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Arthrography following hip replacement has been reviewed. The problems encountered have been analysed with particular reference to technique and accuracy. The accepted criteria for loosening have not been consistently reliable and have led to false positive interpretation of loosening of the acetabular component. The reasons for false negative results are also considered.
The author describes his technique for elbow arthrography. Linear tomography is advocated as a useful supplemental technique in both single and double contrast examinations.
The problem of the patient with the painful clicking temporomandibular joint is one of the most difficult to manage in oral surgical practice. Traditional methods of treatment have been largely empirical and have included the use of analgesics, muscle exercises, psychotherapy, condylar osteotomy and tooth grinding. Temporomandibular joint arthrography offers a method of accurately assessing internal derangements of the joint in order to select those patients for whom surgical reconstruction is appropriate.
OBJECTIVE: Our objective was to integrate digital video and web technology to construct a useful self paced learning tool to deliver recorded techniques of magnetic resonance (MR) arthrography for junior radiology residents and medical students. CONCLUSION: The streaming of audio media, an emerging technology, is an effective vehicle to deliver educational material over the Internet using commercially available PCs and modems, especially when teaching resources are limited.
Arthrography of the shoulder was performed in 16 consecutive cases of primary anterior dislocation and in 11 cases of recurrent dislocation. All the primary dislocations were in African Negro patients and showed an unusually high incidence of capsular rupture rather than labral detachment. It is suggested that this is due to stronger soft tissue attachment to bone in Africans, resulting in fewer labral detachments and thus accounting for the low incidence of recurrent dislocation in the African populace. The series of recurrent dislocations, consisting of African and Asian patients, confirmed the low incidence in Africans but demonstrated labral detachment and humeral head defects common to both racial groups.
Arthrography in cases of trauma to joints may provide valuable information about joint disruption as well as the location of foreign bodies. Allergy to contrast agents and bleeding diathesis are the only contraindications. Four cases are presented that demonstrate the usefulness of this technique.
To evaluate changes in capsular mechanisms and the labroligamentous complex with magnetic resonance arthrography (MRA) after shoulder surgery and to establish possible criteria for the expected post-operative appearance of the shoulder. MRA of the shoulder was performed in 16 patients, before and 6 months after undergoing arthroscopic surgery for recurrent unidirectional dislocation. MR studies were performed after application of a constant amount of contrast solution (2 mmol Gd-DTPA). Axial and coronal oblique T1-weighted images were obtained with and without fat suppression techniques. Anterior (a) and posterior (p) capsular distances were measured, and the p/a ratio was established. Capsule thickness, capsular leaking, estimation of the volume of the axillary recess, appearance of the glenohumeral ligaments, and evidence of labral lesions were compared on pre- and postoperative images. Mean anterior capsular distance (a) decreased from 9.73 +/- 1.03 mm preoperatively to 5.27 +/- 2.49 mm postoperatively, whereas dorsal capsular distance (p) increased from 6.13 +/- 2.36 to 8.93 +/- 2.37. The p/a ratio increased from 0.64 +/- 0.25 to 2.36 +/- 2.54 (p = 0.007). Capsular leaking was suspected preoperatively in seven patients, but was not evident postoperatively. Capsular thickness and the estimated volume in the axillary recess did not change significantly. Contrast extension into pre-existent labral tears (nine patients) decreased or were not evident postoperatively. Changes in the appearance of the glenohumeral ligaments were found in six patients. Changes in capsular distances might be indicative of a decreased capsular laxity and could be a valuable criterion in the evaluation of the postoperative shoulder. Postoperative follow-up of labral tears is demonstrated by a decrease in contrast extension into or under a tear. Reactive capsular thickening or scar tissue formation can be reactive or preexistent. Changes in ligaments might be secondary to surgery. MRA may be helpful in the reevaluation of patients with suspected recurrent instability.
MR arthrography is a recent addition to the imaging evaluation of the hip. The combination of joint distention and multiplanar imaging provides a detailed assessment of the intraarticular structures, most importantly the acetabular labrum. An acetabular labral tear is a potential cause of hip pain in patients with an otherwise normal joint, or patients with underlying pathology such as developmental dysplasia. A summary of the current concepts regarding identification of labral degeneration, labral tears and detachments, and potential pitfalls is presented in this article.
