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PubMed1998

Gadolinium MR Arthrography of the Rotator Cuff.

Conventional magnetic resonance imaging (MRI) of the rotator cuff has not done well in distinguishing partial-thickness tears from tendonitis or small, full-thickness tears. However, these are important distinctions for orthopedic surgeons who are deciding whether to operate and what type of surgery to perform on a patient with suspect rotator cuff pathology. Gadolinium magnetic resonance arthrography (MRA) involves injecting dilute gadolinium into the shoulder under fluoroscopy. Subsequent multiplanar T1-weighted fat-suppressed fast spin echo combined with T2-weighted fast spin echo and short tau inversion recovery (STIR) produces images that can accurately differentiate absence of tear from partial-thickness tear and from small, full-thickness tear; as a fringe benefit, this combination of sequences can identify the inflammation associated with tendonitis. Furthermore, the technique differentiates articular from bursal surface partial-thickness tears, and it accurately quantitates the size of full-thickness tears to help surgeons choose between arthroscopic versus open surgery.

Journal Article↗
PubMed1998

MR Arthrography of the Knee.

The role of magnetic resonance imaging (MRI) in the evaluation of musculoskeletal injuries has been well documented during the last decade. There remain several important clinical situations in which noncontrast MRI has been disappointing. In the knee, magnetic resonance arthrography (MRA) can supplement noncontrast MRI in the evaluation of specific conditions, such as postoperative meniscus and osteochondritis dissecans. MRA significantly increases accuracy in the diagnosis of meniscal retear, as is seen in cases in which there has been a meniscal resection of more than 25% or after meniscal suturing. Also, in the evaluation of osteochondritis dissecans, the addition of intra-articular contrast has proved beneficial. Aside from assessing the integrity of the articular cartilage surface and documenting loose bodies, the contrast allows the clinician to distinguish fibrovascular granulation tissue from fluid partially or completely surrounding the osteochondritic fragment. These topics are discussed in this article.

Journal Article↗
PubMed1997

Distension Arthrography in Frozen Shoulder Syndrome.

Distension arthrography under fluoroscopic control may be useful in frozen shoulder syndrome. The technique consists of an intra-articular injection of 2 to 3 mL of contrast material, 3 mL of 2% lidocaine, 1.5 mL of cortivazol, and distension of the joint capsule with 30 to 40 mL of refrigerated sterile saline solution. This injection is immediately followed by a physiotherapy program. The authors report their experience of distension arthography in 30 shoulders. Results were good to very good in 90% of cases at 40-day follow-up. No recurrence of a frozen shoulder syndrome was observed and no complications were encountered in this series.

Journal Article↗
PubMed1982

The demonstration of lymphatic channels on wrist arthrography in rheumatoid disease with particular reference to associated lymphoedema.

Delineation of lymphatic vessels is a frequent finding in arthrograms of rheumatoid joints. Arthrography of the rheumatoid wrist when associated with oedema of the upper limb reveals a characteristic pattern consistent with lymphatic obstruction. In our opinion, these findings may be regarded as further evidence in favour of lymphatic obstruction as the cause of peripheral oedema in rheumatoid arthritis. The syndrome appears to be a separate entity from idiopathic oedema of women.

Adult↗
PubMedDate not supplied

Epinephrine enhanced knee arthrography.

The effect of .3 cc of 1:1000 epinephrine on iodine concentration, total iodine content, fluid volume and radiographic quality was evaluated in knee arthrograms in dogs. With the addition of epinephrine the iodine concentration and total iodine content were significantly higher initially and remained significantly higher than in controls over a one hour period. The fluid volume in the knee was significantly lower with epinephrine. Initially both contrast absorption and dilution have major effects in decreasing iodine concentration. With increasing time the effect of contrast absorption becomes the major factor, having a two of three times greater effect on decreasing iodine concentration. With epinephrine radiographs were judged significantly better early and while the quality deteriorated rapidly in the controls the enhanced quality with epinephrine persisted up to one hour. Epinephrine is a very useful adjunct in enhancing the quality of knee arthrography.

Animals↗
PubMedDate not supplied

Arthrography using perfluorocarbon compounds.

The neat liquid and an emulsion of two perfluorocarbon compounds were injected into the knee joints of dogs and a human cadaver to investigate their applicability for arthrography. Excellent delineation of joint structures was observed for as long as 24 hours, but after 24 hours each contrast agent leaked out of the joint capsule into surrounding tissue. Light microscopy of joint tissue revealed a synovial proliferative reaction and a foreign-body granuloma reaction in surrounding tissues. No clinically apparent adverse side effects were evident in the test animals.

Animals↗
PubMedDate not supplied

Digital arthrography in the evaluation of painful joint prostheses.

Digital arthrography was accomplished in 16 patients who had painful prostheses. In each instance, resulting arthrographic abnormalities were compared with those apparent on subsequent overhead radiographs. Results indicate the potential value of the digital technique in this clinical setting. The examination is easy to perform and rapid, and allows the examiner to view the changing images in the subtraction mode. Image manipulation and enhancement are also possible.

