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PubMed2002

The hamatolunate facet: characterization and association with cartilage lesions--magnetic resonance arthrography and anatomic correlation in cadaveric wrists.

The objective of this study was to characterize the appearance of the hamatolunate facet using high-resolution magnetic resonance (MR) arthrography in cadavers and to correlate the presence of this anatomic variant with the presence of osteoarthritis in the wrist. High-resolution MR images of 22 cadaveric wrist specimens were obtained after tri-compartmental arthrography. Two readers in consensus analyzed the MR images and recoded the presence or absence of a hamatolunate facet. Geometric characteristics and cartilage and ligament integrity were analyzed. A third reader, who was blinded to the purpose of the study, recorded cartilage lesions of all the bones of the proximal and distal carpal rows. A hamatolunate facet was present in 11 of 22 wrists (50%). The mean coronal size of the lunate facet at the lunate (type II lunate) was 4.5 mm (range, 2-6 mm). The highest frequencies of cartilage lesions were seen in the scapho-trapezio-trapezoid joint (45.5%) and at the proximal pole of the hamate (54.4% and 40.9% for consensus reading/blinded reading, respectively). In cases with a hamatolunate facet, the frequency of cartilage lesions in the proximal pole of the hamate was 81.8% and 63.6% versus 27.3% and 18.2% without such a facet (chi-squared, P=0.01/ P=0.03). No correlation of the presence of a hamatolunate facet with interosseous ligament tears or lesions of the triangular fibrocartilage was seen. In conclusion, the hamatolunate facet is a very common anatomic variant. The presence of a hamatolunate facet is associated with cartilage damage in the proximal pole of the hamate.

Aged↗
PubMed2003

MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation.

OBJECTIVE: Partial thickness tears of the undersurface (articular surface) of the rotator cuff (RTC) have been recognized increasingly in recent years as a source of treatable shoulder pain in the athletic population. This study evaluated the efficacy of MR arthrography (MR-ARTH) in diagnosing these tears. DESIGN AND PATIENTS: The study design was a retrospective review of medical records of patients who had presented with refractory shoulder complaints and subsequently undergone MR arthrography with multiple signal MRI sequences followed by shoulder arthroscopy. Of particular interest were patients who had oblique T1 fat suppression (COT1FS), coronal oblique T2 (COT2), and coronal oblique T2 fat suppression (COT2FS) images taken. Seventy-six subjects met the study criteria. Investigators examined the MR-ARTH images from these patients' charts while blinded as to arthroscopic results, clinical signs and symptoms. RESULTS: Based on COT1FS images, investigators identified nine subjects as having had full thickness tears, 28 as having had partial thickness tears of the undersurface of the rotator cuff (PRTC), and 39 as having had intact RTC. These results were compared to actual findings at arthroscopy: nine full thickness tears, 26 of 28 with PRTC and 34 of 39 intact. The sensitivity of MR-ARTH was 84%, with a positive predictive value of 93%. The overall accuracy was 91% (69/76). The specificity was 96%. That is, if a PRTC was not seen on the MR-ARTH images, it was very unlikely to exist. COT2 and COT2FS sequences failed to increase sensitivity and overall efficacy of MRI. CONCLUSION: PRTC can be diagnosed accurately by MR-ARTH with gadopentatate contrast. A COT1FS sequence is recommended for evaluation when tears are suspected.

Adolescent↗
PubMed2005

The use of MR arthrography to document an occult joint communication in a recurrent peroneal intraneural ganglion.

The pathogenesis of intraneural ganglia remains controversial. Only half of the reported cases of the most common type, the peroneal nerve at the fibular neck, have been found to have pedicles connecting the cysts to neighboring joints detected with preoperative imaging or intraoperatively. We believe that all intraneural ganglia arise from joints, and that radiologists and surgeons need to look closely preoperatively and intraoperatively for connections. Not identifying these connections with imaging and surgical exploration has led not only to skepticism about an articular origin of the cyst, but also to a high recurrence rate after surgery. We present a patient who had two recurrences of a peroneal intraneural ganglion in whom a joint connection was not detected on previous MRIs and operations. Reinterpretation of the original films and high-resolution MRI demonstrated an "occult" joint connection to the superior tibiofibular joint. MR arthrography performed after exercise and 1 h delay, however, clearly showed the connection and communication. The joint connection was then confirmed at surgery through an articular branch. Postoperatively the patient regained nearly normal neurologic function, and follow-up MRI showed no cyst recurrence. MR arthrography with delayed imaging should be considered in cases of intraneural ganglia when a joint connection is not obvious on MRI.

