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PubMed2006

MR arthrography in the differential diagnosis of type II superior labral anteroposterior lesion and sublabral recess.

OBJECTIVE: The objective of our study was to assess the utility of five MR arthrographic findings in differentiating type II superior labral anteroposterior (SLAP) lesion from superior sublabral recess. MATERIALS AND METHODS: The MR arthrograms of 55 patients (57 cases) with either type II SLAP lesion (34 cases) or superior sublabral recess (23 cases) who underwent arthroscopic surgery and MR arthrography were retrospectively reviewed. Two independent reviewers searched for the extension, direction, and shape of high signal intensity in the superior labrum on MR arthrograms. In addition, the presence of concomitant anterosuperior labral tear and anteroposterior extension of high signal intensity on axial images was evaluated. The frequencies of these findings in cases of type II SLAP lesion and sublabral recess were evaluated, and the statistical significance of each finding in differentiation of the two groups was assessed. RESULTS: Extension of high signal intensity behind the biceps anchor that extended beneath the labrum on fat-saturated oblique coronal T1-weighted images was found in 33 (97%) of the cases of type II SLAP lesion and 21 (91%) of the cases of sublabral recess. Laterally curved high signal intensity was found in 17 (50%) of the cases of type II SLAP lesion but in only four (17%) of the cases of sublabral recess. Globular or irregular shape of the superior labrum was present in 22 (65%) of the cases of type II SLAP lesion and in 10 (43%) of the cases of sublabral recess. Concomitant anterosuperior labral tear was seen in 14 (41%) of the cases of type II SLAP lesion but in only two (8.7%) of the cases of sublabral recess. Anteroposterior extension of high signal intensity in the superior labrum on fat-saturated axial T1-weighted images was detected in 33 cases of type II SLAP lesion (97%) and in 14 cases of sublabral recess (61%). CONCLUSION: Although the MR arthrographic findings were similar for type II SLAP lesion and sublabral recess, laterally curved high signal intensity on oblique coronal images, concomitant anterosuperior labral tear, and anteroposterior extension of high signal intensity on axial images were helpful findings in the diagnosis of type II SLAP lesion.

Adolescent↗
PubMed1977

Arthrography in the diagnosis of unexplained chronic hip pain with regional osteopenia.

Three cases of chronic hip pain with radiographic periarticular osteopenia and normal joint spaces are reported. The articular nature of symptomatology, periarticular demineralization, and radionuclide localization suggested intraarticular disease. Computed tomography did not disclose the cause of hip pain when utilized in two instances. Positive contrast hip arthrography was the only diagnostic modality which demonstrated the chondromatosis or adhesive capsulitis responsible for pain. Differential diagnosis and pathophysiologic mechanisms are briefly reviewed.

Aged↗
PubMed1978

Shoulder arthrography as a treatment modality.

Some patients undergoing shoulder arthrography with a stiff and painful joint have a small volume capsule or a frozen shoulder. In certain cases when the rotator cuff is intact, the arthrographic procedure has been therapeutic and joint distention has effected a return to normal function. Four such cases are presented.

Anesthesia, Local↗
PubMed1979

Evaluation of glenoid labrum by double-contrast shoulder arthrography.

Double-contrast shoulder arthrography was used to define the normal and abnormal arthrographic anatomy of the glenoid labrum. A retrospective study of 12 patients suspected of having labral abnormalities or who had unexplained shoulder disability consistent with capsular laxity was undertaken. In four of the nine patients with abnormal arthrograms, the study revealed critical anatomic alterations not detectable on physical examination or pain radiographs.

Adult↗
PubMed1980

Air or CO2 for knee arthrography?

Both air and carbon dioxide (CO2) have been advocated for use as the negative agent in double-contrast knee arthrography. In 39 patients examined, 40 knee arthrograms were obtained, using CO2 as the negative agent for 20 studies and room air in the other 20. In addition, the change in pH of the joint fluid was measured. Of the 20 patients in the CO2 group, 12 had pain, five of whom described it as severe. Of the 20 in the air group, two reported only moderate discomfort. Regardless of the gas used, the incidence of pain was directly related to the amount of decrease in pH. Air is believed superior to CO2 primarily because it produces less pain, persists in the joint longer (allowing for refilming), costs less, and is readily available.

Air↗
PubMed1981

Diagnosis of popliteal cyst: double-contrast arthrography and sonography.