Aged↗
PubMedDate not supplied

Preliminary evaluation of Hexabrix for temporomandibular joint arthrography.

A double-blind randomized study of ten patients compared Hexabrix 32% to Renografin-60 in TMJ arthrography. Equivalent volumes of contrast material were injected under fluoroscopic observation, with film quality and patient subjective response graded independently by three radiologists. In immediate arthrogram quality, Hexabrix was rated excellent; Renografin-60 was rated good. For 10-minute radiographs, Hexabrix had a good to excellent rating; Renografin-60 rated fair to good in image quality. Significantly less pain was experienced with Hexabrix.

Adult↗
PubMedDate not supplied

Postcontrast MR arthrography in assessment of cartilage lesions.

OBJECTIVE: Although MR has been proven effective in evaluating many components of the musculoskeletal system, including ligaments, fibrocartilage, muscle, and bone marrow, its role in the evaluation of articular cartilage remains controversial. Recent studies have demonstrated that intraarticular injection of Gd-DTPA [MR arthrography (MRA)] improves the detection of cartilage abnormalities in cadaveric specimens. The aim of this study was to determine the efficacy of MRA for the detection of naturally occurring cartilage lesions in a clinical population. MATERIALS AND METHODS: Sixty knees of 58 patients were studied with a three-dimensional (3D) T2*-weighted GE sequence (FISP) both before and after and a T1-weighted (T1W) SE sequence after the intraarticular injection of a 2 mmol/L Gd-DTPA solution. All knees subsequently underwent arthroscopy or arthrotomy. RESULTS: The MRA sequences performed significantly better (kappa = 0.85) than the routine FISP sequences (kappa = 0.39) in both the detection and the staging of cartilage abnormalities. The MRA FISP sequence (kappa = 0.91) performed slightly better than the MRA T1W sequence (kappa = 0.85), but there was no statistically significant difference between the two sequences. No complications from the intraarticular injection of contrast material occurred. CONCLUSION: Therefore, MRA appears to be an effective and safe method for the evaluation of articular cartilage abnormalities.

Adolescent↗
PubMedDate not supplied

MR arthrography of the elbow: normal anatomy and diagnostic pitfalls.

PURPOSE: Our goal was to determine the normal MR arthrographic appearance of the elbow and to identify the potential diagnostic pitfalls of this technique. METHOD: MRI with intra-articularly administered gadopentetate dimeglumine was performed in seven elbow joints derived from cadavers. Coronal, sagittal, and axial SE T1-weighted images with fat suppression and coronal 3D SPGR images with fat suppression were obtained in each elbow. The elbows were then sectioned. RESULTS: This technique allowed depiction of the cartilaginous surfaces of the elbow joint as well as clear delineation of the inner surface of the collateral ligaments. Potential diagnostic pitfalls included fat pads projecting into the joint, synovial folds, and cartilaginous pseudoerosions. CONCLUSION: MR arthrography allows clear delineation of the intraarticular structures of the elbow. However, diagnostic pitfalls exist that increase the difficulty of interpreting MR arthrographic images.

Aged↗
PubMedDate not supplied

Ligaments of the ankle: normal anatomy with MR arthrography.

PURPOSE: Our purpose was to define the normal MR arthrographic anatomy of ankle ligaments. METHOD: Prior to injection of intraarticular gadolinium in cadaveric ankle joints, proton density and T2-weighted images were obtained to assess the integrity of the ligaments and tendons as well as the amount of preexisting joint effusion. Following injection of 10 ml of contrast agent (gadopentetate dimeglumine 1:250, Omnipaqe 300, Knox gelatin 50%, and methylene blue), T1-weighted images with fat saturation in axial, oblique axial, coronal, and sagittal planes were obtained in neutral, dorsiflexion, and plantar flexion positions. Specimens were sectioned, allowing anatomic and MR correlation. RESULTS: Contrast agent outlining anterior and posterior aspects of the anterior talofibular ligament and posterior talofibular ligament (PTAF) was a normal finding, related to anterior and posterior recesses of the ankle joint that extend out beyond these ligaments in an anteroposterior direction above the level of the ligaments. Intraarticular contrast material allowed resolution of superficial and deep components of the posterior tibiofibular ligament. Both were seen separately from PTAF with dorsiflexion. Posterior intermalleolar ligament was not present in our specimens. Visualization of calcaneofibular ligament was much improved by contrast material outlining the articular aspect of the ligament. Visualization of the syndesmotic ligamentous complex also was improved by contrast material outlining the articular side of the ligaments and separating them from adjacent bone. Superiorly, the distribution of contrast agent was limited by the interosseous ligament. Visualization of the medial collateral ligaments was not improved by the presence of the intraarticular contrast material. CONCLUSION: MR arthrography of the ankle allows improved visualization and evaluation of the lateral and syndesmotic ligamentous complex.

