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PubMed2000

Is a mixture of gadolinium and iodinated contrast material safe during MR arthrography?

OBJECTIVE: This study was designed to determine whether a mixture of iodinated contrast material and gadopentetate dimeglumine used during MR arthrography yields free gadolinium ion, a systemically toxic metal. MATERIALS AND METHODS: Mixtures of commercially available nonionic and ionic iodinated contrast agent, gadopentetate dimeglumine, lidocaine, and epinephrine were analyzed using a spectrophotometric titration with a gadolinium ion titrant and methyl thymol blue indicator. RESULTS: We found no significant dissociation of gadolinium ion when gadopentetate dimeglumine was mixed with iodinated contrast agents, lidocaine, or epinephrine in any of the dilutions tested. CONCLUSION: Gadopentetate dimeglumine and iodinated contrast material can be mixed before MR imaging without any release of free gadolinium and are therefore safe for confirming the intraarticular placement of contrast material before MR arthrography.

Arthrography↗
PubMed2003

MR imaging, MR arthrography, and specimen correlation of the posterolateral corner of the knee: an anatomic study.

OBJECTIVE: We sought to evaluate the anatomy of the posterolateral aspect of the knee with anatomic dissection, MR imaging, MR arthrography, and sectional anatomy. MATERIALS AND METHODS: We assessed the posterolateral corner of the knee during dissection of one gross anatomic specimen. MR imaging and MR arthrography were performed in seven additional knee specimens. T1-weighted spin-echo MR images were obtained in the standard imaging planes as well as in the coronal oblique plane. The specimens underwent T1-weighted spin-echo MR imaging after administration of intraarticular contrast material and were sectioned into planes corresponding to those of the MR images. RESULTS: At anatomic dissection, the following posterolateral structures were identified: the arcuate ligament (medial and lateral limbs), fabellofibular ligament, popliteofibular ligament, popliteus tendon and its two posterior attachments to the lateral meniscus, fibular collateral ligament, direct and anterior arms of the tendon of the long head of the biceps femoris muscle, and direct and anterior arms of the tendon of the short head of the biceps femoris muscle. Correlation of MR imaging and anatomic findings showed that the popliteofibular ligament and oblique popliteal ligament were found in 57% and 100% of specimens, respectively. At least one of the two limbs of the arcuate ligament was identified in 71% of specimens. The fabellofibular ligament was not identified on MR images in any of the specimens. The anteroinferior and posterosuperior popliteomeniscal fascicles were identified in all specimens. CONCLUSION: The posterolateral corner of the knee comprises complex and variable anatomic structures. Recognition of these variations is important in the assessment of MR images of the knee.

Arthrography↗
PubMed2005

Optimization of gadodiamide concentration for MR arthrography at 3 T.

OBJECTIVE: The purpose of our study was to determine the optimal concentration of a gadolinium-based contrast agent (gadodiamide) for direct MR arthrography at 3 T compared with 1.5 T in an in vitro study. CONCLUSION: Optimized concentrations of gadolinium-based contrast agents for MR arthrography are similar at 3 and 1.5 T, although a slightly greater dilution may be useful at 3 T. Signal-to-noise ratio peak levels are significantly reduced by adding an iodinated contrast agent, relatively significantly more at 3 T than at 1.5 T.

Arthrography↗
PubMed1996

Diagnosis of ligament rupture of the ankle joint. Physical examination, arthrography, stress radiography and sonography compared in 160 patients after inversion trauma.

We prospectively enrolled 160 consecutive patients with inversion trauma of the ankle in a diagnostic protocol that included physical examination within 2 days and at 5 days after trauma, arthrography, stress radiography, and ultrasonography. 135 patients had pathological lateral ligament laxity on the later physical examination or lateral ligament rupture diagnosed on arthrography and they were operated on 122 of these patients had ligament ruptures. At clinical follow-up after a minimum of half a year, all of the patients who were not operated on had stable joints without signs of previous ligament ruptures. Delayed physical examination at 5 days after the injury led to the highest overall sensitivity (96%) and specificity (84%) for the detection of a ligament rupture. Additional diagnostic procedures, at a considerable cost, yielded little additional information.

Adolescent↗
PubMedDate not supplied

Color subtraction arthrography in the diagnosis of component loosening in hip arthroplasty.

While component loosening in arthroplasty of the hip joint may not always be associated with pain, the painful total hip arthroplasty frequently can be shown to be associated with loosening of one or both components. The application of color subtraction techniques to routine arthrography of the hip has greatly increased the authors' accuracy in identifying component loosening in the painful total hip. The technique and its method of application are described in this preliminary report. Several examples of its use are presented. The authors have found this technique to be a useful adjunct to routine arthrography of the hip in selected instances. It has improved overall diagnostic accuracy and is more rapid and less costly than standard photographic subtraction techniques.

Arthrography↗
PubMed2000

[Indirect MR arthrography in the diagnosis of rotator cuff lesions].