Adult↗
PubMed1996

Humeral avulsion of the anterior shoulder stabilizing structures after anterior shoulder dislocation: demonstration by MRI and MR arthrography.

OBJECTIVE: To demonstrate the MRI findings of an anterior shoulder capsular avulsion from the humerus, with or without subscapularis rupture, after anterior dislocation or severe abduction external rotation injury. DESIGN AND PATIENTS: We retrospectively reviewed the MRI and MR arthrographic examinations of seven patients who were identified at surgery with avulsion of the anterior shoulder stabilizers from the humerus. MRI was correlated with clinical history and surgical results. RESULTS: MRI findings included: inhomogeneity or frank disruption of the anterior capsule at the humeral insertion (all), fluid intensity anterior to the shoulder (six patients), tear of the subscapularis tendon (six patients), dislocation of the biceps tendon (four patients), and a Hill-Sachs deformity (four patients). MR arthrography additionally found extravasation of contrast through the capsular defect (two patients). CONCLUSIONS: Our findings suggest that MRI is helpful for diagnosing humeral avulsion of the anterior glenohumeral capsule, especially when a tear of the subscapularis tendon insertion is present. MR arthrography may be of benefit for diagnosing capsular avulsion without associated subscapularis tendon abnormality.

Adult↗
PubMed2005

Adhesive capsulitis of the shoulder: evaluation with MR arthrography.

The purpose of this study was to determine the usefulness of magnetic resonance (MR) arthrography for diagnosing adhesive capsulitis. Shoulder MR images of 28 patients with (n=14) and without (n=14) adhesive capsulitis were retrospectively analyzed. MR images were assessed for capsule and synovium thickness as well as the width of the axillary recess on oblique coronal fat-suppressed T1-weighted images and T2-weighted images, respectively. On oblique sagittal fat-suppressed T1-weighted images, the width of the rotator interval and the presence of abnormal tissue in the interval were evaluated. Significant differences were found between the two groups in capsule and synovium thickness on both sides of the recess on oblique coronal T2-weighted images (P=0.000), whereas thickness on the humeral aspect showed no significant difference on oblique coronal fat-suppressed T1-weighted images (P=0.109). On oblique coronal T2-weighted images, a cut-off value of 3-mm thickness gave the highest diagnostic accuracy for adhesive capsulitis with sensitivity, specificity, and accuracy of 79% (11/14), 100% (14/14), and 89% (25/28) at the humeral side and 93% (13/14), 86% (12/14), and 89% (25/28) at the glenoid side, respectively. There were significant differences in rotator interval width, presence of abnormal tissue in the rotator interval, and axillary recess width between the two groups (P<0.05). Thickness of capsule and synovium of the axillary recess greater than 3 mm is a practical MR criterion for diagnosing adhesive capsulitis when measured on oblique coronal T2-weighted MR arthrography images without fat suppression. The presence of abnormal tissue in the rotator interval showed high sensitivity but rather low specificity.

Adult↗
PubMed2006

MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls.

The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiographs.

Adult↗
PubMed2000

MR arthrography of the hip: normal intra-articular structures and common disorders.

This pictorial review illustrates the anatomical features of normal intra-articular components of the hip and their common disorders on MR arthrography. On T1-weighted MR arthrograms, the normal contrast-filled joint cavity shows a homogeneous high signal intensity. Normal acetabular labrum appears as a well-delineated triangle showing a low signal intensity, surrounded by contrast material in the perilabral recess. Intra-articular paramagnetic contrast outlines labral tears, loose bodies, communicating labral cysts and cartilage lesions (traumatic tears, focal defects, degenerative fissures and thinning), and improves their detection. Overall, MR arthrography enables accurate detection and staging of hip intra-articular structure abnormalities.

Hip Joint↗
PubMed2000

MR arthrography of the shoulder: comparison of low-field (0.2 T) vs high-field (1.5 T) imaging.