One hundred consecutive patients who had trauma to the knee were examined by sonography and double-contrast arthrography to evaluate the presence or absence of popliteal cyst. In 58 cases both tests were negative, while in 15 both were positive. Each of those 15 patients had pain and/or a palpable mass behind the knee. In 27 remaining patients the arthrogram demonstrated a popliteal cyst that was not detected on the sonogram. None of the 27 patients complained of pain in the popliteal fossa or had a palpable mass in the area. The sonographic findings, however, showed good correlation with these clinical symptoms. This paper attempts to analyze these discrepancies and to evaluate the advantages and disadvantages of each method.

Diatrizoate Meglumine↗
PubMed1983

The supine view in double-contrast knee arthrography.

Knee arthrography is a widely used diagnostic procedure, but there is disagreement regarding the relative efficacy of single vs. double-contrast examinations in the evaluation for meniscal tears. In 353 double-contrast knee arthrograms, combining supine positioning with the routinely accepted prone views, there were 222 meniscal tears diagnosed using prone positioning alone, and seven additional tears were found with the added supine maneuver. Even though the knee joint was distended with both contrast material and air, the prone views tended to outline the meniscus in a double-contrast fashion, whereas the supine views provided single positive contrast detail of the same area. Supine views are particularly helpful when an obvious meniscal tear is not fluoroscopically apparent during prone filming.

Adolescent↗
PubMed1986

CT arthrography of capsular structures of the shoulder.

The capsular mechanism of the shoulder joint consists of the joint capsule, which is strengthened by the glenohumeral ligaments and the rotator cuff, the glenoid labrum, and a variable number of synovial recesses. Although the fibrous capsule is a lax structure, the normal function of the capsular mechanism makes it an effective barrier against anterior dislocation, particularly in external rotation. There has been a tendency in the past to overestimate the role of the glenoid labrum in stability of the shoulder joint. In patients with instability, the significance of the capsular attachment or its anomalous insertions to the glenoid has not been adequately recognized. Labral tears may develop as secondary lesions due to repeated dislocations and subluxations rather than representing the primary lesion responsible for instability. Operative visualization of capsular defects or detachments is often difficult. Prior knowledge of these lesions can effectively help the choice of an appropriate surgical procedure and reduce operating time. The results of computed tomographic (CT) arthrography of the shoulder joint in 45 patients are reported and the normal and pathologic variations of the joint capsule and particularly the capsular insertions are described. Configuration of the joint recesses and the glenoid labrum are also evaluated. These CT findings were correlated and verified by surgery or arthroscopy in 26 cases.

Adolescent↗
PubMed1993

Three-compartment wrist arthrography: correlation of pain site with location of uni- and bidirectional communications.

OBJECTIVE: Our objective was twofold: (1) to determine whether the site of patients' pain correlates with abnormal findings on three-compartment wrist arthrograms and (2) to determine whether the directional nature (uni- vs bidirectional) of communication(s) between adjacent wrist joint compartments shown on three-compartment wrist arthrograms correlates with the presence and site of pain. MATERIALS AND METHODS: We retrospectively studied 462 three-compartment wrist arthrograms of 458 patients. The patients were divided into four groups according to the site of pain, the correlation of that site with the site of the communication, and the directional characteristics of communications shown on the arthrogram: (1) exact correlation between site of pain and arthrographic findings, (2) correlation only between side of pain (ulnar or radial) and arthrographic findings, (3) ambiguous correlations (e.g., multifocal, midline, or diffuse pain), and (4) no correlation between site of pain and arthrographic findings. RESULTS: In 191 patients (42%), 226 intercompartmental communications were detected (51 uni- or 173 bidirectional). One hundred sixty-one patients had only one communication (uni- or bidirectional), and 30 patients had more than one (uni- and/or bidirectional) communication for a total of 65 defects. Regardless of the directional nature of the communication, no positive association between sites and/or the side of symptoms and sites of communications was demonstrable. However, a potential association appears to exist between ulnar-sided pain and combined lunotriquetral and triangular fibrocartilage tears. CONCLUSION: Our results suggest that the directional nature of interjoint communications has little or no clinical significance. Thus, with the exception of seeking the cause of ulnar-sided pain, our results question the usefulness of routine arthrography for correlating sites of patients' symptoms and individual interjoint communications.

Adolescent↗
PubMed1997

The rope ladder: an uncommon artifact and potential pitfall in MR arthrography of the shoulder.