By 115 arthrographies of the wrist in patients with posttraumatic pain, the importance of the method for diagnosis in injured patients is discussed. It was possible to detect 29 cases with a lesion of the articular disc, 4 patients with ruptured radiocarpal joint and 3 cases with an injury of the distal radioulnar joint. The technique of filling the wrist is described and different manifestations of "normal" arthrogramms are exhibited.
PURPOSE: To investigate frequency of acetabular labral lesions in elderly hip joints, and to determine sensitivity and specificity of MR arthrography (MRa) for the detection of these abnormalities. MATERIALS AND METHODS: Twenty cadaveric hip joints were examined by MRa. For MRa, 15 ml of a solution of iodinated contrast solution (Solutrast 300) and Gd-DTPA (100:1) were injected under fluoroscopic guidance. MR imaging was performed on a 1.5 T MR scanner (Vision, Siemens; FOV 16 cm, matrix 256 x 256, fat-suppressed 3D-FLASH). Multiplanar image reconstructions were done perpendicular to the acetabulum in the oblique-coronal, oblique-axial, and radial planes. The labral specimens were examined macroscopically. RESULTS: In 12/20 hips (60%), a labral lesion was found on pathologic examination. In 7 specimens, the labrum was partially or completely detached in the weight-bearing superior region. One flap-like variant of the labrum was seen; in 4 hip joints, the labrum was degenerated (one cystic degeneration). Pathologic findings were confirmed by MRa in 8/12 specimens (sensitivity 67%). All degenerated labra were correctly diagnosed on MRa. Three small labral detachments and the flap-like variant were misinterpreted as being normal. There were no false positive findings (specificity 100%). The accuracy was 80%. Labral lesions were seen in 6/8 and in 6/12 of hips with and without osteoarthritis, respectively. CONCLUSION: MRa is well suited to delineate the acetabular labrum and to diagnose labral abnormalities. Detection of small labral detachments and anatomic variants is difficult and requires some experience. Labral lesions are correlated to osteoarthritis of the hip, but may be frequently seen in the elderly without underlying osteoarthritis.
PURPOSE: A prospective study to assess the value of indirect magnetic resonance-arthrography (MR-Arthro) in the detection of lesions of the superior labrum (SLAP-lesions). MATERIALS AND METHODS: Unenhanced magnetic resonance imaging (MRI) and indirect MR-Arthro of the shoulder were performed in 35 patients (9 females and 26 males) with a history of acute or chronic shoulder disorder. The images of unenhanced MRI and indirect MR-Arthro were analyzed independently from each other for the occurrence of SLAP-lesions and the findings correlated with the arthroscopic results. For arthroscopy, MRI and MR-Arthro, the SLAP-lesions were categorized based on the classification system of Snyder. RESULTS: SLAP-lesions were diagnosed by arthroscopy in 22 of 35 patients (63 %). 9 of the 22 lesions (41 %) were classified as type 1, 9 (41 %) as type 2, three (13.5 %) as type 3 and one (4.5 %) as type 4. Using unenhanced MRI sensitivity, specificity and accuracy in the detection of SLAP-lesions were calculated to be 73 %, 85 % and 77 %. Indirect MR-Arthro showed a sensitivity of 91 %, a specificity of 85 % and an accuracy of 89 %. Unenhanced MRI revealed correlation to the arthroscopic classification in 9 of 22 cases (41 %) and indirect MR-Arthro in 18 of 22 cases (82 %). CONCLUSION: Indirect MR-Arthro is a non-invasive method which offers excellent sensitivity in the diagnosis of SLAP-lesions. It provides important preoperative informations with regard to the exact location and extent of a tear.
