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PubMed2003

Internal derangement of the wrist: indirect MR arthrography versus unenhanced MR imaging.

PURPOSE: To compare indirect magnetic resonance (MR) arthrography with unenhanced MR imaging of the wrist for evaluation of the central disk of the triangular fibrocartilage complex (TFCC) and the scapholunate and lunotriquetral interosseous ligaments. MATERIALS AND METHODS: Eighty-six wrists were evaluated at MR imaging (41 indirect MR arthrography and 45 unenhanced MR imaging examinations). Three musculoskeletal radiologists independently evaluated the central disk of the TFCC and scapholunate and lunotriquetral ligaments and compared the results with those of wrist arthroscopy. Sensitivity and specificity were calculated for each of the readers, and the means were obtained. Sensitivities and specificities were compared with the Student t test. RESULTS: Thirty-three tears of the central disk of the TFCC and 13 scapholunate and 18 lunotriquetral ligament tears were identified at arthroscopy. Sensitivities and specificities were 54%-73% and 83%-91%, respectively, in the evaluation of the central disk of the TFCC, with no significant difference between indirect MR arthrography (P =.666) and unenhanced MR imaging (P =.559). Sensitivities and specificities in the evaluation of the scapholunate ligament were 38%-69% and 75%-99%, respectively, with a significant improvement in sensitivity at indirect MR arthrography (P =.017) and no significant difference in specificity (P =.876). Sensitivities in the evaluation of the lunotriquetral ligament were poor, 0%-22%, though the specificities were 88%-99%, with no significant difference between indirect MR arthrography and unenhanced MR imaging (P =.592 and P =.354, respectively, for sensitivity and specificity. CONCLUSION: Indirect MR arthrography significantly improves sensitivity in the evaluation of the scapholunate ligament when compared with unenhanced MR imaging of the wrist but does not significantly improve the ability to evaluate the central disk of the TFCC or the lunotriquetral ligament.

Adult↗
PubMed1988

MR imaging of recurrent anterior dislocation of the shoulder: comparison with CT arthrography.

Posttrauma damage due to anterior glenohumeral joint dislocation may result in recurrent dislocation. Currently CT arthrography is the method of choice to evaluate the extent of osseous and soft-tissue changes before reconstructive surgery. This study was undertaken to determine if MR was able to depict postdislocation abnormalities and if MR is a possible replacement for CT arthrography. Thirteen patients with recurrent anterior shoulder dislocation were evaluated with conventional radiography and MR; CT arthrography was performed in 10. Twelve patients underwent surgery, and the findings of MR and CT arthrography were verified. MR and CT arthrography showed the integrity of the glenoid labrum equally well. All humeral head defects, detected in nine patients with plain film radiography and CT, were easily identified with MR. Information about anterior joint capsule abnormalities is difficult to obtain with MR. However, separation of the capsule from the bony glenoid can be detected if a joint effusion is present to adequately distend the joint. Preliminary results of this study indicate that MR is useful in the assessment of postdislocation abnormalities and may possibly replace CT arthrography in the evaluation of patients with recurrent shoulder dislocation.

Humans↗
PubMed2005

Fat-suppressed 3D spoiled gradient-echo MRI and MDCT arthrography of articular cartilage in patients with hip dysplasia.

