Hip arthrography in infants and children: the inferomedial approach.
We describe the use of the inferomedial approach in hip arthrography in children and review the technical aspects of the procedure and its complications.
Carbon Dioxide↗
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Elbow arthrography: a reassessment of the technique.
Twenty-six elbow arthrograms were retrospectively reviewed. Each arthrogram consisted of conventional radiography, conventional tomography, standard double-contrast arthrography, and arthrotomography. Each of these four components was independently interpreted in a blinded fashion by six radiologists, each working alone. The four components were evaluated for presence or absence of intraarticular bodies, cartilage loss, or fractures. The results showed that conventional tomography was the most accurate single study. Arthrotomography rarely improved the diagnostic accuracy of noncontrast methods. It was useful in those few patients where detection of purely cartilaginous bodies, precise position of mineralized densities, or status of articular cartilage was desired. It may be possible to reduce the number of elbow arthrograms, thereby reducing time, cost, and radiation dose factors.
Adolescent↗
Knee arthrography: comparison of iotrolan and ioxaglate sodium meglumine.
Arthrographic image quality and relative morbidity resulting from use of the nonionic dimer iotrolan and the ionic dimer ioxaglate sodium meglumine were compared in a prospective double-blind study performed in 80 patients. Radiographs obtained 2, 5, 10, 15, 20, and 25 minutes after injection of contrast agent were graded for diagnostic quality. Relative morbidity was evaluated by the physician during the examination and later by the patient by means of a questionnaire. Iotrolan demonstrated better image quality on serial radiographs in knee joints without previous effusions. Most differences were not significant. The mean duration of diagnostic-quality images for both contrast media was about 23 minutes. Iotrolan and ioxaglate caused equal postprocedural pain (in about 50% of patients). Other types of discomfort were less when iotrolan was used, but the differences were not significant. With regard to long-lasting image quality, both contrast media are suitable for arthrography.
Adolescent↗
Three-compartment wrist arthrography: use of a low-iodine-concentration contrast agent to decrease study time.
To decrease examination time, the authors used a contrast agent with a low iodine concentration for three-compartment (radiocarpal joint, distal radioulnar joint, midcarpal compartment) wrist arthrography. The material was used in 24 patients. Many patients demonstrated dissipation of contrast material in the radiocarpal joint by 30 minutes after injection. By 45 minutes, all patients demonstrated sufficient dissipation to permit the second injection. The technique produces diagnostic images and reduces the time required for the study.
Diatrizoate Meglumine↗
Wrist arthrography: value of the three-compartment injection method.
Arthrography of the wrist was performed on 300 consecutive patients by injecting contrast material separately into the radiocarpal (RCJ), midcarpal (MCJ), and distal radioulnar (DRUJ) joints. The addition of MCJ and DRUJ injections to the standard RCJ injection significantly improved diagnostic yield. In 78 (26%) of the 300 cases, the abnormality was found after MCJ or DRUJ injections alone. Of the 103 triangular fibrocartilage complex (TFCC) abnormalities identified, 27 (26%) could be demonstrated after DRUJ injection alone. Of the 145 abnormal RCJ and MCJ communications, 42 (29%) could be seen after MCJ injection alone. Similarly, 22 (15%) of the 145 abnormal RCJ and MCJ communications were seen after RCJ injection alone and would have been missed if only MCJ injection had been performed. Thus, three separate injections into the RCJ, MCJ, and DRUJ are necessary for complete arthrographic evaluation.
Adolescent↗
Indirect MR arthrography: optimization and clinical applications.
