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PubMed1979

Arthrography as a method of diagnosing tear of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb ("gamekeeper's thumb").

Arthrography of the metacarpo-phalangeal (MP) joint of the thumb was performed on 47 thumbs. The normal arthrographic appearance shows a closed joint space, whereas leakage of contrast material indicates tear of the joint capsule with or without an associated tear of a stabilizing ligament. Arthrographic demonstration of the heads of the adductor pollicis muscle was found to be specific for tear of the ulnar collateral ligament (UCL) of the MP joint, a tear which is commonly responsible for its instability. Arthrography is suggested as a safe and accurate diagnostic examination for the early detection of tears of the UCL of the MP joint.

Adolescent↗
PubMed1981

Arthroscopy and arthrography of the knee: a comparison study.

Between 1975 and 1978, over 200 knee arthroscopies were performed at the Emory University Hospitals; the findings were totally correct in 91%. During the same period, arthrograms were performed on 79 different patients, 39 of whom had confirming arthrotomies. The arthrograms were totally correct in 38%. Fifteen totally incorrect arthrograms were reviewed without knowledge of the operative findings; 12 were considered by the radiologist to be technically acceptable for review. Of these, five correlated partially, but none completely, with findings at arthrotomy. We discuss the difficulty in arthrographic reading of lateral meniscus tears, anterior cruciate tears, and osteochondral loose bodies. We conclude that, although arthroscopy and arthrography can be complementary, arthrography must be used only with the best equipment and technic by a motivated, experienced, and enthusiastic radiologist.

Adolescent↗
PubMed2005

The role of arthrography-guided closed reduction in minimizing the incidence of avascular necrosis in developmental dysplasia of the hip.

Avascular necrosis of the femoral head is the most serious complication after closed reduction in developmental dysplasia of the hip. Although arthrography has a well-established role in the treatment of developmental dysplasia of the hip, its use is not universal. A prospective study was conducted to compare the incidence of avascular necrosis after closed reduction in developmental dysplasia of the hip performed with and without arthrography in 85 patients, with a minimum of 5 years follow up. Arthrographic criteria were evaluated including lateralization of the femoral head and the type of limbus encountered. Hips treated by closed reduction based on arthrographic evaluation had significantly less incidence of avascular necrosis when compared with those treated by closed reduction without arthrographic guidance. Closed reduction with lateralization of more than 4 mm, and those hips with an inverted limbus were associated with an increased risk of avascular necrosis.

Female↗
PubMed2001

Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS.

We report the first described case of Arthrographis kalrae pansinusitis and meningitis in a patient with AIDS. The patient was initially diagnosed with Arthrographis kalrae pansinusitis by endoscopic biopsy and culture. The patient was treated with itraconazole for approximately 5 months and then died secondary to Pneumocytis carinii pneumonia. Postmortem examination revealed invasive fungal sinusitis that involved the sphenoid sinus and that extended through the cribiform plate into the inferior surfaces of the bilateral frontal lobes. There was also an associated fungal meningitis and vasculitis with fungal thrombosis and multiple recent infarcts that involved the frontal lobes, right caudate nucleus, and putamen. Post mortem cultures were positive for A. kalrae.

AIDS-Related Opportunistic Infections↗
PubMed1975

Arthrography of the ankle joint: problems in diagnosis of acute lateral ligament injuries.

Arthrography of the ankle joint is a reasonably accurate and helpful method of delineating the extent of injuries to the lateral ligament. Forty-six arthrograms were obtained following acute injuries, with 26 patients having operative evaluation. Eight false negative results were encountered, all in combination with fairly massive capsular tears. Although ankle arthrography in acute injuries is useful, it is not infallible. An explanation for the large number of false negative results is offered and additional suggestions are made about the technique of examination.

Acute Disease↗
PubMed1975

Rupture of the quadriceps tendon: diagnosis by arthrography.

Arthrography revealed an abnormal tract of contrast agent dissecting from the suprapatellar bursa into the soft tissue anterior to the patella and downward to a level 9 cm beneath the tibial plateau in a patient with complete rupture of the quadriceps tendon. The bursal anatomy of the anterior portion of the knee is reviewed in relation to the capsule-forming structures of the quadriceps expansion. The use of knee arthrography for the assessment of quadriceps tendon injury is advocated.

Aged↗
PubMed1977

Arthrography in the diagnosis of ligament injuries and classification of ankle injuries.

Arthrography was assessed in 300 cases of ankle injury to determine its diagnostic information yield and its aid in classifying ankle injuries. No complications occurred as a result of the procedure. In 59 cases, information gained from the procedure was verified at surgery. Arthrography was considered to give valuable information in 85% of the cases of ligament ruptures.

Ankle Injuries↗
PubMed1978

Radiography, radionuclide imaging, and arthrography in the evaluation of total hip and knee replacement.

Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis.

Hip Joint↗
PubMed1975

Lymphatic visualization during hip arthrography.