In a prospective study the diagnostic value of MRI compared to CT arthrography (CT-A) was evaluated in 26 patients with 27 instable shoulder joints. Surgical and/or arthroscopic correlation was available in all cases. Both methods showed a high accuracy (96% CT-A, 94% MRI) in the evaluation of the glenoid labrum. CT-A was significantly superior to MRI in the detection of capsular lesions (sensitivity 96% vs. 44%, accuracy 96% vs. 72%, negative predictive value 96% vs. 67%). CT-A and MRI results regarding humeral head fractures were similar; fractures of the glenoid rim were better detected by CT-A, the difference, however, was statistically not significant. Overall, CT-A proved to be superior to MRI, as lesions of the joint capsule were shown with greater certainty.
In this paper, the principles of vibration arthrography are briefly described and the analysis of the resulting signals is explained. Using such a system, localisation of signals from within the joint is possible. Finally, the development of a vibration-based arthrographic system is proposed as a safe, relatively inexpensive, and totally non-invasive aid to the diagnosis of internal disease of the knee.
In the present paper the authors point out in the importance of arthrography in the preoperative diagnosis of stiffness of the knee joint; their findings are based on a study of 29 cases. The majority of the roentgenograms show the knees of patients who subsequently underwent surgical arthrolysis. The technique and special features of the procedure are described. The evaluated contrast films may be classified in three groups, the first including joints with a residual mobility of up to 50 degrees, the second including those with between 50 and 90 degrees and the third those with more than 90 degrees. Typical for the first group is an obliteration of the upper recessus and an omega-shaped form in AP films. Films from Group 2 only show constrictions of the recessus suprapatellaris. In the third group only slight changes are found, which in some cases could only be assessed more accurately by comparison with the healthy side. In cases of knee-joint stiffness due to extra-articular causes there is no correlation between the arthrogram and the range of mobility. The authors conclude that X-rays of the interior of the joint using contrast medium can be a valuable help in planning surgical treatment for fibrotically stiffened knee joints.
Shoulder arthrography in a patient with rheumatoid arthritis is performed to differentiate between a rheumatoid flare and limitation of motion secondary to tear in the rotator cuff. Accurate diagnosis is important because of the therapeutic implications. The arthrographic findings characteristic of rheumatoid involvement of the shoulder joint are nodular filling defects of the joint, the subacromial and subdeltoideal bursa in case of rotator cuff tear, irregular capsular attachment, contracted joint space and visualized lymphatic drainage. A dilatation of the biceps tendon sheath has not been shown.
Bilateral distension arthrography was performed in 40 non traumatized cadavers and the ratio of peroneus tendon sheath filling, and filling of the subtalar joints and medial tendon sheaths were compared with data from groups of normal and pathological arthrograms in patients who had sustained inversion trauma. The investigation confirms that filling of the peroneus tendon sheath is always of pathological significance, and is independent of age. The different mechanisms which may produce filling of the peroneus tendon sheath are discussed. Filling of the medial tendon sheaths and subtalar joints are normal arthrographic findings, not related to trauma or age.
Conventional MR imaging allows clear depiction of the muscles, tendons, nerves, vessels, ligaments, bones, and cartilage that compose the elbow. MR arthrography can be a valuable supplementary technique for optimizing evaluation of intraarticular structures, including the undersurfaces of the collateral ligaments. Regardless of the imaging technique utilized, knowledge of normal anatomy-and normal anatomic variants-is fundamental for accurate assessment of normal and diseased states.
Magnetic resonance imaging (MRI) of the hip has been valuable in the diagnosis of occult osseous abnormalities and of periarticular soft tissue disorders. MRI has been less useful in the evaluation of acetabular labral tears and other intra-articular abnormalities. Image optimization is more technically challenging in the hip than in smaller joints because the overlying soft tissues are thicker, resulting in decreased spatial and contrast resolutions that may not be adequate to distinguish the acetabular labrum from subchondral bone, articular cartilage, and joint capsule. MR arthrography (MRA) extends the capabilities of conventional MRI because contrast solution separates intra-articular structures and outlines abnormalities. In hips with suspected acetabular labral injury, arthrographic MR images demonstrate the location and length of tears and the presence of associated capsular defects. Arthrographic MR images may also enable the accurate diagnosis of cartilage lesions and intra-articular loose bodies. This article illustrates normal arthrographic MR features of the hip as well as pathologic disorders of the acetabular labrum, capsule, and articular cartilage