The objective of this study was to compare the image quality, sensitivity, specificity, and diagnostic accuracy of an open low-field MR system (0.2 T) with a standard high-field MR system (1.5 T) after arthrography of the shoulder. Thirty-eight patients either with suspected chronic instability (n = 12) or rotator cuff abnormalities (n = 26) were examined. Intra-articular injection of diluted Gd-DTPA was followed in randomized order either first by imaging on an open 0.2-T system or on a 1.5-T system. The image material was evaluated independently by two radiologists in a blinded fashion with respect to overall image quality and the detection of rotator cuff as well as capsular and labral abnormalities. Surgical correlation was available in 27 (71%) of 38 patients. For both systems, sensitivity and specificity for rotator cuff tears were 100% each, and for labrum pathologies, these values were 100 and 93%, respectively. The agreement for detection of labral pathologies between low-field and high-field examinations was good (kappa = 0.69, kappa = 0.61). For the detection of full-thickness tears of the rotator cuff, the agreement between the low-field and high-field MR examinations was very good and significant (kappa = 0.94, kappa = 1, p < 0.001). Overall image quality was rated good in 17 (45%) and fair in 21 (55%) of 38 cases on the 0.2-T MR system, and good in 32 (84%) and fair in 6 (16%) of 38 cases on the 1.5-T system. Motion artifacts were considered low in 24 (63%) and moderate in 14 (37%) of 38 cases for the 0.2-T system and low in 34 (89%) and moderate in 4 (11%) for 1.5-T system. Based on our results, low-field MR compares favorably to high-field MR in the detection of major abnormalities of the glenohumeral joint, at least when MR arthrography is used. Disadvantages are the duration of the examination and thus the risk of reduced image quality caused by motion artifacts.

Adult↗
PubMed2006

One-shot CT and MR arthrography of the shoulder with a mixture of iodinated and paramagnetic contrast agents using arthroscopy as a gold standard.

PURPOSE: Our aim was to perform computed tomography arthrography (CTA) and magnetic resonance arthrography (MRA) of the shoulder as a one-shot examination and to evaluate its value on the basis of arthroscopy as a gold standard. MATERIALS AND METHODS: Fifteen men and 16 women with planned arthroscopy for chronic (n=17) or traumatic tear of the rotator cuff (n=8), congenital atraumatic (n=1) or traumatic glenohumeral instability (n=2), traumatic tear of the rotator cuff with glenohumeral instability (n=1), or "frozen shoulder" (n=2) underwent plain helical CT in neutral position and intra-articular CT-guided injection of a mixture of iodinated and paramagnetic contrast agents (gadodiamide at 1:250 and iobitridol 350 at 1:5 in 20 ml of saline solution). CT helical scans in intra- and extrarotation and T1-weighted MRA scans in the neutral position were obtained. CTA and MRA were evaluated separately and jointly (CTA-MRA) in different blinded sessions, giving a 0-3 score to the agreement of CTA, MRA, and CTA-MRA with arthroscopy. RESULTS: The injected volume of the solution ranged from 10 to 24 ml. No side effects were observed. CTA obtained a score of 2.33+/-0.62, MRA 2.47+/-0.52, and CTA-MRA 2.67+/-0.49. Significant differences were found for CTA-MRA versus CTA (p=0.0281) and MRA (p=0.0277). There was no significant difference for CTA versus MRA. CONCLUSIONS: CTA and MRA can be performed as a one-shot exam. CTA-MRA seems to give more information than CTA or MRA separately.

Adult↗
PubMed1984

Arthrography of the temporomandibular joint.

The TMJ is anatomically and functionally complex. Arthrography has shown that anatomic abnormalities account for many causes of TMJ dysfunction. Arthrography is a valuable tool for understanding TMJ disorders and assisting in the establishment of a rational basis for treatment planning.

Cartilage, Articular↗
PubMed1983

Temporomandibular joint arthrography: negative pressure, nontomographic techniques.

The injection of contrast material through a catheter under direct fluoroscopic vision seems to be more informative than blind injection technique. Injection of a controlled amount of Renografin can diminish the likelihood of overfill and allow more complete opening of the mouth. If overfilling is suspected, after waiting approximately 15 minutes for absorption, the patient will then be able to move his condyle more freely. The use of a 100 mm. camera will provide good films and eliminate the need for tomograms. A catheter is preferred over a steel needle, and its position is more accurately assessed by using the negative pressure technique. Catheterization of the superior joint space is not done if the lower compartment injection shows obvious anterior subluxation of the meniscus. In certain borderline cases, the upper compartment filling may yield more positive diagnotic information. It is within the scope of this article to present a technique, not to indicate the usefulness or necessity of TMJ arthrography or tomography. The role of arthrography in the diagnosis and subsequent decision as to whether surgical or nonsurgical modalities should be performed will become evident only when the state of the art is defined.

