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Double-contrast arthrography with direct sagittal CT imaging is a technique that permits reliable examination of the disk and its relationship to the condyle, the glenoid fossa, and/or the eminence.
This comparative imaging study of the TMJ was conducted to examine the diagnostic data obtained from arthroscopy as compared to data from tomography and arthrography. Six joints from cadaver material were imaged by each technique and subsequently dissected. Each technique had value, but none was comprehensive. Tomography was the technique of choice for imaging osseous changes. Double joint space arthrotomography was useful for examining articular disk position and morphology. Diagnostic arthroscopy, through direct visualization of surface morphology, showed localized surface pathosis, such as synovitis; provided data on the location and size of disk perforations; and contributed reliably to a diagnosis of disk displacement on the basis of associated pathosis such as stretching of the posterior attachment.
Arthrography and arthrotomography were performed on 29 fresh temporomandibular joint autopsy specimens to diagnose medial and lateral disk displacement. A horizontal contrast medium margin crossing over the condyle (edge sign) and the relative size of the anterior recess of the lower joint compartment in the lateral and medial parts of the joints were used as indicators of the mediolateral position of the disk. Arthrographic findings were compared with coronal cryosections in a blinded fashion. The edge sign underdiagnosed all the joints with lateral disk displacement and about 50% of the joints with medial disk displacement. The assessment of the relative size of the anterior recess of the lower joint compartment underdiagnosed 50% of the joints with medial disk displacement and overdiagnosed lateral disk displacement by 100%. It was concluded that arthrographic diagnosis of medial and lateral disk displacement may be difficult and includes substantial risks of both overdiagnosis and underdiagnosis. Other diagnostic methods should be considered when these types of disk displacement are suspected.
Thirty-three patients with an arthrographically documented anterior disk displacement without reduction were randomly assigned to be treated with upper joint space lavage or to serve as controls in an 8-week clinical trial. Pain was evaluated by the patients on a visual analog scale at rest and after chewing gum. The clinical examination followed a standardized protocol. Improvements in pain and mouth opening were found in both the lavage and control group after 8 weeks, but there were no statistically significant differences between the treatment and control groups. It was concluded that upper joint space lavage after arthrography seems to be ineffective to decrease pain and to increase mouth opening in patients with anterior disk displacement without reduction.
Contrast arthrography was performed in 20 patients with duplicated thumbs where the interphalangeal, metacarpophalangeal, and carpometacarpal joints were involved. Three groups were apparent, those with no joint alteration, those with joint involvement and separate articular impressions, and those with abnormal duplex joints.
The plica is a synovial fold inside the knee joint that may become symptomatic if for any reason the fold is converted into a bowstring. In 42 patients with chronic knee problems, arthrograms of the knee were obtained with evidence of the plica syndrome. Twenty-four were asymptomatic, 18 symptomatic, and of these 16 were excised. After a mean follow-up period of 3 years, 10 of the symptomatic patients were free of symptoms, while eight were unchanged or worse. The plica syndrome is not common, and careful assessment must be made by exclusion with clinical examination, double-contrast arthrography, and arthroscopy.
Arthroscopic findings in 11 patients with chronic ulnar painful wrist were compared both with arthrographic and magnetic resonance (MR) imaging results to evaluate the accuracy of the former procedure in the detection of triangular fibrocartilage complex (TFCC) lesions. MR imaging and arthrography investigations appeared to be sensitive modalities when compared with arthroscopic findings in TFCC lesions (specificity 100%; sensitivity 82 and 80%). MR imaging can be advantageously employed in the screening of patients suspected of having a TFCC tear, eliminating the necessity of an arthrographic examination. However, MR imaging could not define the exact site of the tear within the degenerate TFCC or detect lesions of the articular cartilage. Arthroscopy offers sure evidence of the site of TFCC lesion and more information about the intraarticular associated causes of chronic ulnar wrist pain such as chondromalacia and synovitis. An added benefit is that many of the pathologies seen can be treated using arthroscopic surgical techniques.
