clearly not indicated for all pediatric elbow trauma, can contribute valuable information in the complex elbow fracture.

Adolescent↗
PubMed1986

Digital wrist arthrography: precision in determining the site of radiocarpal-midcarpal communication.

Wrist arthrography is used for precise determination of posttraumatic interosseous ligament tears. Digital subtraction arthrography adds to the precision in diagnosis of the site of radiocarpal-midcarpal communication. Using the technique for digital subtraction wrist arthrography outlined in this paper, the classic scapho-lunate and lunate-triquetral perforations were delineated. Scaphotrapezium and triquetral-hamate interosseous ligament perforations were also delineated. The added diagnostic precision of digital subtraction at the first injection was useful in planning the correct surgical procedure.

Carpal Bones↗
PubMed1989

Comparison of omnipaque with hypaque in temporomandibular arthrography.

Decreasing or alleviating pain experienced by some patients during or after temporomandibular arthrography would make this relatively inexpensive and highly accurate technique more attractive. This is particularly true for those patients without access to MR or those whose referring physicians prefer arthrography to other techniques for diagnosing internal derangements. Ionic and nonionic contrast agents were compared in a randomized, double-blind trial to determine if pain could be decreased by using a nonionic contrast material. Forty patients received either Omnipaque 300 (nonionic, iohexol) or Hypaque 60 (ionic, diatrizoate meglumine). Radiographs were assessed for diagnostic quality, and patients were asked to note their level of discomfort. No significant differences between the agents were detected. Maximal discomfort was noted at 24 hr. Discomfort was classified as none, mild, or moderate, with no patients describing marked discomfort. This study does not support the use of nonionic contrast agents over the less expensive ionic agents for decreasing pain or improving film quality in temporomandibular joint arthrography.

Adult↗
PubMed1995

MR arthrography of the shoulder: normal intraarticular structures and common abnormalities.

MR imaging with gadopentetate dimeglumine (MR arthrography) is a new technique for evaluating the shoulder. Early clinical experience indicates that MR arthrography improves the visualization of intraarticular structures [1-3]. On T1-weighted images, high-signal contrast solution outlines the low-signal surface of the cuff tendons, the contour of the glenoid labrum, and the course of the glenohumeral ligaments. This essay illustrates the anatomic features of normal glenohumeral structures seen on MR arthrography and common pathologic disorders of the labral-ligamentous complex and rotator cuff.

Adult↗
PubMed1998

Prospective evaluation of MR arthrography performed with high-volume intraarticular saline enhancement in patients with recurrent anterior dislocations of the shoulder.

OBJECTIVE: The purpose of this study was to evaluate the accuracy of high-volume saline-enhanced MR arthrography in assessing the labrum, the ligaments, and the bony components of the glenohumeral joint. SUBJECTS AND METHODS: Forty-four patients with recurrent anterior dislocations of the shoulder underwent MR arthrography after intraarticular injection of 15-40 ml of saline solution. Two-dimensional fast low-angle shot and T1-weighted spin-echo sequences were prospectively evaluated by two observers. Anterior (Bankart) lesions, superior labral lesions extending from anterior to posterior, and Hill-Sachs lesions were diagnosed. Glenohumeral ligaments (GHLs) were identified and classified using a standard system. MR imaging results were compared with those of arthroscopy (n = 32) or open surgery (n = 12), either of which was the gold standard. RESULTS: Bankart lesions and superior labral lesions extending from anterior to posterior were revealed with a sensitivity of 93% and 89%, respectively, and a specificity of 80% and 89%, respectively. Diagnostic accuracy was 89% for both types of lesions. All six patients with bony Bankart lesions had high fat-marrow signal intensity within the fragment on T1-weighted MR images. For GHLs, MR imaging results and arthroscopy correlated in 25 of the 31 patients. In three patients all three GHLs were visible on MR imaging, but only two GHLs were detected with arthroscopy. In three patients two GHLs were detected on MR imaging but all three were visible on arthroscopy. Hill-Sachs lesions were revealed with a sensitivity of 95%, a specificity of 50%, and an accuracy of 81%. CONCLUSION: High-volume saline-enhanced MR arthrography is accurate in revealing the labrum, the ligaments, and the bony components of the glenohumeral joint Saline solution is inert and inexpensive, two advantages over gadopentetate dimeglumine.

Adult↗
PubMed1999

Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography.