OBJECTIVE: Our objective was to assess the diagnostic ability of MDCT arthrography for acetabular and femoral cartilage lesions in patients with hip dysplasia. MATERIALS AND METHODS: A disorder of the articular cartilage was evaluated in 20 hips of 18 patients with acetabular dysplasia who did not have osteoarthritis or who had early stage osteoarthritis before undergoing pelvic osteotomy surgery. The findings on fat-suppressed 3D fast spoiled gradient-echo MRI and MDCT arthrography of the hip were evaluated by two independent observers, and sensitivity, specificity, and accuracy were determined using arthroscopic findings as the standard of reference. Kappa values were calculated to quantify the level of interobserver agreement. RESULTS: The sensitivity and specificity for the detection of any cartilage disorder (grade 1 or higher) were (observer 1/observer 2) 49%/67% and 89%/76%, respectively, on MRI, and 67%/67% and 89%/82%, respectively, on CT arthrography. The sensitivity and specificity for the detection of cartilage lesions with substance loss (grade 2 or higher) were (observer 1/observer 2) 47%/53% and 92%/87%, respectively, on MRI, and 70%/79% and 93%/94%, respectively, on CT arthrography. CT arthrography provided significantly higher sensitivity in the detection of grade 2 or higher lesions than MRI for both observers. Interobserver agreement in the detection of grade 2 or higher cartilage lesions was moderate (kappa = 0.53) on MRI and substantial (kappa = 0.78) on CT. CONCLUSION: MDCT arthrography is a sensitive and reproducible method for assessing articular cartilage lesions with substance loss in patients with hip dysplasia.

Adolescent↗
PubMed1987

Assessment of anterior shoulder instability by CT arthrography.

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.

Adult↗
PubMed1999

[Clinical Application of CT assisted Double Contrast Arthrography of Temporomandibular Joint]

OBJECTIVE:To introduce double-contrast arthrography of TMJ with reformatted sagittal and coronal CT imaging and to evaluate the value of its application in the diagnosis of temporomandibular joint dysfunction. METHODS: 14 patients in whom diagnosis can not be established with conventional arthrography were examined by double contrast arthrography with reformatted sagittal and coronal CT imaging. RESULTS: In double-contrast arthrography with CT imaging, 1 case was normal;1 case had anterior displacement with reduction;2 cases were anterior displacement without reduction, and 8 cases were with disk adhesion. CONCLUSION:The double contrast arthrography with reformatted sagittal and coronal CT imaging was a very important alternative to conventional arthrography, and has special value to demonstrate adhesion of TMJ.

Journal Article↗
PubMed2003

Sacroiliac arthrograms and post-arthrography computerized tomography.

Sacroiliac joint (SIJ) injection and arthrography have been described, yet no study has specifically categorized the morphological characteristics of SIJ arthrograms versus post arthrogram computerized tomography (CT). Forty-three patients with a mean age of 33 years (range 20-48 years) and an equal male to female distribution were studied radiographically for SIJ pathology. A total of 74 SIJ injections were performed using Image-intensifier-control and a posterior-inferior approach. Symptom reproduction indicating a provocation positive outcome, was reported in 63.5% with a mean injected volume of contrast media of 1.08 cc (S.D. 0.29). SIJ findings were then classified and scored in each aspect of the SIJ capsule by plain film arthrography followed by post arthrogram CT (anterior, posterior, superior and inferior aspects of the capsule). There was a significant direct correlation between the plain film and CT arthrography findings in each category (Kendall correlation coefficients 0.63 - 0.99, p<0.01). In addition, there was a significant direct correlation between provocation positive outcomes and volume of contrast injected (Kendall correlation 0.25, p<0.01; ANOVA, p<0.03). Post arthrogram CT revealed significantly more positive anterior capsule findings compared to plain film arthrography (McNemar's test, p<0.04). Conversely, plain film arthrography noted more diverticula compared to post arthrogram CT (McNemer's test, p<0.01). These findings demonstrate that a detailed radiographic analysis of the SIJ capsule is reasonable by either plain film arthrography or post arthrogram CT, with excellent agreement between the two techniques. Further, each test has specific regional benefits that may be appreciated in certain cases.

Journal Article↗
PubMed1989

Arthrography of the post-traumatic knee, shoulder, and wrist. Current status and future trends.

The current status of arthrography of the wrist, knee, and shoulder has been discussed with particular emphasis given to those conditions seen in patients following acute or chronic trauma. Cross-sectional techniques that impact on the current usage of arthrography of these joints also were discussed. Wrist arthrography remains the standard procedure for the evaluation of ligamentous abnormalities about the wrist. MR imaging is unlikely to make a large impact in this area until improvements in technique and surface coil technology allow routine visualization of the very small, but important, interosseous ligaments. MR imaging of the knee will likely replace arthrography except in those cases in which cost considerations or availability prevent its implementation. MR imaging undoubtedly will continue to contribute to the evaluation of shoulder abnormalities, but whether or not it will completely replace standard arthrography and CT arthrography depends upon the results of future studies.