OBJECTIVE: MR arthrograms were retrospectively reviewed for susceptibility artifacts induced by accidental injection of a small amount of gas when paramagnetic contrast solution was injected. A pitfall to interpretation, an unusual distribution of intraarticular gas into the sheath of the long biceps tendon that resembled a rope ladder, was observed and compared with findings of bicipital tenosynovitis. CONCLUSION: Intraarticular gas contamination during MR arthrography must be differentiated from intraarticular loose bodies and findings of bicipital tenosynovitis. Most reliable for the differential diagnosis are the different shapes and sizes of the gas-induced susceptibility artifacts on spin-echo and gradient-recalled echo images.

Adult↗
PubMed1997

Using abduction and external rotation of the shoulder to increase the sensitivity of MR arthrography in revealing tears of the anterior glenoid labrum.

OBJECTIVE: The purpose of this study was to compare oblique axial MR arthrograms obtained with the patient's shoulder in abduction and external rotation (ABER) position with conventional axial MR arthrograms obtained with the patient's arm in neutral position and the shoulder not rotated in revealing tears of the anterior glenoid labrum (AGL). SUBJECTS AND METHODS: MR arthrography of the shoulder that included an additional oblique axial imaging sequence with the patient in the ABER position was performed in 256 patients. Assessment of AGL integrity with patients in both conventional axial and ABER positions was made before surgery. These assessments were compared with the surgical findings. RESULTS: Of the 92 patients who underwent surgery, AGL tears were found in 27. Conventional axial MR arthrograms revealed 13 tears (sensitivity, 48%; specificity, 91%). A separate review of MR arthrograms obtained with patients in the ABER position revealed 24 tears (sensitivity, 89%; specificity, 95%). Reviewed together, axial MR arthrograms and MR arthrograms obtained with patients in the ABER position revealed 26 tears (sensitivity, 96%; specificity, 97%). CONCLUSION: Oblique axial MR arthrograms obtained with the patient's shoulder in the ABER position were significantly more sensitive in revealing AGL tears (p = .005) than were conventional axial MR arthrograms obtained with the patient's aim in a neutral position and the shoulder not rotated.

Adolescent↗
PubMed1998

Tendinopathy and rupture of the tendon of the long head of the biceps brachii muscle: evaluation with MR arthrography.

OBJECTIVE: The purpose of this study was to assess the diagnostic role of MR arthrography in patients with tendinopathy or rupture of the long biceps tendon. MATERIALS AND METHODS: MR arthrograms of 42 consecutive patients with arthroscopic or surgical confirmation of diagnosis (16 normal biceps tendons, 19 with tendinopathy, and seven with ruptures) were analyzed independently by two radiologists. Visibility of the biceps tendon, caliber changes, contour irregularities, and signal intensities were assessed separately in the parasagittal and axial planes. In addition, the two radiologists made an overall evaluation of abnormalities of the biceps tendon using both MR imaging planes. RESULTS: The most reliable MR findings for tendinopathy were caliber changes (sensitivity was 59% for observer 1 and 82% for observer 2; specificity was 88% and 64%, respectively) and signal abnormalities (sensitivity, 77% and 88%, respectively; specificity, 75% and 43%, respectively) in the parasagittal plane. Absence of visualization of the tendon in the parasagittal plane was a reliable sign for rupture (sensitivity, 86% and 86%, respectively; specificity, 94% and 87%, respectively). The overall sensitivity for detecting abnormalities (tendinopathy or rupture) was 92% for observer 1 and 89% for observer 2. Specificity was 56% and 81%, respectively. CONCLUSION: MR findings of tendinopathy and rupture of the biceps tendon are subtle. However, the combination of several MR criteria in two imaging planes makes a reasonably accurate diagnosis possible. The biceps tendon should not only be assessed in the bicipital sulcus on axial images but also on parasagittal images.

Adult↗
PubMed1999

Quantification of intact quadriceps tendon, quadriceps tendon insertion, and suprapatellar fat pad: MR arthrography, anatomy, and cryosections in the sagittal plane.

