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PubMed1996

Site and size of rotator-cuff tear. Findings at ultrasound, double-contrast arthrography, and computed tomography arthrography with surgical correlation.

RATIONALE AND OBJECTIVES: The authors discuss findings of ultrasound (US), double-contrast arthrography (AG), and contrast computed tomography arthrography (CTA) in assessing precise site and size of rotator-cuff tears. METHODS: Eighty-six patients were compared prospectively in a masked fashion; the results of surgery were studied in 25 patients and the results of arthroscopy were studied in 61 patients. RESULTS: Ultrasound detected 80% (8 of 10) of the partial-thickness tears and 90% (18 of 20) of the full-thickness tears. Arthrography and CTA had identical results with 70% sensitivity (7 of 10) in partial-thickness tears; AG showed 90% (18 of 20) and CTA 95% (19 of 20) of the full-thickness tears. Arthrography had two false-positive findings, and US and CTA had one each. The size of a tear could be evaluated correctly with AG in 30% (9 of 30), with US in 70% (21 of 30) and with CTA in 76% (23 of 30). More extensive tears were encountered at US than had been found at surgery in 2% (2 of 86) and less extensive tears in 9% (8 of 86); CTA depicted more extensive tears in 2% (2 of 86) and less extensive tears in 6% (6 of 86), respectively. The site of a tear could be evaluated with AG in 30% (9 of 30); US and CTA showed the site correctly in every patient in which the tear could be diagnosed. CONCLUSION: Ultrasound and CTA were equally accurate in diagnosing and evaluating the size and site of rotator-cuff tears. Double-contrast AG was less accurate in the diagnosis of tears and the size and site of tears clearly could be assessed worse.

Adult↗
PubMed1995

[Double-contrast tomographic arthrography and double-contrast CT arthrography in rotator cuff lesions].

Arthrotomography is a good method for the evaluation of incomplete or complete tears of the supraspinatus tendon, the assessment of the size of tears and the quality of the nonruptured part. CT arthrography is useful in the evaluation of the subscapularis tendon and the labral-capsular components. It depends on the clinical symptoms and the result of primary arthrography whether both methods are performed in one session or not. Based on the experience of 1200 arthro(tomo)graphy and axial CT arthrography examinations, the procedure and results in our institution are reported.

Adult↗
PubMed1988

Digital subtraction wrist arthrography: use of double contrast technique as a supplement to single contrast arthrography.

A new technique using double contrast after digital subtraction wrist arthrography is presented. Results of the double contrast wrist arthrograms were essential to the diagnosis, confirmed the diagnosis, or salvaged an otherwise poor or nondiagnostic examination. It was found that intra-articular injection of air augments the information obtained during postarthrogram active motion studies under fluoroscopy. Double contrast wrist arthrography has proved valuable when the standard contrast arthrogram fails to yield diagnostic information.

Arthrography↗
PubMedDate not supplied

Magnetic resonance arthrography in the assessment of anterior instability of the shoulder: comparison with double-contrast computed tomography arthrography.

Forty-seven shoulders with traumatic anterior instability were studied by magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA) to compare the diagnostic performance of these examinations in the evaluation of Bankart lesions. All shoulders were examined by arthroscopy to verify the lesions. Labral damage evaluated by MRA and by CTA correlated significantly with arthroscopic findings (MRA, r = 0.55, p < 0.0001; CTA, r = 0.45, p = 0.0050). MRA possessed higher sensitivity in detecting torn labra (MRA, sensitivity = 87%, specificity = 75%; CTA, sensitivity = 33%, specificity = 88%). In detecting displaced labra, sensitivity and specificity were 65% and 94% for MRA and 75% and 69% for CTA. The inferior glenohumeral ligament was depicted as a lax structure in 74% by MRA but in only 21% by CTA. We conclude that MRA is superior to CTA in detecting lesions associated with shoulder instability.

Adolescent↗
PubMed2004

[Direct CT-arthrography versus direct MR-arthrography in chronic shoulder instability: comparison of modalities after the introduction of multidetector-CT technology].

PURPOSE: To evaluate the diagnostic accuracy of direct multidetector CT arthrography (CTA) and direct MR arthrography (MRA) in patients suffering from chronic shoulder instability. MATERIALS AND METHODS: Twenty-nine patients suffering from chronic shoulder instability were included into a prospective study. In all cases, the indication for direct CTA and arthroscopy was set by the orthopedic surgeon. Prior to the imaging procedures, 10 to 20 ml of a special combination of contrast media (including saline, Isovist(R) and Magnevist(R) in a relation of 125 : 125 : 1) was injected into the joint under sterile conditions. First, CTA was performed with a multidetector CT, with images reconstructed in the axial, semi-coronal and semi-sagittal planes. Thereafter, MRA was performed. Axial images were obtained using a T1-weighted, fat-saturated spin echo sequence and semi-coronal images using a T1-weighted FLASH-3D GRE sequence. The results of CTA and MTA were compared with results obtained from arthroscopy or arthrotomy. RESULTS: MRA was superior to CTA in the detection of labral lesions. The sensitivity of MRA was 96 % and the specificity 96 %, compared to a sensitivity of 76 % (p < 0.05) and specificity of 92 % for CTA. Both methods showed the same effectiveness concerning the assessment of capsule distension (sensitivity for both techniques: 91 %). CONCLUSIONS: MRA seems to be superior to CTA in the diagnostic workup of chronic shoulder instability even when using a multidetector CT technique.