Humans↗
PubMed1983

Clinical utility of knee arthrography.

We evaluated how information obtained from knee arthrography was used in clinical management by means of questionnaires answered by orthopedists both before and after arthrography. In 55 of the 76 patients, the abnormality was considered "moderately severe," and in two patients "insignificant" before arthrography. After arthrography, 30 were considered "moderately severe," and 22 were thought "insignificant." There was a similar diminution in the perceived need for surgery when the results of arthrography were known. Arthrography alters patient management in that a normal arthrogram in a clinically equivocal case seems to convince the orthopedist that the injury is not significant and that surgery is not necessary.

Humans↗
PubMed1999

The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy.

We assessed the value of three-compartment magnetic resonance (MR) wrist arthrography in comparison with non-enhanced magnetic resonance imaging (MRI) for the evaluation of 13 individual wrist ligaments in 35 patients with refractory wrist pain. In 20 of these patients MR findings were correlated with the findings from multiportal wrist arthroscopy. For MR imaging (1.5-T magnet) a three-dimensional volume acquisition with a gradient-recalled echo sequence and 0.6-1.0 mm effective slice thickness was used. The delineation of individual wrist ligaments was rated as "good" in 10% of non-enhanced MR and 90% of MR arthrography images. Ligament evaluation was possible with high diagnostic confidence in 11% by non-enhanced MR imaging and 90% by MR arthrography. With wrist arthroscopy as the standard of reference, average sensitivities/specificities/accuracies for the diagnosis of full-thickness ligamentous defects were 0.81/0.75/0.77 for non-enhanced MR imaging and 0.97/0.96/0.96 for MR arthrography. Our findings suggest that MR arthrography is more accurate than standard MRI in delineating and evaluating the ligaments of the wrist.

Adolescent↗
PubMed1992

Combined nuclear and digital subtraction contrast arthrography in painful knee prosthesis.

The evaluation of a painful knee prosthesis remains a difficult problem for both orthopaedic surgeons and radiologists. We have compared digital subtraction arthrography with nuclear arthrography in 7 patients with a painful knee prosthesis. Three patients showed a loose tibial component, demonstrated by both digital subtraction and nuclear arthrography. All 3 underwent revision of their prosthesis. One patient had an equivocal digital subtraction arthrogram and negative nuclear arthrogram, while both studies were negative in the 3 remaining patients. Nuclear arthrography is a simple procedure and can provide useful additional information when combined with digital subtraction arthrography.

Aged↗
PubMed1991

Contrast and nuclear arthrography in loosening of the uncemented hip prosthesis.

The recent popularity of ingrowth or uncemented hip arthroplasties has presented problems in the radiographic diagnosis of loosening because there is no longer a cement interface in which lucencies may be seen. We evaluated a combination of positive contrast and nuclear arthrography to see whether these studies could accurately detect loosening of uncemented femoral components of hip prostheses. We performed routine contrast and nuclear arthrography in 21 patients with ingrowth total hip arthroplasties or bipolar endoprostheses. The results were surgically confirmed in 12 patients. The contrast arthrogram was true positive in 5 and false negative in 5. There were no false positives and 2 true negatives. The nuclear arthrogram was true positive in 7 patients, false negative in 3, and true negative in 2. Taken together, there was only 1 patient in whom both contrast and nuclear arthrography were false negative, and there were no false positives. Thus, when either contrast or nuclear arthrography is positive, the sensitivity of the combined procedures is 90%; when both studies are negative, the specificity is 100%. The combination of contrast and nuclear arthrography is an accurate method of determining loosening of the femoral component of an uncemented hip arthroplasty or bipolar endoprosthesis in the patient with postoperative hip pain.