OBJECTIVE: This article describes the appearance of the anterolateral recess of the posttraumatic ankle on CT arthrography and clearly shows the benefit of this technique in the diagnosis of soft-tissue impingement. MATERIALS AND METHODS: The study was carried out on 44 patients examined by CT arthrography and arthroscopy for chronic, posttraumatic ankle pain. The analysis principally concerned the lateral compartment--in particular, the synovial regularity and the cartilage of the talar dome. RESULTS: Four CT patterns were identified: type 0, uniform filling of the recess with clear limits; type I, intraarticular linear structure outlined by contrast agent; type II, nodular formation in the lateral groove; and type III, irregular appearance of the edges of the lateral groove. Ninety-one percent (10/11) of type II patterns were characterized as meniscoid lesions by arthroscopic examination, 100% (14/14) of type III patterns corresponded to an abundant fibrous reaction, and arthroscopic findings were normal for 100% (2/2) of type 0 patterns and 88% (15/17) of type I patterns. The latter was thus considered as a normal variant outlining the accessory anterior inferior tibiofibular ligament. Type II and III lesions were statistically associated (p = .001) with a chondropathy when time from initial trauma was greater than 22 months. CONCLUSION: CT arthrography provides evidence of anterolateral soft-tissue impingement--in particular, in type II or III patterns. These lesions are statistically associated with a chondropathy.

Adult↗
PubMed1999

Clinical impact of MR arthrography of the shoulder.

PURPOSE: To evaluate the effect of MR arthrography of the shoulder on diagnostic thinking and therapeutic decisions by orthopedic shoulder surgeons. MATERIAL AND METHODS: Orthopedic surgeons completed a questionnaire before and after MR arthrography for 73 consecutive patients. The main indications were suspected rotator cuff abnormalities. The clinical diagnosis, the degree of confidence in this diagnosis, and the therapeutic decision were noted before and after MR imaging. Surgical reports were available for 34 patients. RESULTS: Thirty-four percent of the pre-MR imaging diagnoses were withdrawn after MR imaging, and new diagnoses were made after MR imaging in 13% of the cases. Confidence in the diagnosis increased significantly after MR imaging for supraspinatus and infraspinatus lesions (p<0.05). Changes of therapeutic decision after MR imaging were noted in 36 of the 73 patients (49%). In 23 patients, more invasive therapeutic procedures were initiated after MR imaging, and a more conservative treatment was implemented for 13 patients. Agreement of MR diagnoses with surgery was 94% for supraspinatus tears, 87% for infraspinatus tears, 77% for subscapularis tears, and 81% for biceps tendon lesions. Agreement of clinical diagnoses with surgery was 56%, 83%, 50%, and 64%, respectively. CONCLUSION: MR arthrography of the shoulder has a major effect on diagnostic thinking and therapeutic decisions by orthopedic shoulder surgeons.

Adult↗
PubMed1984

The diagnostic value of arthrography and plain radiography in rotator cuff tears.

In 26 patients with surgically verified rotator cuff tears, the findings at radiography and arthrography were analysed. Plain anteroposterior radiograms were of no value in diagnosis. In plain groove-films, the slope of the medial wall and the depth of the intertubercular groove correlated with dislocations of the biceps tendon. In arthrography, leakage of the contrast medium into the subacromial or subdeltoid bursa was a reliable sign of a full-thickness tear. There was no correlation between the size of the tear measured at arthrography and at surgery. In cases where the biceps tendon sheath was visualised, the appearance was in agreement with the surgical findings.

Adult↗
PubMed2002

[Findings of the subcoracoid bursa on MR arthrography and their clinical significance].

We studied visualization of the subcoracoid bursa by conducting a retrospective analysis of the MR arthrograms of 101 shoulders with surgical confirmation. MR arthrography showed the subcoracoid bursa in 28 shoulders, among which the bursa was revealed by inadvertent direct injection of contrast material into the bursa in 10 shoulders. Of the remaining 18 shoulders, 16 shoulders had rotator cuff tears, one had shoulder instability, and one had dislocation of the long head of the biceps tendon. Both the subcoracoid and subscapularis bursae are located in the subcoracoid space. The subcoracoid bursa does not communicate with the subscapularis bursa, but occasionally communicates with the subacromial-subdeltoid bursa. On MR arthrography, contrast material in the subcoracoid bursa indicates a pathologic condition such as rotator cuff tear. Careful examination of the subcoracoid bursa on MR arthrography helps to achieve better assessment of the rotator cuff.

Adolescent↗