Lymphatic visualization at arthrography has been reported previously in patients with rheumatoid arthritis. The authors describe this phenomenon in 4 patients undergoing arthrography of the hip following prosthetic surgery, only one of whom had a history of rheumatoid arthritis. It is suggested that lymphatic visualization is not a reliable indicator of any specific type of arthritis, but rather an ancillary sign of inflammation, and that it may occur whenever lymphatic hyperplasia or increased synovial membrane permeability is present.

Aged↗
PubMed2002

Horizontal component of partial-thickness tears of rotator cuff: imaging characteristics and comparison of ABER view with oblique coronal view at MR arthrography initial results.

PURPOSE: To determine the characteristics of horizontal components of partial-thickness tears of the rotator cuff at magnetic resonance (MR) arthrography and to determine whether use of the abduction and external rotation (ABER) position improved detection of a horizontal component in partial-thickness tears. MATERIALS AND METHODS: MR studies in 16 patients (mean age, 32 years) who had partial-thickness tear with a horizontal component were retrospectively evaluated. All 16 patients had undergone arthroscopic surgery. The depth and extent of the horizontal component were measured on MR images, and the presence or absence of articular surface tear was recorded. The characteristics of the horizontal component on ABER views were compared with those on oblique coronal views. RESULTS: A horizontal component (24 lesions; one tendon involved in eight patients and two tendons involved in eight patients) was observed in 100% of the lesions on ABER views and in 21% of the lesions (n = 5) on oblique coronal images. The mean length of the horizontal components, measured on ABER views, was 1.9 cm (range, 0.6-4.5 cm). Thirteen (54%) of the 24 lesions were classified as grade I (<3 mm) in depth, four (17%) were classified as grade II (3-6 mm), and seven (29%) were classified as grade III (>6 mm). Articular separation sites with a flap lesion were visualized in 15 (62%) of 24 lesions on ABER views. CONCLUSION: MR arthrography of the shoulder with patients in the ABER position may provide additional information in cases of partial-thickness tears of the rotator cuff with a horizontal component.

Adult↗
PubMed2003

Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography.

PURPOSE: To evaluate the diagnostic performance of magnetic resonance (MR) arthrography in the detection of articular cartilage lesions in patients suspected of having femoroacetabular impingement and/or labral abnormalities. MATERIALS AND METHODS: Forty-two MR arthrograms obtained in 40 patients with a clinical diagnosis of femoroacetabular impingement and/or labral defect were retrospectively analyzed. Two readers independently interpreted the images for cartilage lesion location, depiction, and characteristics. Within 6 months after MR arthrography, each patient underwent open hip surgery, during which the entire cartilage of the hip joint was inspected. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. kappa values were calculated to quantify the level of interobserver agreement. RESULTS: At surgery, most (37 [88%] of 42) cartilage defects were identified in the anterosuperior part of the acetabulum. In 23 (55%), 12 (29%), 10 (24%), and 10 (24%) hips, lesions were found in the posterosuperior acetabulum, anteroinferior acetabulum, posteroinferior acetabulum, and femoral head, respectively. The sensitivities and specificities of MR arthrographic detection of cartilage damage in all regions combined were 79% (73 of 92 regions) and 77% (91 of 118 regions), respectively, for reader 1 and 50% (46 of 92 regions) and 84% (99 of 118 regions), respectively, for reader 2. At interobserver comparison, agreement was fair (kappa = 0.31) for detection of cartilage lesions in the femoral head and poor (kappa <or= 0.2) for detection of lesions in all acetabular regions. CONCLUSION: Cartilage lesions are common in young and middle-aged patients with femoroacetabular impingement and/or labral abnormalities and are most frequently found in the anterosuperior part of the acetabulum. 2003

Adult↗
PubMed2004

Anterior bundle of ulnar collateral ligament: evaluation of anatomic relationships by using MR imaging, MR arthrography, and gross anatomic and histologic analysis.

PURPOSE: To evaluate the gross and microscopic anatomy and the magnetic resonance (MR) imaging and MR arthrographic appearance of the anterior bundle of the ulnar collateral ligament (UCL) of the elbow. MATERIALS AND METHODS: The origin and insertion of the anterior bundle of the UCL, the bundle's relationship to the overlying flexor tendons, and the presence of a layered configuration were assessed through inspection and dissection of an elbow specimen. T1-weighted spin-echo MR imaging and MR arthrography in standard imaging planes and a coronal oblique plane were performed in eight other elbow specimens. Additional MR arthrography was performed in four specimens by using the coronal plane with the elbow in 20 degrees of flexion. The specimens were then cut in planes corresponding to those of the MR images. Histologic analysis of two specimens was performed. RESULTS: The anterior bundle of the UCL appeared as a low-signal-intensity structure on T1-weighted spin-echo MR and MR arthrographic images. It consisted of a uniform layer of parallel collagen fibers attaching proximally to the base of the medial epicondyle of the humerus and distally to the medial aspect of the coronoid process of the ulna (sublime tubercle). A layer of synovium separated the anterior bundle from the more superficial tendon of the flexor digitorum superficialis muscle. MR imaging-anatomic comparison in four (50%) specimens revealed separation between the anterior bundle of the UCL and the sublime tubercle. Results of histologic analysis of two of these specimens confirmed insertion of the anterior bundle of the UCL 3 and 4 mm distal to the articular margin. Ligamentous degeneration was detected in only one of these specimens. CONCLUSION: There is variability in the distal insertion of the anterior bundle, and this suggests that caution should be exercised in the diagnosis of its partial detachment from the sublime tubercle of the ulna.