OBJECTIVE: The purpose of this study was to quantify quadriceps tendon length, thickness, and insertion in relation to the suprapatellar fat pad. SUBJECTS AND METHODS: We used three methods to analyze the anatomy of intact quadriceps tendons and insertions into the patellar base: MR arthrography (53 knees with intact extensor mechanisms), gross anatomy (16 cadaveric knees), and cryosections (four cadaveric knees). With an electronic cursor, two observers independently quantified the extensor mechanism on midline sagittal T1-weighted spin-echo sequences acquired on a low-field-strength (0.23 T) scanner. RESULTS: On MR arthrograms, quadriceps tendon length, determined from the superior patellar pole to the most superior part of the suprapatellar recess, measured 49 +/- 7 mm in women and 50 +/- 9 mm in men. Thickness of quadriceps tendon at three sites (suprapatellar recess, center, and superior patellar pole) measured 7 +/- 1 mm in women and 8 +/- 1 mm in men. Thickness was significantly larger in men at all measurement locations. Quadriceps tendon insertion and the suprapatellar fat pad along the patellar base measured 16 +/- 2 and 6 +/- 2 mm, respectively, in women, and 18 +/- 3 and 7 +/- 2 mm, respectively, in men. CONCLUSION: On midline MR images, sagittal thickness of the quadriceps tendon and its insertion was significantly larger in men than in women. The prevalence of the suprapatellar fat pad was 100%.

Adipose Tissue↗
PubMed2002

Anteromedial impingement of the ankle: using MR arthrography to assess the anteromedial recess.

OBJECTIVE: Our objective was to describe the appearance of the anteromedial tibiotalar joint on MR arthrography in patients with clinically and arthroscopically confirmed anteromedial impingement. CONCLUSION: Anteromedial impingement of the ankle is now being recognized in the orthopedic literature as a distinct entity. MR arthrographic findings of anteromedial impingement include capsular and synovial soft-tissue thickening anterior to the tibiotalar ligaments and any associated osseous abnormality. Although anteromedial impingement is uncommon compared with other impingement syndromes of the ankle, the radiologist should be aware of the diagnosis and possible findings on cross-sectional imaging.

Adolescent↗
PubMed2005

Cystic lesions in the posterosuperior portion of the humeral head on MR arthrography: correlations with gross and histologic findings in cadavers.

OBJECTIVE: The purpose of this study was to describe the appearance of cysts in the posterosuperior portion of the humeral head on MR arthrography and to correlate the MRI findings with the gross and histologic findings in cadavers. CONCLUSION: Cysts in the posterosuperior portion of the humeral head (the bare area) were located in the lateral humeral head just posterior to the greater tuberosity. These cysts were lined with collagen connective tissue and were connected to the joint spaces. We suggest that these pseudocysts in the posterosuperior portion of the humeral head may be a normal variant rather than being an abnormal change or vascular channel.

Adult↗
PubMed1985

Joint distension arthrography for disabling hip pain. A controlled clinical trial.

Thirty-eight patients (age 27-73 years) with unilateral hip pain, restricted movement of the hip joint and radiologically no or only slight osteoarthrosis were studied in a double-blind controlled clinical trial. Twenty-one patients received active treatment with hip joint distension arthrography and 17 received placebo treatment. All patients were assessed clinically on entry, the day after and 3 months after treatment. The incidences of subjective improvement were similar in the two groups. Apart from a slight deterioration in the treated group of hip flexion, abduction and lateral rotation at the one-day assessment, neither group showed any change in the registered movements of the hip joint compared with the assessment on entry. The measured intermalleolar distance at maximal straight-leg abduction was the sole variable which tended to increase (p = 0.05) 3 months after active treatment. Thus, the therapeutic effect of a single treatment with joint distension seems to be dubious.

Adult↗
PubMed1976

Lymphatic filling during knee arthrography.

Six cases of lymphatic filling during knee arthrography have been recorded in literature, all of which have had advanced rheumatoid arthritis. We report a case of lymph vessel filling from a popliteal cyst in a young male nonrheumatoid patient. It is concluded that abnormal synovial-lymphatic connection in the knee joint may occur also in other forms of synovial pathology and such a finding does not indicate rheumatoid inflammation.

Adult↗
PubMed2000

[MR arthrography].

Review article on MR arthrography: technique and main indications. Intra-articular injection of diluted Gadolinium provides good distension and better appreciation of intra-articular structures than standard MRI. It is useful for partial tears of the rotator cuff, in cases of gleno-humeral instability, lesions of the acetabular labrum and hyaline articular cartilage and also for elbow, wrist and ankle ligamentous ruptures.

Acetabulum↗