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A practical approach to the arthrography of the temporomandibular joint is presented. More than 80 cases have been performed in one year in our institution with the failure rate of less than 10% and very low complication rate. Advantages and disadvantages of arthrography compared to MR are discussed.
Fifteen patients with painful total hip prostheses were referred for nuclear medicine and roentgenographic arthrography studies to exclude loosening of the acetabular and/or the femoral component. A new radioisotopic technique suitable for the evaluation of both components was developed using dual-isotope single-photon tomography with 99mtechnetium methylene diphosphonate bone imaging and indium-111 diethylenetriaminepentacetic acid arthrography. Thirteen of the 15 subjects were subsequently treated with additional surgery. The surgical findings were compared with the nuclear medicine and roentgenographic results. The overall diagnostic accuracy of both arthrographic procedures was approximately 80%, but the roentgenographic arthrogram was more sensitive and the radionuclide arthrogram was more specific.
The authors performed a statistical study on a series of 1000 patients examined with double-contrast fluoroscopically-guided knee arthrography. Arthrographic diagnoses were compared with the arthrotomic (500 patients), arthroscopic (350 patients) or clinical diagnoses of 150 patients with a follow-up of 6 months. In this series of patients with a history of "recurrent meniscal injury", arthrographic diagnoses were confirmed in a high percentage of cases, with 96.9% accuracy, 96.7% sensitivity for tears, and 98.6% specificity. On the basis of these results the authors suggest double-contrast arthrography as an examination of considerable value in the diagnosis of meniscal lesions, while in their opinion arthroscopy should be limited to questionable cases, to complex lesions with involvement of multiple articular structure and to the alterations clearly treatable by arthroscopy.
Birth injuries of the shoulder and proximal humerus of infants can be difficult to evaluate on plain radiographs because of lack of ossification in the proximal humeral epiphysis. We here describe arthrography of the infant shoulder and advocate it as a useful diagnostic procedure in the evaluation of humeral fractures and brachial palsies. Two infants with birth injuries of the shoulder are described. The value of dynamic fluoroscopic evaluation of the injured joint in conjunction with arthrography is illustrated in evaluation of a brachial plexus palsy.
We re-examined 800 arthrographies performed between 1984 and 1986 according to the Lindblom-Ficat-Philippe method. 280 had pure meniscal lesions. In the remaining 520 cases, arthrography revealed extrameniscal pathology, sometimes associated with meniscal lesions, as well as other pathologies which were either negative or equivocal. The purpose of this study was to emphasize the advantages of a simple method of diagnosis applicable to out patients in the study of extrameniscal pathologies which are often concealed by the associated meniscopathy. In fact, it is possible to observe chondral, synovial, capsular and ligamentous pathologies which may be very useful as a prelude to diagnostic arthroscopy, which we consider to be a second level test.
One hundred and ninety-three shoulder arthrographies were performed between 1979 and 1985 on patients affected by recurrent dislocations. The diagnostic doubt was cleared up in 162 cases (83%). Arthrographic diagnosis was confirmed by pathological findings in 92% of the patients who underwent surgery. The double-contrast technique under local anaesthesia with anterior access is suggested, since it allows several arthrograms in different projections. Thus, an analytic study of the articular damage can be carried out. The patterns of each projection are briefly shown. Revision of case histories points out that: a) the use of arthrography should always be assessed on a clinical-radiological basis for each patient; b) there is no doubt as to the usefulness of this examination as a direct means of exploration, as far as the articular damage is concerned, not only as an aid to future surgery, but also in the follow-up of the results of the treatment in the long run.
Arthrography shows a Bankart lesion in 28% of all first shoulder dislocations. Recurrences (17.3%) are found only in this group. Arthrography is therefore a simple and important procedure in the examination and prognosis of the shoulder dislocation.
Arthrography was performed during the last 12 months in 14 patients who had 2 months to 10 years after implantation of a silicone-elastomer- or fascia-lata-prosthesis recurrent complaints in their operated wrists. Following an extensive radiological native examination either midcarpal or radiocarpal arthrography was performed in dependence of the site of carpal-bone-substitute. Inflammatory changes of the prosthetic bed, missing penetration of contrast medium into the periprosthetic space and other less common additional findings showed the advantages of the relatively handsome procedure.
Results of 104 arthrotomography scans with contrast of temporomandibular joints of 71 patients are used to define normal arthrography criteria (15.4% of cases). Reducible anterior displacements represented 28.8% of cases, non-reducible displacements 40.4%, perforations 12.5% (5.8% associated with a reducible luxation, 6.7% with a non-reducible luxation). The failure rate was 2.9%. Arthrography provides important information on articular morphology and dynamics, the state and position of the meniscus and of the posterior brake, and the state of the joint capsule. Performed by an experienced operator it possesses few complications.