The purpose of this study is to investigate the diagnostic accuracy of magnetic resonance arthrography (MRAr) on the diagnosis of intraarticular adhesions of the temporomandibular joint (TMJ). Twenty-four patients (31 joints) diagnosed as internal disorders of TMJ were examined to establish the presence, suspicion or absence of intraarticular adhesions through MRAr according to the MRAr radiographic criteria in a blind fashion, subsequent arthroscopy were performed on all 31 joints. The findings were compared to MRAr with those of arthroscopy. The comparison data were assessed by generating receiver operating characteristic curve (ROC curve) and analyzing the area (Az) under the curve with SPSS11.0 software. The area under the ROC curve was 0.91 (0.86, 0.95), P<0.05. MRAr proves to be an excellent modality to diagnose intraarticular adhesions of TMJ.
Eleven cases of osteochondritis dissecans of the elbow are reviewed. Computed tomography (CT) accurately identified the abnormality, its extent and its precise location. Computed tomographic arthrography (CTA) allowed accurate delineation of the overlying cartilage in all cases, identifying cartilage defects in four patients, fissuring in two and cartilage thinning in a further two. In those patients who had plain CT, four were shown to have loose bodies, one of which was obscured by contrast medium at subsequent CTA. Two further patients with loose bodies were identified using CTA alone. The possible relevance of these findings to management is discussed.
Twenty selected patients with spondylolysis have been studied following apophyseal joint arthrography. In each instance a communication with the defect of the pars interarticularis was demonstrated by the extension of contrast medium from injection into the adjacent facet joint. The clinical and radiological features are described. The anatomical basis of the abnormality is presented using macroscopic and radiographic correlation from a dissected cadaveric specimen of spondylolysis. Sixty-five per cent of the patients experienced significant relief of pain symptoms when long-acting local anaesthetic was introduced into the facet joint.
Temporomandibular joint symptoms are common. Patients not successfully treated by conservative methods require accurate assessment of the internal derangements of the joint. Temporomandibular joint arthrography using only videorecorded intensifier fluorography displays the anatomy and function accurately with a low radiation dose.
The addition of adrenaline to meglumine iothalamate (Conray 280) in double-contrast knee arthrography significantly improves meniscal coating, in both immediate and delayed films, when compared with iothalamate alone. The quality of coating is comparable to that with sodium meglumine ioxaglate (Hexabrix 320) without adrenaline. The addition of adrenaline to ioxaglate produces no significant improvement in arthrographic quality in either immediate or delayed films. The use of iothalamate with adrenaline is less expensive than ioxaglate alone, but this financial advantage has to be balanced against the significantly greater pain associated with the use of intra-articular adrenaline.
One justification for triple-injection wrist arthrography is detection of unidirectional interjoint communication that might escape notice if only a single joint were injected. To determine whether the direction of 1-way communications is related to the choice of the first joint injected, the authors prospectively randomized 100 wrists undergoing consecutive single-contrast, fluoroscopically controlled arthrograms into 2 well-matched groups. One group received the initial injections into the midcarpal and distal radioulnar joints and the other group received the initial injection into the radiocarpal joint. Two unidirectional radial capsular communications with the radiocarpal joint were detected on delayed midcarpal joint injection. No other unidirectional communications were found. No statistically significant difference was found between the midcarpal and radiocarpal study groups. Thus, the first joint injected appears to be a major determinant in demonstrating unidirectional communications between wrist compartments.
The aim of this study was to determine the value of a fat suppressed 3D gradient-echo sequence (GRE) data set in comparison to a 2D GRE sequence in direct MR arthrography of the shoulder. For this purpose we examined 50 consecutive patients with subacute or chronic disorders of the shoulder using a 1.5 T scanner: Transverse T1-weighted 2D (slice thickness 4 mm) and 3D GRE (slice thickness 1.5 mm reconstructed from 3 mm), oblique coronal T2- and T1-weighted turbo spin-echo (TSE) and sagittal T1-weighted TSE with fat saturation were applied. Visual image analysis of anatomical and pathological structures was performed by two independent observers. A correlation to surgical results was available in 21 patients. Transverse GRE sequences were well suited for analysis of the anterior/posterior labrum, the middle glenohumeral ligament, and cartilage. 3D GRE with fat suppression was slightly superior to 2D GRE without fat suppression in the evaluation of the anterior/posterior labrum, and the middle glenohumeral ligament, whereas for cartilage no significant differences were found between both sequences. Concerning pathological findings, in most of the cases 2D delivered the same results as 3D. In conclusion, a T1-weighted 3D GRE data set with fat saturation in transverse orientation may be useful for evaluation of the anterior/posterior labrum, and the middle glenohumeral ligament. However, similar measured slice thickness of 3 mm-even if interpolated to 1.5 mm-compared to a 2D sequence with 4 mm does not provide significant diagnostic advantages.