PURPOSE: To determine the value of indirect MR arthrography in lesions of the rotator cuff, prospectively versus arthroscopy. METHODS: 63 patients with suspected shoulder pathology were examined: oblique-coronary and axial T1w sequences, axial FLASH-2D sequences, furthermore oblique-coronary T2- and PD-weighted sequences were taken. After intravenous administration of 0.1 mmol Gd-DTPA/kilogram body weight and active motion of the shoulder T1w sequences were repeated. Signal intensities (SI) inside the tendon were quantitatively measured by the ROI technique (region-of-interest) and the percentual contrast-enhancement CE was calculated. In 32 patients the results were confirmed by surgical follow-up. RESULTS: The mean SI measured in the supraspinous tendon were higher in lesions (degeneration, impingement, partial and total rupture), before as well as after contrast medium, compared to intact findings (p < 0.05). Similarly the percentual CE (p < 0.05) was higher. We detected 9 total ruptures and three impingements (for both sensitivity before/after Gd-DTPA 100%), furthermore 6 partial ruptures. Of the latter three were false positive and one false negative, leading to a sensitivity of 75% and a specificity of 50%. CONCLUSION: The visualization of rotator cuff lesions can be optimized with indirect MR arthrography. The detection of partial ruptures remains faulty, because the exact demarcation of degenerative change and partial rupture is still difficult.

Adolescent↗
PubMed2002

Magnetic resonance arthrography of the labral-ligamentous complex of the shoulder: an update.

Magnetic resonance (MR) arthrography is increasingly replacing conventional MR imaging for many clinical indications in the shoulder. It is particularly useful in providing additional information about structures which form the labral-ligamentous complex, an important stabilizer of the shoulder. These structures are the fibrocartilaginous glenoid labrum, the glenohumeral ligaments, and the long head of the biceps tendon. The MR arthrographic technique is reviewed, together with anatomical considerations, including normal variants, relating to the labral-ligamentous complex. Lesions such as glenoid labral tears, SLAP lesions, glenohumeral ligament tears, loose bodies and paraglenoid cysts can be demonstrated. In summary, MR arthrography is a useful imaging technique that provides detailed information about the labral-ligamentous complex, particularly when surgery is being contemplated.

Arthrography↗
PubMedDate not supplied

[Arthrography in congenital hip dislocation].

The paper is concerned with the results of contrast arthrography in 73 children with hip joint dysplasia, among which true dislocations prevailed (70 patients). In addition to bone alterations, arthrography revealed various soft tissue changes like hypertrophy and deformity of limbus, soft tissue interposition, separation of the articular sac with the presence of an isthmus, disintegration of articular cartilages. These findings are used to define indications for surgical intervention as well as for planning the area of operation.

Arthrography↗
PubMed1992

[Technique and interpretation of arthrography of the temporomandibular joint. Study of 120 cases].

The goal of the study was to assess the predictive value of inferior joint space arthrography for detection of abnormalities found during surgery. Therefore, a retrospective analysis of arthrographic and surgical findings in 120 joints was performed. Arthrography showed high accuracy for detection of anterior disk displacement (90%) and disk perforation (90.8%). The shape of the anterior recess proved to be the most valuable arthrographic criterium for detection of anterior disk displacement. Cinematographic registration of joint dynamics after injection of contrast material and arthrotomographic analysis of the shape of the superior margin of the anterior recess of the inferior joint space were necessary for an optimal evaluation of the disk position.

Arthrography↗
PubMed1991

[Double-contrast arthrography of the knee: a digital technique study].

From October 1989, in our Radiology Department, digital radiographic techniques have been applied to double-contrast arthrography of the knee. In this preliminary work we examine the diagnostic contribution of computed radiography to arthrographic findings by comparing image quality of conventional and digital radiographs using a dedicated Philips unit. The digital unit is compatible with all the extant radiographic equipment in our department and automatically supplies two images, the first one resembling a conventional radiograph, the second one characterized by a broader exposure range that allows a clear visualization of soft tissues. To obtain high-quality radiographs the processing curves of the system were modified, in particular by shifting the curve leftward, thus reducing its slope, and by amending the parameters related to spatial frequencies. The changes in the reading curves made these images more useful: they were more homogeneous and allowed a better evaluation of fine details. Relative to the second type of images, characterized by both edge enhancement and a broader recording range, it was enough to shift the curve along the X-axis to compensate for a moderate image overexposure. Keeping in mind that the aim of this preliminary work was not compare the two techniques from a diagnostic point of view, in the authors' opinion the two yield similar information for the diagnostic evaluation of meniscal traumas. On the contrary, if the same principles are applied to the evaluation of capsulo-ligamentous components, digital arthrography appears to be more accurate than the conventional technique, the latter being deceptive especially in the evaluation of cruciate ligaments.