Ankle Joint↗
PubMed1979

Arthrography as a method of diagnosing soft-tissue injuries of the wrist.

Wrist arthrography was performed in 30 patients suffering from post-traumatic wrist sprain, or whom 15 sustained fractures. A longstanding soft-tissue injury was demonstrated in 70% of the whole group and in 60% of wrist sprains not associated with fracture. Findings include radiocarpal-radionulnar communications (26.6%), radiocarpal-midcarpal communications (36.6%), midcarpal-carpometacarpal communications (30%), radiocarpal-pisotriquetral communications (60%), tendon communications (20%), and lymphatic filling (43.3%).

Adolescent↗
PubMed1979

Arthrography in acute shoulder dislocations.

Arthrography of the shoulder was performed on 50 patients with acute traumatic shoulder dislocations. The mean interval between injury and arthrogram was 2.3 days, with a median interval of one day. Anterior dislocations occurred in 96% of patients, and posterior dislocations in 4%. Initial dislocations were present in 74%, and recurrent dislocations in 26%. The most frequent abnormality identified or arthrograms was an enlarged but intact shoulder capsule (58%), most commonly seen in shoulders subject to recurrent dislocations (77%). Shoulder joint capsular tears or disruptions were seen in 48% of the patients. The next most common lesion was fracture (52%), identified on standard roentgenograms. These included Hill-Sachs lesions (28%), greater tuberosity fractures (22%), and coracoid fractures (2%). Ruptures of the rotator cuff, present in 28% of the cases (14 patients), occurred more frequently in initial dislocations (62%) than in recurrent ones (36%). The high frequency of enlarged intact shoulder capsules, even after an acute initial joint dislocation (58%), suggests that the humeral head does not routinely rupture the capsule during dislocation, but rather tears the glenoid labrum at its bony attachment and dislocates subperiosteally, dissecting a false pouch below the periosteum and under the subscapularis.

Acute Disease↗
PubMedDate not supplied

Computed tomographic arthrography of the normal canine stifle.

Computed tomographic (CT) imaging of eight normal cadaveric canine stifles was performed before and after intra-articular administration of iodinated contrast medium. Transverse CT images were reconstructed in dorsal, parasagittal, and oblique planes. The following ligamentous structures were identified on transverse CT images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, and the medial and lateral collateral ligaments. The following ligamentous structures were identified on transverse computed tomographic arthrography (CTA) images in all stifles: cranial cruciate ligament, caudal cruciate ligament, medial meniscus, lateral meniscus, meniscofemoral ligament, cranial meniscotibial ligaments, caudal meniscotibial ligaments, intermeniscal (transverse) ligament, and the medial and lateral collateral ligaments. The patellar tendon was identified on transverse and reconstructed dorsal and sagittal CT and CTA images in all stifles. Multiplanar reconstructions enabled further evaluation of the continuity of the cranial and caudal cruciate ligaments and menisci. The medial and lateral collateral ligaments were not clearly identified on CT or CTA multiplanar reconstructed images.

Animals↗
PubMed2004

First case of Arthrographis kalrae ethmoid sinusitis and ophthalmitis in the People's Republic of China.

We present here the first case in the People's Republic of China of human disease caused by the fungus Arthrographis kalrae. The male patient had fungal panophthalmitis and invasive sinusitis involving the maxillary and ethmoid sinuses. He was an apparently healthy man before receiving trauma to his left eye. He complained of pain and loss of visual acuity in the injured eye, which displayed redness and edema and eventually discharged pus. His symptoms became more severe after he was treated with steroids and several antibacterial agents. A computed tomography scan of the left eye revealed that the maxillary and ethmoid sinuses were involved. A smear of purulent material from the left eye orbit revealed fungal elements, and cultures of the material grew a fungus. The isolate was identified as A. kalrae based on gross and microscopic morphologies, biochemical assays, and DNA sequence analysis. The patient received amphotericin B intravenously, itraconazole orally, and atomized allitridum by nebulizing allitridum therapy. The patient's wound healed following surgical intervention, but the patient lost the use of his left eye. This case should remind ophthalmologists and other clinicians to consider the possibility of infections being fungal when antibacterial agents have no effect and the patient's condition worsens.

Adult↗
PubMed1975

A simplified injection technique for shoulder arthrography.

An easy and reliable technique to inject the shoulder joint for arthrography is described. The technique utilizes a straight anteroposterior position of the patient and a directly vertical placement of the needle with the aid of fluoroscopy.

Contrast Media↗
PubMed1975

Elbow Arthrography with the Application of Tomography.

The intra-articular structure of the elbow joint was studied in 18 patients with double contrast arthrography and tomography. All tomographic examinations were made with the hypocycloid motion. The authors feel that the disadvantages of the method, i.e., getting access to tomographic equipment, the 30 to 45 minutes required to complete the examination, and the radiation from multiple exposures needed for tomographic sections are obviated by the results: the arthrographic findings were confirmed in all 7 patients who later underwent surgery.

Adolescent↗