PURPOSE: To evaluate and optimize a method for producing magnetic resonance (MR) images similar to MR arthrograms of multiple synovial joints with intravenous gadopentetate dimeglumine injection. MATERIALS AND METHODS: The authors examined the effects of joint motion, dose of gadopentetate dimeglumine (0.1, 0.2, and 0.4 mmol/kg), and fat saturation on the enhancement rate of the joint cavity and the degree of image contrast generated among articular structures on MR images in 14 healthy volunteers. Shoulder, elbow, wrist, hip, knee, and ankle joints of 10 volunteers were imaged with optimized parameters. Indirect MR arthrographic findings in 17 patients with joint disorders (eg, rotator-cuff tears, meniscal tears, and osteoarthritis) were compared with arthroscopic findings. RESULTS: Fat-saturated images obtained after 10 minutes of exercise and administration of 0.1 mmol/kg gadopentetate dimeglumine were similar to those obtained after intraarticular injection of contrast medium. Exercising the joint yielded the strongest joint-cavity enhancement. Increasing the dose of contrast medium in the unexercised joint did not statistically significantly improve the contrast-to-noise ratio. Rotator cuff tears, meniscal tears, and cartilage defects were better delineated with this method than with unenhanced MR imaging and showed good correlation with arthroscopic results. CONCLUSION: Indirect MR arthrography of an exercised joint provides homogeneous enhancement and improved delineation of soft-tissue structures.
Adult↗
Simultaneous arthrography of the talocrural and talonavicular joints in children. I. Technique.
A method is described by which simultaneous arthrography of the talocrural and talonavicular joints is performed on neonates and small infants with a high degree of success and a very low risk of complications. From films exposed in exact, standardized projections, valuable and highly reproducible information is obtained about the configuration of the talus, the shapes and mutual relationships of the joint surfaces, and any obliteration of the recesses. One disadvantage of the method is the need for general anaesthesia.
Anesthesia, General↗
Simultaneous arthrography of the talocrural and talonavicular joints in children. II. Comparison between anatomic and arthrographic measurements.
Simultaneous arthrography of the talocrural and talonavicular joints was performed on 32 autopsy foot specimens from 19 children of ages up to 3 years. Measurements concerning the size and shape of the talus were made on the films and the results were compared with corresponding measurements made on the anatomic specimens. The differences between the results and the reliability of the radiographic method as analysed by duplicate and triplicate examinations are discussed.
Child, Preschool↗
Evaluation of a modified method for arthrography of the knee.
A modified method for knee arthrography based on the technique introduced by Lindblom has been applied in 1 200 patients. The arthrographic reports on 132 patients submitted to arthrotomy are compared with the findings at surgery. The modified technique is easy to perform and offers a fairly reliable all-round method for diagnosis of both meniscus and crucial ligament lesions.
Adolescent↗
Simultaneous arthrography of the talocrural and talonavicular joints in children. III. Measurements on normal feet.
Simultaneous arthrography of the talocrural and talonavicular joints was performed on 32 normal feet from an autopsy material, and corresponding examinations were conducted clinically on 22 feet with no signs of deformity. The material comprised the age group 0 to 8 years. A linear correlation was observed between the length of the talus and the width of the talar trochlea. The radius and chord of the trochlear curvature increased proportionately with the length and trochlear width. These relationships were expressed as indices, by means of which the normal values for the radius and chord of the trochlea may be calculated for children up to 8 years of age. The mean value, standard deviation and tolerance limits were calculated for the central angle of the trochlear curvature and for the plantar and medial deviations of the talonavicular joint. These angles were found to be virtually constant between the neonatal period and the age of 8 years.
Age Factors↗
Arthrography of the knee joint with amipaque.
In a double-blind investigation, 30 knee arthrographies were performed by injection of either Amipaque 290 mg I/ml or Urografin 60% (292 mg I/ml). Both contrast media are well tolerated, and give excellent initial contrast quality, which deteriorates rapidly. This occurs more slowly with Amipaque, which has lower osmolality and causes less joint effusion.
Adolescent↗
Lymphatics filled at knee arthrography.
A review of 587 knee arthrographies revealed filling of lymph vessels in 12 cases. They occurred in connection with arthritis (4 rheumatoid), osteoarthritis, ruptured meniscus, ruptured popliteal cyst and after operation. Lymphatic filling was not related to the leakage of contrast through a ruptured popliteal cyst or to inadvertent extra-articular injection. Filling of lymphatics is more likely to occur in examinations with a positive contrast medium when a larger amount of medium is used.