Adult↗
PubMed2003

[TFCC-lesion. MR arthrography vs. arthroscopy of the wrist].

In a blinded study from January to July 2000, 125 patients suffering from specific complaints of the wrist were examined with direct MR arthrography prospectively. Within 24 hours an arthroscopy of the wrist was performed. With the MR arthrography in 70 patients or 56% of all patients injury of the TFCC was diagnosed. In 65 patients this could be verified arthroscopically. In the remaining 55 patients no TFCC lesion was diagnosed with the MR arthrography. However lesions were found via arthroscopy in three cases,were MRI findings expected an intact TFCC. In the remaining 52 cases the MRT could exclude a lesion of the TFCC correctly. An agreement of the MRT and arthroscopic results could be determined in 93.6% of the cases (correlation). The diagnosis of a TFCC lesion by means of MRI was correct in 94% of the cases (sensitivity), the exclusion of such lesion in 89% (specificity). Positive or negative predictive values of 91% or 93% were achieved. Since neither a specificity nor a sensitivity of 100% can be reached at the moment, the MR arthrography cannot replace the arthroscopy. However it could be a potent additional tool for wrist diagnosis if intraarticular contrast is used. It can facilitate the diagnostics and the indication for surgery at the ulnocarpal wrist and help to reduce arthroscopic interventions that are only for diagnostic purposes and without any therapeutic consequences. With improvement of the technique of magnet resonance tomography we can expect further increase of accuracy and the clinical use of the MR arthrography in the diagnostic workup at the ulnocarpal wrist.

Adult↗
PubMed1999

[MRI arthrography of the ankle joint].

Due to its superior soft tissue contrast conventional MRI is the imaging method of choice in the evaluation of ankle joint disorders. Conventional MR imaging can accurately demonstrate normal or acutely injured ligaments; however, in subacute and chronic injury joint fluid necessary for delineation of injured ligaments is absent and MR arthrography should be performed. MR arthrography uses the intraarticular injection of contrast material to distend the joint, yielding improved discrimination of intraarticular structures. This joint distension with MR arthrography is also helpful in the staging of osteochondritis dissecans, since in cases of unstable lesions tracking of contrast material into the interface can be more easily demonstrated. Finally, high contrast and joint distension by MR arthrography improves the detection of intraarticular loose bodies, which often require surgery. MR arthrography, although invasive, may provide additional information in various ankle joint disorders.

Ankle Injuries↗
PubMed1998

Value of arthrography after supination trauma of the ankle.

OBJECTIVE: To investigate the merits of arthrography after supination trauma of the ankle. DESIGN AND PATIENTS: In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. RESULTS: The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (kappa 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. CONCLUSION: Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture.

Adolescent↗
PubMed2002

Low-field MR arthrography of the shoulder joint: technique, indications, and clinical results.

In the age of cost containment and urgent reductions in health care expenditures, new options have to be explored to satisfy both diagnostic requirements and economic limitations. The introduction of low-field MR systems for assessment of joint disorders seemed to be an option for lower costs. The purpose of this article is to summarize available experiences with low-field MR arthrography of the glenohumeral joint with respect to image quality and diagnostic accuracy in detecting labral and rotator cuff lesions. Up to now, there has been only a limited number of studies available dealing with low-field MR arthrography of the glenohumeral joint. They reveal that, despite a minor image quality in comparison with high-field imaging, low-field MR arthrography of the shoulder allows for sufficient evaluation of intra- and extra-articular structures in the detection of major abnormalities such as glenohumeral instability or rotator cuff disease. Furthermore, open-configured MR scanners enable kinematic studies: Besides the analysis of normal motion, pathological findings in patients with instabilities and impingement syndrome can be delineated. They further offer the possibility for performing MR imaging-guided arthrography of the shoulder. This was first described using an open C-arm scanner with a vertically oriented magnetic field so that MR arthrography may be performed in one setting.