Adolescent↗
PubMed1997

-Arthrography and computed tomography arthrography of the wrist-.

After a brief review of the pertinent anatomy of joint compartments and main ligaments of the wrist, the authors present the technique of wrist arthrography and CT arthrography. They discuss the normal and pathological patterns. The main indications are the chronic painful wrist and posttraumatic wrist. Imaging can reveal ligament defects (particularly scapholunate ligament, or lunotriquetral ligament), triangular fibrocartilage tears, capsular defects, cartilage thinning, foreign bodies, synovial ganglia or synovitis of the wrist.

Arthrography↗
PubMed2005

Evaluating hip labral tears using magnetic resonance arthrography: a prospective study comparing hip arthroscopy and magnetic resonance arthrography diagnosis.

PURPOSE: To evaluate the sensitivity and accuracy of magnetic resonance arthrography (MRA) with true sagittal scout image mapped radial reformation in localizing hip labral tears. TYPE OF STUDY: Case series. METHODS: Thirty patients were examined with hip MRA because of suspected labral tears. Every patient underwent normal hip arthrography and MR examinations using a 1.5-T scanner with a 3D-FLASH pulse sequence. Multiplanar reformation using double oblique technique produced radial reformatted rotation images with 10 degrees increment on the acetabular rim. Labral tears were annotated as anterior-superior (AS), anterior-inferior (AI), posterior-superior (PS), and posterior-inferior (PI) quadrant based on the cranial-caudal axis in true sagittal reformatted scout localizing image. Patients with positive MRA findings were counseled to have the arthroscopic hip procedure. RESULTS: Five patients showed no MRA indication of labral tear. Of 25 patients who had MRA evidence of labral tear, 17 underwent arthroscopic hip surgery. One patient had only synovial process in the hip joint near the suspected MRA area. The remaining 16 operated patients had labral tears with a total of 21 quadrant lesions on arthroscopy (distributed as AS, 14; AI, 3; PS, 2; and PI, 2). Radial reformatted images revealed accurate mapping with arthroscopic findings in 21 of the 22 quadrant lesions. The sensitivity and accuracy of MRA for the diagnosis of hip labral tear were 100% and 94%, respectively, and the sensitivity and accuracy of radial reformatted MRA for mapping the tear location were 100% and 96%, respectively. CONCLUSIONS: MRA using radial reformatted images with a true sagittal localizer may achieve superior success rates in diagnosing hip labral lesions and in guiding the arthroscopist in portal selection, thus rendering location of hip labral tears simpler in surgery. It supplied detailed preoperative information to the surgeon, avoiding unnecessary surgery for patients if the diagnosis was unconfirmed. LEVEL OF EVIDENCE: Level III.

Acetabulum↗
PubMed1996

[Indirect MR arthrography of the shoulder. An alternative to direct MR arthrography?].

INTRODUCTION: The purpose of this study was to evaluate the diagnostic power of indirect MR arthrography (I-MRA) particularly in rotator cuff tears. MATERIAL AND METHODS: Sonography, conventional MRI and I-MRA were compared with arthroscopy in 25 patients. Additionally literature about experience with the method in other shoulder disease was searched. RESULTS: Sensitivity and specificity in the detection of rotator cuff tears were 0.6 and 0.7 respectively using sonography, 0.66 and 1 with conventional MRI and 1 and 0.86 for I-MRA. I-MRA was especially useful in diagnosing partial tears. In other studies I-MRA showed good results in the evaluation of glenoid labral tears, with a sensitivity of 91% and a specificity of 92%. CONCLUSION: I-MRA can be successfully used to diagnose rotator cuff and labral tears.

Adult↗
PubMed2001

[Value of digital subtraction arthrography and radionuclide arthrography in determination of indications and planning of revision surgery in total hip replacement].