Aged↗
PubMed1980

Finger arthrography.

The use of arthrography in patients with chronic finger complaints is discussed. Magnification arthrography was performed to assist the clinical evaluation of 15 patients with pain in the metacarpal-phalangeal or proximal interphalangeal joints. Conditions detected include collateral ligament laxity, extravasation around the volar plate, and fibrous ankylosis. Demonstration of normal articular cartilage was important for clinical management in some patients. Direct radiographic magnification was considered useful for best visualization, but tomography was not helpful.

Adolescent↗
PubMed1981

Arthrography of the lumbar facet joints.

The injection of anesthetics and/or steroids into the lumbar facet joints has been advocated in the management of low back pain. During this procedure, arthrography was performed in 70 joints of 27 patients with osteoarthritis and 3 patients with bilateral spondylolysis of a lower lumbar vertebra. The size of the recesses surrounding the facets is emphasized, particularly at the medial aspect of the joint, near the intervertebral foramen. The articular capsule nearly always bursts during or after arthrography, and the path followed by the leaking contrast medium provides an explanation of how injected anesthetics and steroids act in relieving low back pain. Leakage can occur at the lateral aspect of the joint, where the branches of the posterior ramus of the spinal nerve pass, or at the medial side, where the opacification of a joint near a spondylolysis, the contrast medium may spread into the adjacent joint through the defect.

Anesthetics, Local↗
PubMed1983

Arthrography after total hip arthroplasty: a modified technique used in the diagnosis of pain.

The results of plain film radiography and arthrography in diagnosing loosening of a prosthetic component after total hip arthroplasty were correlated with surgical findings in 31 patients who required surgery because of hip pain. The accuracy of arthrography in diagnosing component loosening using 5 ml of contrast material was 51%, and the accuracy of plain radiography was 69%. An accuracy of 92% was achieved using a modified arthrographic technique in which the pressure in the joint was recorded after injection of contrast material and while the patient walked to ensure that it was comparable with the pressure that caused the patient's pain prior to the study. Three per cent of the arthrographic studies using this technique were false negative and 5% were false positive.

Acetabulum↗
PubMed1983

Acute injuries of the lateral ligaments of the ankle: comparison of stress radiography and arthrography.

Anterior and inversion stress were applied to the lateral ligaments of the ankle and the findings compared with the arthrograms. Fifty-five patients underwent stress radiography of both ankles and arthrography of the injured ankle within 72 hours of acute injury to the lateral ligaments. Ten patients had normal arthrograms and 45 had evidence of ligamentous injury. Anterior stress measurements could not be correlated with arthrography, and no differentiation between single and double ligament tears could be made. Inversion stress testing was very accurate in predicting ligamentous injury when the angle of inversion was 10 degrees or greater but achieved this degree of accuracy in only 38.2% of patients.

Ankle Injuries↗
PubMed1985

Shoulder arthrography: comparison of morbidity after use of various contrast media.

This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.

Air↗
PubMed1985

Bursae and abscess cavities communicating with the hip. Diagnosis using arthrography and CT.

Bursae or abscess cavities communicating with the hip joint were demonstrated by hip arthrography or by computed tomography (CT) in 40 cases. The bursae or abscess cavities were associated with underlying abnormalities in the hip, including painful hip prostheses, infection, and inflammatory or degenerative arthritis. Structures communicating with the joint capsule included iliopsoas bursae (13 cases), bursae associated with the greater trochanter (21 cases), ischiotrochanteric bursae created by abnormal articulation between the ischium and lesser trochanter (two cases), and abscess cavities not associated with a bursa (four cases). Symptoms may be produced directly as a result of infection or indirectly as a result of inflammation or pressure on adjacent structures. In cases of suspected infection, direct puncture and aspiration of the bursa or abscess cavity, in addition to joint aspiration, may be necessary to obtain organisms for culture as joint aspiration may not yield fluid. Hip arthrography can confirm a diagnosis of bursae and abscess cavities communicating with the hip joint in patients with hip pain or soft-tissue masses around the groin. Differentiation of enlarged bursae from other abnormalities is important to avoid unnecessary or incorrect surgery.

Abscess↗