Adolescent↗
Arthrography in dislocation of the acromioclavicular joint.
Arthrography was performed in 10 patients with dislocation of the acromioclavicular joint. The examination was unsuccessful in one case. In the remaining 9 patients, leakage of the contrast medium was observed around the joint and in the direction of the coracoid process. The arthrographic abnormalities were compared with the findings at operation. The distribution of the medium that had leaked out provided information on the severity of the injury to the ligaments.
Acromioclavicular Joint↗
Double contrast arthrography of the knee. Comparison between three contrast media.
Meglumine iothalamate (Conray Meglumin), sodium-calcium-meglumine metrizoate (Isopaque Cerebral) and dimeglumine iocarmate (Dimerex), each containing about 280 mg I/ml, were compared in two series of double contrast knee arthrography, 190 and 184 patients each. With Dimerex the mixing of the contrast medium with the synovial fluid was slower than with Conray Meglumin, and a good or fair image quality, as evaluated subjectively, lasted longer. No difference was observed between Isopaque Cerebral and Conray Meglumin, regardless of dosage.
Adolescent↗
Limited arthrography in acute knee injuries.
Fifty consecutive limited arthrograms in acute knee injuries are reported with operative findings in 27 knees. The arthrograms were completely accurate regarding cruciate and medial collateral ligament integrity in 82% of all of the cases. Improvements in technique and recognition of superimposed anatomical structures led to fewer errors in interpretation as the series progressed. Limited arthrography is recommended as a useful office procedure in the early evaluation of knee ligament integrity in acute painful knee injuries.
Adolescent↗
Detection of intraarticular loose osteochondral fragments by double-contrast wrist arthrography. A case report of a basketball injury.
Gravity was used in a case of double-contrast wrist arthrography to demonstrate the intraarticular loose nature of osteochondral fracture fragments. These calcified loose bodies were successfully removed surgically.
Adult↗
Subtalar arthrography in acute injuries of the calcaneofibular ligament.
We treated 43 acute tears of the calcaneofibular ligament by operation in 43 patients after subtalar arthrography. There were 22 men and 21 women with a mean age of 22.3 years (14 to 61). Anteroposterior (AP), lateral and oblique views were obtained with the foot in 45 degrees of internal rotation and the ankle in the neutral position. Any communication or leakage to the ankle, tendon sheaths, subcutaneous tissue and sinus tarsi was recorded. We examined an oblique view of the microrecess along the interosseous ligament and an AP view of the lateral recess just under the distal end of the fibula. We also studied a control group of 27 patients with isolated injuries of the anterior talofibular ligament without rupture of the calcaneofibular ligament. The findings in the two groups were significantly different when examined for leakage to the ankle (p=0.0002), to the peroneal tendon sheaths (p=0.0347) and to the subcutaneous tissue (p=0.0222), absence of the microrecess (p=0.0055) and presence of the lateral recess (p=0.0012). Many ankle sprains which involve tearing of the calcaneofibular ligament are accompanied by injuries of the subtalar joint. Combined injuries of the anterior talofibular ligament and calcaneofibular ligament, and isolated injury of the anterior talofibular ligament should be differentiated.
Adolescent↗
Tubular acetabular intraosseous contrast tracking in MR arthrography of the hip: prevalence, clinical significance, and mechanisms of development.
OBJECTIVE: The purpose of this study was to describe tubular intraosseous tracking of contrast medium in the acetabular fossa, to our knowledge a previously undocumented imaging finding in MR arthrography of the hip, and to discuss its prevalence, clinical significance, and possible mechanisms of development. CONCLUSION: Tubular acetabular intraosseous contrast tracking is a common MR arthrographic finding that seems to have little clinical significance. Although the exact pathophysiologic mechanism is unknown, we presume repeated pumping of joint fluid through the nutrient foramina of the acetabular fossa may be one mechanism.
Acetabulum↗