PURPOSE: Clinical and radiographic findings are of little value in the diagnosis of hip endoprothesis loosening. Refined contrast and radionuclide arthrographic techniques are more precise in predicting endoprothesis loosening. Here we compare both techniques with respect to the surgical result. MATERIAL AND METHODS: 68 patients with hip pain after various arthroplasty procedure were investigated by clinical examination, X-ray, DSAr and AS. Surgical proof was obtained in 73.5%. RESULTS: An acetabular component loosening was detected in 89% by DSAr and in 86% by AS with a specificity for both methods of 93%. The femoral component loosening was seen with a sensitivity of 89% by DSAr and 100% by AS, respectively. Specificity of DSAr in the femoral compartment was 94%, of AS 88%. CONCLUSIONS: DSAr and AS are useful tools in the diagnosis of hip endoprothesis loosening and in planning surgical treatment. Both methods are comparable concerning the acetabular component, whereas AS is more sensitive in detecting femoral stem loosening. Combination of both methods is not recommended for routine diagnosis.

Aged↗
PubMed2004

Shoulder MR arthrography: which patient group benefits most?

OBJECTIVE: We sought to compare the diagnostic accuracy of conventional MRI versus MR arthrography of the shoulder in the assessment of high-performance athletes (professional baseball players) and to compare our findings in these patients with the conventional MRI and MR arthrographic findings in an age-matched control group of nonprofessional athletes. MATERIALS AND METHODS: Conventional MRI and MR arthrographic examinations of the shoulder in 20 consecutive professional baseball players with shoulder pain were reviewed retrospectively by two musculoskeletal radiologists in consensus. These interpretations were compared with retrospective consensus interpretations of conventional MRI and MR arthrographic examinations of the shoulder obtained in a control group of 50 consecutive nonprofessional athletes with shoulder pain. MR images were assessed for full- or partial-thickness supraspinatus tendon tears, superior labral anteroposterior (SLAP) tears, and anterior or posterior labral tears. RESULTS: In the 20 consecutive professional athlete patients, two full-thickness and six partial-thickness undersurface supraspinatus tendon tears were seen on MR arthrography but not seen on conventional MRI as well as six SLAP tears, two anterior labral tears, and one posterior labral tear. Three patients had both SLAP tears and full- or partial-thickness supraspinatus tendon tears. Of 14 patients with findings on MR arthrography that were not seen on MRI, 11 had arthroscopic correlation. In all 11, arthroscopic findings confirmed findings on MR arthrography. In the group of 50 nonprofessional athlete patients, five had additional findings on MR arthrography not seen on conventional MRI: two anterior labral tears, two partial-thickness supraspinatus tendon tears, and two SLAP tears. One patient had both a partial-thickness supraspinatus tendon tear and a SLAP tear seen on MR arthrography. The five patients with additional findings on MR arthrography had arthroscopy. In all five, arthroscopic findings confirmed the findings on MR arthrography. CONCLUSION: MR arthrography is considerably more sensitive for detection of partial-thickness supraspinatus tears and labral tears than conventional MRI. MR arthrography showed injuries in addition to those seen on conventional MRI in 14 of 20 patients in the high-performance athlete group. These results suggest high-performance athletes may be a subgroup of patients for whom MR arthrography yields considerably more diagnostic information than conventional MRI.

Adolescent↗
PubMed1996

Nuclear arthrography: combined scintigraphic and radiographic procedure for diagnosis of total hip prosthesis loosening.

UNLABELLED: Radiographic arthrography and bone scintigraphy are common diagnostic procedures used for evaluating total hip prostheses. In this study, both techniques are combined, and nuclear contrast imaging (nuclear arthrography) is added. The efficacy of the procedures is evaluated. METHODS: After intravenous injection of 99mTc-methylene diphosphonate (MDP), standard radiographic arthrography was performed in 105 patients (107 prostheses). The radiographic contrast medium was mixed with insoluble 111In-colloid (5 MBq/20 ml). After completion of the radiographic arthrography, nuclear arthrography was performed, and multiple-view dualisotope images (111In, 247-keV peak only) were recorded. Images were interpreted by superposition of the 111In image and the corresponding 99mTc-MDP image, the latter serving as a landmark for the position of the prosthesis and osseous structures. Findings at surgery were used as the gold standard. RESULTS: In both cemented and uncemented acetabular and femoral components, nuclear arthrography performed better than or equal to radiographic arthrography (70%-90% and 60%-75%, respectively). Nuclear arthrography had higher diagnostic accuracy than 99mTc-MDP images alone. CONCLUSION: Nuclear arthrography is a sensitive technique for detection of loosening of prostheses, offering added value over radiographic arthrography and bone scanning alone, especially for evaluation of the femoral component. Radiographic arthrography remains necessary not only for adequate deposition of contrast agents but also for detailed evaluation of osseous structures.

Cementation↗
PubMed2002

[MR arthrography of the hip joint].