Arthrography↗
PubMed1990

A comparative study of ultrasonography and arthrography in evaluation of the rotator cuff.

Fifty patients with signs and symptoms of chronic impingement syndrome and/or rotator cuff tear were evaluated with shoulder arthrograms and ultrasonography. Ninety asymptomatic shoulders of a comparable age had ultrasonography to serve as a control group. All controls had normal ultrasonograms with no hypoechoic or sonolucent areas. The 50 symptomatic shoulder patients had the following: 28 had a normal arthrogram with either normal ultrasonograms or buckling of the supraspinatus tendon; eight had normal arthrograms, but ultrasonography indicated a thin (less than 4 mm) irregular supraspinatus tendon; 11 had complete rotator cuff tears visualized on both arthrography and ultrasonography (nine of these 11 patients had surgery confirming complete tears in all); two had a false-positive sonogram, and one had a false-negative sonogram. Thus, the ultrasonography's overall positive predictive value to detect a full-thickness rotator cuff tear was 85%, its negative predictive value was 97%, its sensitivity was 92%, and its specificity was 95%. Real-time ultrasonography is a diagnostically sensitive and specific noninvasive method to evaluate patients with shoulder impingement syndrome, leading to the recommendation that it be used as a primary imaging technique to obviate or supplement arthrography in evaluating rotator cuff disease. However, static ultrasonographic pictures, without real-time ultrasonography as a supplement, were not helpful.

Adult↗
PubMed1990

Digital subtraction arthrography of the wrist.

Digital subtraction arthrography of the wrist was used to identify abnormalities in eighty-six (60 per cent) of 139 patients during a fifteen-month period. Multiple abnormalities were noted in thirty-four (25 per cent) of the wrists. The clinical signs and symptoms in the eighty-six wrists did not always correlate with the defects that were seen on the arthrograms. Three of five patients who had an isolated tear of the scapholunate ligament, six of thirteen who had an isolated tear of the lunotriquetral ligament, and seven of nineteen who had an isolated tear of the triangular fibrocartilage complex also had signs and symptoms on the opposite side of the wrist. Many of the lesions that were seen on arthrography may have been serendipitous, degenerative, or unrelated to a specific injury. There was a high prevalence of positive ulnar variance in patients who had at least one ulnar abnormality. Capsular tears, most often seen on the radiovolar aspect of the wrist, were best outlined by contrast medium injected into the radiocarpal joint. The arthroscopic findings differed from the arthrographic findings in five of the twenty patients in whom both studies were done. The three-compartment technique of injection is a valuable diagnostic tool. Injections of contrast medium into the distal radio-ulnar joint outlined five of thirteen tears of the triangular fibrocartilage complex that were not seen after injection into the radiocarpal joint. Of the eleven tears that were seen after injection into the radiocarpal joint, five were not seen when contrast medium was injected into the distal radio-ulnar joint.

Adolescent↗
PubMed1990

Arthrography. Where does it fit in?

Although magnetic resonance imaging and arthroscopy, respectively, have become state-of-the-art techniques for imaging and treating knee ailments, arthrography remains a useful, cost-effective technique in the evaluation of the meniscal abnormalities. Arthrography is a viable procedure in the initial assessment of suspected meniscus pathology.

Arthrography↗
PubMed1990

[A comparison of arthrography and magnetic resonance tomography in painful limited movements of the hand].

In 18 patients with unclear pain in the wrist limiting hand movement, arthrography and magnetic resonance imaging (MRI) were compared. The FISP gradient echo sequence turned out to be superior to the T1 weighted spin-echo sequence in the imaging of the triangular fibrocartilage complex. MRI is very sensitive in detecting triangular fibrocartilage lesions and therefore represents a suitable non-invasive screening method. It is, however, not possible to assess the degree of the lesion. Ruptures in carpal tendons could only be diagnosed by means of arthrography.

Adult↗
PubMed1990

[Arthrography of the temporomandibular joint].

In 1989, opaque contrast arthrography of temporomandibular joint is still seldom used. A brief historical review of the procedure is presented here, and the technique of puncturing the menisco-condylar and menisco-temporal compartments is discussed. The value of injecting opaque contrast material into the lower compartment and carrying out kinetic and tomographic studies as well as bilateral examinations is stressed. Normal aspects are described with their variants, as well as pathological ones (reducible and non-reducible luxations, perforations, distension of the bilaminar zone, adhesions, etc.). Both the place of arthrography in relation to other investigations (TDM, IRM) and its indications for visualization of menisco-condylar problems are discussed.

Arthrography↗
PubMed1990

[Arthrography of the hip. Role of the acetabular rim].

The authors describe the technique of arthrography of the hip and the aspect of the limbus in the normal hip as well as in subluxation and different types of dislocation. Arthrography may establish whether a dislocated hip may be reduced by conservative means. This radiological technique is reliable when reduction, or stabilization are unsatisfactory or after previous treatment failure.

Acetabulum↗