Adult↗
PubMed1989

Panoramic radiography for temporomandibular joint arthrography: a description of arthropanoramograms.

TMJ arthrograms done with panoramic radiography, i.e., arthropanoramography, can demonstrate intracapsular disk displacement and perforation pathoses. These views are very practical for inferior synovial cavity arthrograms performed in the dental operatory since panoramic radiographic machines have become common in modern dental practices. Specific advantages of arthropanoramography include the decreased financial cost and decreased radiation exposure to the patient. Arthropanoramography does not replace tomography or videofluoroscopy in TMJ arthrography. It is, however, described as a simple alternative to the more conventional forms of arthrography.

Cartilage, Articular↗
PubMed1997

Intense photophobia caused by Arthrographis kalrae in a contact lens-wearing patient.

PURPOSE: To report a case of Arthrographis kalrae keratitis and to note that its clinical manifestation resembles Acanthamoeba corneal infection. METHODS: Case report. RESULTS: The patient's keratitis was caused by A kalrae, a very rare soil fungus. CONCLUSIONS: Arthrographis kalrae can cause a keratitis that manifests with severe photophobia and a slowly progressive corneal infiltrate whose symptoms can mimic Acanthamoeba. Our patient most likely acquired the fungus from exposure to soil and not from her contact lenses.

Administration, Oral↗
PubMed1991

Glenoid hypoplasia: assessment by computed tomographic arthrography.

Four cases of an uncommon congenital skeletal anomaly, isolated bilateral glenoid hypoplasia, are presented with discussion of the possible pathogenesis and clinical significance. Bilateral computed tomographic arthrography of the shoulder demonstrated thickening of the inferior glenoid cartilage in two cases. The technique was of value in the symptomatic shoulder revealing the location of a contrast medium filled cleft within the posterior cartilage in one case and the true configuration of the glenohumeral joint in the second case, when the degree of deformity had rendered plain radiographs and conventional arthrography uninterpretable.

Adolescent↗
PubMed1984

Comparative study of iohexol and meglumine iothalamate in double-contrast knee arthrography.

A comparison has been made between meglumine iothalamate and a low-osmolar contrast medium, iohexol, in arthrography of the knee. A controlled study evaluated the immediate and delayed patient response as well as the quality of the examination, which was assessed by two radiologists without knowledge of which contrast medium had been employed. The results show that iohexol is a good contrast medium for knee arthrography but offers no advantages to offset the increased cost compared with contrast media in current use.

Adolescent↗
PubMed1981

New observations with routine and CT-assisted arthrography in suspected internal derangements of the temporomandibular joint.

A simplified arthrotomographic technique has been performed successfully in more than 200 patients with symptoms referable to the temporomandibular joint. Soft-tissue abnormalities not detected by plain film radiography were demonstrated. Anterior meniscus displacement was the most significant finding in patients with unilateral pain and limitation of opening. New arthrographic observations and research imaging methods, including CT-assisted arthrography, are described. Leakage of contrast material along the lateral condylar neck in patients with anterior meniscus displacement suggests associated tearing of the lateral capsular attachment. Our results confirm that arthrography is a useful diagnostic procedure for suspected internal derangements of the temporomandibular joint.

Cartilage, Articular↗
PubMed1981

Experience with arthrography of the first metacarpophalangeal joint.

Arthrography of the first metacarpophalangeal joint at various times after trauma involving suspected rupture of the joint capsule or collateral ligaments has been performed since 1975 and the first four and a half years experience is reviewed. More variations in arthrogram appearance were found than previously reported and the appearance recorded elsewhere as being typical of a Stener lesion was not seen in the forty-one arthrograms examined. The selection of patients for surgery produced satisfactory results subjectively and objectively and the arthrographic appearance agreed with the operative findings up to twenty-one days after injury. Some patients were saved from unnecessary surgery by arthrography.

Adolescent↗
PubMed2000

MR and MR arthrography to identify degenerative and posttraumatic diseases in the shoulder joint.

MR imaging provides a comprehensive evaluation of a wide spectrum of both intraarticular and extraarticular pathology of the shoulder. MR imaging enables the detection or exclusion of degenerative and posttraumatic diseases of the shoulder with a reasonable accuracy. MR arthrography is useful in the visualization of subtle anatomic details and further improves the differentiation. In this article, findings of MR imaging and MR arthrography of degenerative and posttraumatic shoulder diseases (impingement syndrome, rotator cuff tears, and glenohumeral instability) has been reviewed.

Humans↗