A prospective double-blind study was performed to assess the side effects and visualization quality of 2 contrast media, iohexol and meglumine iothalamate in single contrast arthrography. There were very few adverse reactions during the examination. During the 2 days after arthrography pain occurred in about 29% of each group. Iohexol caused somewhat less delayed pain on movement and fewer sensations of swelling than iothalamate. The quality of the arthrograms was significantly better with iohexol both in films taken immediately after injection as well as after 20 minutes.
Digital subtraction arthrography (DSA) was performed in 14 patients in the evaluation of painful hip prostheses. Information about component loosening seems to be as reliable as with conventional arthrography. The examination time is very short, and results are immediately available. Electronic image manipulation allows the examiner to produce optimal picture quality.
The authors carried out a study of contrast arthrography in 48 cases of primary genu varum, i.e. not secondary to trauma or to pathological conditions of the hip or foot. The patients all had symptoms and were classified according to the commonly used Trillat-Dejour method into four groups or stages depending on the degree of varus and the radiographic and arthrographic findings. Associated lesions secondary to the basic pathology were observed in all cases. These ranged from hypertrophic synovitis to torn medial or lateral menisci up to total compromise of the joint typical of stage 4 arthritic varus knee. In these patients, contrast arthrography is useful in planning surgery, particularly high tibial osteotomy. It also enables the surgeon to decide whether complementary intra-articular measures are indicated without having to resort to arthroscopy. This is always a more invasive method, necessitating general anaesthesia, as these knees are quite painful and the arthroscopic access is difficult.
Findings on arthrography of posterior lumbar spine joints in 55 patients were compared with those reported in the literature. Two major degenerative lesions of these joints, diverticula and cysts, can provoke back pain and symptomatic nerve compression. Whereas diagnosis of a cyst is dependent mainly on computed tomography imaging, that of a diverticulum is ensured by arthrography, an investigation which also has a therapeutic aim since it allows infiltrations to be performed.
A new method is described for verification of needle placement during hip aspiration or hip arthrography using suction air arthrography. The method is safe, rapid, reliable, and reproducible, and it eliminates problems with obscuring pathology by incorrect injection of dye or air, reactions to dye, or air embolism.
The authors face the problem of accuracy, specificity and sensitivity of double-contrast arthrography in meniscal injury of the knee. They report the results obtained in a clinical-statistic and retrospective investigation on 206 patients. The final diagnoses were obtained by arthrotomy (105 cases) by arthroscopy (70 cases) and clinically with a follow-up of 6 months (31 patients). Diagnostic accuracy (94,5%), sensibility (92%), specificity (98,7%) and predictive values on positives (99%) and negatives (87,5%), confirm double-contrast arthrography as a highly accurate examination. A specific diagnosis can be made only when the diagnostic modalities are correctly applied and the arthrographers are qualified.
Single contrast knee arthrography was performed in a group of 50 patients, using either Urografin or Ioexol as contrast agents. Both contrast media were well tolerated clinically and no significant difference was found to exist as far as image quality is concerned. However, while Urografin produced a significant increase of the white cells in the synovial fluid, no inflammatory change was observed in the synovial fluid after Ioexol. So we believe that Ioexol is a significantly preferable contrast medium in arthrography, especially in patients with inflammatory joint diseases.
Arthrography using the contrast medium Hexabrix was performed in 120 patients. The knee arthrographies executed in double-contrast technique showed very good contrast, thanks to the chemical and physical properties of the contrast medium, in x-rays taken 1 to 3 minutes after injection of the contrast medium. Even if the x-ray films were taken 15 minutes after administration of the contrast medium, the results were still good. The contrast medium is well tolerated.
In a prospective study of 22 patients (24 hips) with Legg-Calvé-Perthes disease (LCPD) the findings at conventional radiography, arthrography, bone scintigraphy and MR imaging, obtained at the time of diagnosis, were compared. MR was superior to conventional radiography and bone scintigraphy in the detection of the extent of involvement in the femoral head. Arthrography was as good as or better than MR imaging in determining the shape of the articular surfaces and the occurrence of lateral subluxation. Conventional radiography was less sensitive in identifying the degree of lateral subluxation and the extent of the necrosis in the femoral head. MR imaging provided anatomical and pathophysiological information about the extent and location of head involvement as well as the degree of lateral subluxation. Revascularisation was more clearly demonstrated with MR than with bone scintigraphy, irrespective of symptom duration.