MR arthrography of the hip joint is usually performed after a conventional MRI has been obtained to rule out other pathologies of the hip joint as for instance bone marrow edema or osteonecrosis of the hip. MR arthrography is mainly performed as a very special investigation, and it is executed in most cases if the clinician asks for the diagnosis of a labral lesion. In very rare cases, MR arthrography of the hip is performed to image cartilage disease or osteochondrosis dissecans or free intraarticular bodies. In this paper, the indications, the technique, and the most important pathology of the hip joint--labral lesions--will be described as well as variants of the normal acetabular labrum. After a conventional MRI of the hip joint has been performed, a MR arthrography of the hip will be obtained to search for labral pathology or cartilage disease. MR arthrography is obtained after the intraarticular injection of 10-20 ml of a 0.1 mmol solution of gadopentate-dimeglumine has been performed. The intraarticular injection can either be fluoroscopic-guided or CT-guided or directly MR-guided. After the intraarticular injection, MR arthrography will be performed by the use of paracoronal and parasagittal T1-weighted spin echo or gradient echo sequences. In cases of labral lesions (degeneration, labral tear, labral detachment) or cartilage disease MR arthrography proved to be more sensitive as conventional MRI as shown in the literature. The sensitivity of MRI to detect labral pathology was reported to be about 65%, and that of MR arthrography was reported to be about 92-95% compared to surgical results. According to the current literature, MR arthrography is the most sensitive method to delineate these kind of pathologies. Therefore, the invasive technique of MR arthrography may be justified for the correct diagnosis of these kind of pathologies after other pathologic entities have been ruled out by conventional MRI.

Acetabulum↗
PubMed2005

Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging.

PURPOSE: To compare the accuracy of multi-detector row computed tomographic (CT) arthrography and magnetic resonance (MR) imaging in depicting tears of dorsal, central, and palmar segments of scapholunate (SL) and lunotriquetral (LT) ligaments in cadavers. MATERIALS AND METHODS: Cadaver wrists were obtained and used according to institutional guidelines and with informed consent of donors prior to death. Nine cadaver wrists of eight subjects were evaluated. MR images were obtained with a 1.5-T MR unit. Imaging protocol included intermediate-weighted coronal and transverse fast spin-echo and coronal three-dimensional gradient-echo sequences. Multi-detector row CT arthrography was performed after tricompartmental injection of 3-6 mL of contrast material with a concentration of 160 mg per milliliter of iodine. Palmar, dorsal, and central segments of both ligaments were analyzed on transverse and coronal MR images and multiplanar multi-detector row CT reconstructions by two musculoskeletal radiologists working independently. Open inspection of the wrists was the reference standard. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated from the imaging and gross pathologic readings. Statistical significance was calculated with the McNemar test. Weighted kappa values for interobserver agreement were calculated for both imaging modalities. RESULTS: All ligament segments could be visualized in all cases with both imaging modalities. CT arthrography was more sensitive (100%) than MR imaging (60%) in detection of palmar segment tears (P = .62); specificity of both imaging modalities was 77%. Sensitivity (CT arthrography, 86%; MR imaging, 79%) and specificity (CT arthrography, 50%; MR imaging, 25%) for detection of the central segment tears were determined. Dorsal segment tears were detected only with CT arthrography, while all tears were missed with MR imaging (P = .02). Interobserver agreement was better for multi-detector row CT arthrography (kappa = 0.37-0.78) than for MR imaging (kappa = -0.33 to -0.10). CONCLUSION: Performance in depiction of palmar and central segment tears of SL and LT ligaments is almost equal for multi-detector row CT arthrography and MR imaging, with much higher interobserver reliability for CT arthrography. CT arthrography is significantly superior to MR imaging in the detection of dorsal segment tears of SL and LT ligaments.

Aged↗
PubMed1996

Surgeons' decision making in patients with chronic wrist pain: role of bilateral three-compartment wrist arthrography--prospective study.

PURPOSE: To determine if wrist arthrography changes surgeons' diagnoses and treatment plans for patients with chronic wrist pain. MATERIALS AND METHODS: Bilateral, three-compartment wrist arthrography was performed in 64 patients. Prospective questionnaires evaluated surgeons' diagnoses and management plans at three stages: before arthrography, after arthrography of the symptomatic wrist, and after arthrography of the asymptomatic wrist. RESULTS: Surgeons tended to plan more conservative management after receiving the results of arthrography. The number of patients for whom the reported treatment plan included surgery dropped from 28 of 64 patients (44%) to 19 of 64 patients (30%) after review of the arthrography results (P = .05). The number of patients for whom the treatment plan included treatment of any kind dropped from 55 of 64 patients (86%) to 49 of 64 patients (77%) after review of the arthrography results (P = .09). An overall change in treatment plan occurred in 29 of 64 patients (45%). CONCLUSION: Wrist arthrography influences surgeons' decision making. After reviewing the results of arthrography, surgeons tended to change treatment plans toward more conservative, less invasive treatment.

Adult↗