Arthrography↗
PubMed1993

Evaluation of chronic wrist pain by arthrography, arthroscopy, and arthrotomy.

Arthrography and arthroscopy of the wrist were compared as diagnostic tools in the evaluation of chronic wrist pain. Arthroscopy proved to be a more sensitive procedure than arthrography in 20 consecutive patients with confirmed wrist injuries. There was 86% correlation (the exception--one false negative arthroscopic procedure) between arthroscopy and arthrography in eight patients with triangular fibrocartilage tears. Compared with arthroscopy, there were five false negative and five false positive arthrograms when evaluating interosseous scapholunate and lunotriquetral ligament tears. Arthroscopy more readily identified the location and extent of triangular fibrocartilage and the significance of interosseous ligament tears. Wrist arthrotomy confirmed the findings of wrist arthrography and arthroscopy and demonstrated that arthrography is not as accurate in localizing specific wrist injuries. Furthermore, wrist arthroscopy is a more valuable technique in determining the location, size, and extent of ligament injuries within the wrist.

Adolescent↗
PubMed2005

Arthroscopically repaired Bankart lesions and the effect of two different arm positions on immediate postoperative evaluation with magnetic resonance arthrography.

PURPOSE: To evaluate and describe the findings of immediate postoperative magnetic resonance (MR) arthrography of repaired capsulolabral buttress using 2 different arm positions (internal rotation and external rotation) for patients who have undergone arthroscopic Bankart repair. TYPE OF STUDY: Case series. METHODS: Arthroscopically repaired Bankart lesions in 22 nonconsecutive patients were examined with axial T2-weighted MR arthrography. We studied each of the 22 shoulders on the day of surgery for each patient. We measured 3 parameters (height, slope, and medial overhang) on the axial image at the anteroinferior portion of the glenoid (near the most inferior anchor) while placing each patient's arm into 2 different positions. The first involved internal rotation and the second, external rotation of the shoulder with the arm held at the side of the trunk and the elbow at 90 degrees flexion. The mean internal rotation of the arm was 30 degrees (range, 14 degrees to 45 degrees) and the mean external rotation was 19 degrees (range, 2 degrees to 44 degrees). RESULTS: The mean labral height and slope differences between the 2 arm positions were 1.47 mm (standard deviation [SD], 0.75 mm; range, 0.6 mm to 3.5 mm; P < .001) and 6.91 degrees (SD, 3.4 degrees; range, 2.2 degrees to 11.2 degrees; P < .001), respectively. Medial overhang on the glenoid rim was 81% positive with the arm at internal rotation whereas medial overhang was 86% negative with the arm at external rotation (P < .001). On MR arthrography, internal rotation of shoulder showed the loss of the capsulolabral buttress in all patients. CONCLUSIONS: On MR arthrography, the arthroscopically repaired capsulolabral buttress was affected by rotation of the arm after Bankart repair. Internal rotation of the arm significantly decreased our ability to see the repaired capsulolabral buttress on MR arthrography. LEVEL OF EVIDENCE: Level III, diagnostic study of nonconsecutive patients.

Adolescent↗
PubMed2006

An overview of MR arthrography with emphasis on the current technique and applicational hints and tips.

Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however, direct MR arthrography using diluted gadolinium as the contrast agent is the most commonly used technique and is the most reliable of all. MR arthrography is useful for demonstrating labrocapsular-ligamentous abnormalities and distinguishing partial thickness rotator cuff tears from focal full thickness tears in the shoulder, identifying or excluding recurrent tears following meniscal operations in the knee, demonstrating perforations of the triangular fibrocartilage complex (TFCC) and ligaments in the wrist, showing labral tears in the hip, diagnosing ligament tears in the ankle and identifying osteochondral lesions or loose bodies in any of the aforementioned joints. In this article, an overview of techniques of MR arthrography is provided with emphasis on direct MR arthrography using diluted gadolinium as the contrast agent. The current applications of the technique in major peripheral joints are reviewed, with emphasis given to the shoulder joint where the role of this technique has become well established.

Arthrography↗