Established methods for the measurement of articular cartilage thickness are invasive and cannot be sequentially applied in living subjects. In the present study, the distribution of cartilage thickness throughout entire joint surfaces was determined from MR images obtained with a fat-suppressed gradient-echo sequence at a resolution of 0.31 x 0.31 x 2.00 mm3, and compared to that derived from CT arthrography. A minimal distance algorithm was employed to produce 3D cartilage thickness maps of seven cadaveric human knee joints. The mean amount of deviation of the cartilage volumes was 5.6% (+/- 4.6), statistical analysis showing that there was high agreement between the two methods (r = 0.995, slope = 1.037, y-intercept = -90.5 mm3). The 3D thickness maps yielded a striking agreement between the two methods, the maximum values generally yielding a deviation of none or one thickness interval of 0.5 mm. This investigation shows that accurate 3D assessment of articular cartilage thickness can be performed with MRI, this technique having the advantage that it is suitable for investigating living subjects.
To assess the continued value of arthrograms in the wake of arthroscopic diagnosis, an analysis of arthrographic data on 240 knees was carried out. The accuracy, sensitivity, and specificity of the arthograms were compared with the arthroscopic findings for each knee. For meniscal lesions, the arthrogram is reasonably accurate. An algorithm is presented that defines the relative roles of arthrography and arthroscopy.
A prospective analysis of plain serial radigraphs (PSR), digital subtraction arthrography (DSA), and radionuclide bone scans (RBS) was performed in 56 cemented total hip arthroplasties to evaluate the efficacy and usefulness of each study in the diagnosis of loosening. To avoid selection bias in the evaluation of DSA and RBS, the decision to perform repeat surgery was based exclusively on the clinical history and PSR. Results of each study were compared with intraoperative assessment of the status of components and expressed in terms of sensitivity, specificity, and accuracy. Overall accuracy for the acetabular component by PSR was 66%; by DSA, 93%; by RBS, 46%. Overall accuracy for the femoral component by PSR was 79%; by DSA, 93%; RBS, 50%. Our results indicate that DSA can be recommended as a further analysis in cases with a painful hip prosthesis and no or inconclusive findings on PSR. RBS did not give any useful information and cannot be recommended routinely.
OBJECTIVE: The purpose of this study was to compare the diagnostic efficacy conventional MRI and MR arthrography (MRA) in the diagnosis of chondromalacia patella (CP) on a low-field open magnet system (LFOMS), correlated with arthroscopy. SUBJECTS AND METHODS: Forty-two patients (50 knees) with pain in the anterior part of the knee were prospectively examined with LFOMS, including T1-weighted, proton density-weighted and T2-weighted sequences. All were also examined T1-weighted MRI after intraarticular injection of dilue gadopentetate dimeglumine. Two observers, who reached a consensus interpretation, evaluated each imaging technique independently. Thirty-six of the 50 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity and accuracy of each imaging technique in the diagnosis of each stage of CP were determined and compared by using the McNemar two-tailed analysis. RESULTS: Arthroscopy showed that 16 facets were normal. Four (30%) of 13 grade 1 lesions were detected with T1. Four lesions (30%) with T2 and three lesions (23%) with proton-weighted images were detected. Seven (53%) of 13 grade 1 lesions were detected with MRA. Grade 2 abnormalities were diagnosed in two (33%) of six facets with proton density-weighted pulse sequences, two (33%) of six facets with T1-weighted pulse sequences, in three (50%) of six facets with T2-weighted pulse sequences, in five (83%) of six facets with MRA sequences. Grade 3 abnormalities were diagnosed in three (71%) of seven facets with proton density- and T1-weighted images, five (71%) of seven facets with T2-weighted pulse sequences, six (85%) of seven facets with MRA sequences. Grade 4 CP was detected with equal sensitivity with T1-, proton density- and T2-weighted pulse sequences, all showing seven (87%) of the eight lesions. MRA again showed these findings in all eight patients. All imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesion, so that no significant difference among the techniques could be shown. CONCLUSION: All imaging technique studied had high specificity and accuracy in the detection and grading of CP; however, MRA was more sensitive than T1-weighted and proton density-weighted MR imaging on a LFOMS. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnosis was greatest with T2-weighted MRI.