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PubMed2006

Therapeutic arthrography and bursography.

Arthrography and bursography as therapeutic venues have found their place in the musculoskeletal procedure armamentarium. Therapeutic arthrography not only rules in and rules out the origin of pain but can provide 6 to 9 months of pain relief in diseased joints. Therapeutic arthrography allows injections of anesthetic, corticosteroid, or alternatively hyaluronic acid to be delivered accurately to the source of pain. Corticosteroids have a long history of use in osteoarthritis. Alternative therapy with hyaluronic acid is anew procedure. This article reviews the technique of arthrography in different joints and bursae and discusses the pros and cons of the use of corticosteroids versus viscosupplementation in therapeutic arthrography.

Adjuvants, Immunologic↗
PubMed2002

MR arthrography of the lower extremity.

MR arthrography by virtue of its ability accurately to demonstrate intra-articular structures and abnormalities of these structures has become an important tool for the evaluation of a variety of articular disorders. Although not necessary in all patients, MR arthrography may facilitate the evaluation of patients with suspected intra-articular pathology in whom conventional MRI is not sufficient for an adequate therapy planning. MR arthrography combines the advantages of arthrography, like joint distention and delineation of intra-articular structures, with the superior spatial resolution of MRI. This technique improves diagnostic confidence, particularly in the assessment of subtle lesions and of complex anatomic structures. MR arthrography is of high value in the evaluation of osteochondral defects, loose bodies, previously operated menisci, and acetabular labral lesions.

Ankle Joint↗
PubMed1998

Arthrography is superior to magnetic resonance imaging for diagnosing injuries of the triangular fibrocartilage.

The ability of single-injection radiocarpal arthrography and magnetic resonance imaging (MRI) to detect full-thickness tears of the triangular fibrocartilage were compared with wrist arthroscopy in 102 patients with wrist pain. The sensitivity of arthrography was 85%, and of MRI was 73%. Specificity was 100% for arthrography and 72% for MRI. Accuracy was 92% for arthrography, and 73% for MRI. Although future advances in MRI technology will probably improve its usefulness, single-injection wrist arthrography currently is superior to routine MRI for the detection of full-thickness triangular fibrocartilage tears.

Adolescent↗
PubMed2001

Sacro-iliac joint arthrography in low back pain: feasibility of MRI guidance.

OBJECTIVE: Evaluation of the feasibility of MR-guidance in sacro-iliac joint arthrography in patients whose low back pain is suspected to arise from the sacro-iliac joint (SIJ). METHODS AND PATIENTS: Twenty patients with low back pain underwent MR-guided sacro-iliac joint arthrography. Needles made from titanium (size 20 G, MDTech, USA) were used. For image guidance a 0.23T open-configuration C arm magnet (Proview, Marconi Medical Systems, USA) with special interventional hardware and software package (I-Path 200, Marconi Medical Systems) containing an MR compatible in-room console, large-screen (36") display, optical navigator and accompanying software with dedicated sequences was used. No other image guidance modalities were used. RESULTS: MR-guided SIJ arthrography was successfully performed in all twenty patients without complications. The optimal imaging sequence both for preoperative and intraoperative images was 3D-Gradient Echo sequence. The dispersal of the injected saline and anaesthetic could be determined inside the joint in all cases with heavily T2-weighted fast spin echo sequence. In the present study, 60% of the patients had significant reduction of pain after sacro-iliac joint arthrography and sacro-iliac joint was considered to be the source of patients low back pain in these patients. CONCLUSION: The present study shows that MR guidance with open configuration low field scanner is an accurate guiding method for sacro-iliac joint arthrography.

Adolescent↗
PubMed2002

[Scapholunate ligament tears in MR arthrography compared with wrist arthroscopy].

In a blinded study from January to July 2000, 125 patients suffering from specific complaints of the wrist were prospectively examined with direct MR arthrography. Within 24 hours an arthroscopy of the wrist was performed. With MR arthrography in 21 patients or 17 % of all patients, injury of the scapho-lunate ligament was diagnosed. In all patients this could be verified arthroscopically. In the remaining 104 patients, no SL-ligament lesions were diagnosed with the MR arthrography. However, partial lesions were found via arthroscopy in seven cases and complete lesions of the ligament were found in one case, where MRI findings expected an intact SL ligament. In the remaining 96 cases, the MRI could correctly exclude a lesion of the SL-ligament. The diagnosis of a SL-ligament lesion by means of MRI was correct in 100 % of the cases (specificity), the exclusion of such lesions in 72 % (sensitivity). Positive or negative predictive values of 100 % or 92 % were achieved. Since a sensitivity of 100 % cannot be reached at the moment, MR arthrography cannot replace 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 of the wrist and help to reduce arthroscopic interventions for purely diagnostic purposes and without any therapeutic consequences. With improvement of the technique of magnet resonance tomography we can expect a further increase of accuracy in the clinical use of the MR arthrography in the diagnostic workup of the wrist.

Adult↗
PubMed2003

[Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients].

OBJECTIVE: In literature the diagnostic value of MRI for detecting lesions of the carpal ligaments and the TFCC is judged controversially. The aim of the following study is to determine the diagnostic accuracy of direct MR arthrography for depicting and staging of intraarticular lesions of the wrist. MATERIAL AND METHODS: One day before undergoing arthroscopy, 125 patients suffering from wrist pain were examined with direct MR arthrography in a prospective and blinded study. A mixture of contrast medium (iodine-containing contrast medium and gadopentetate in relation 200 : 1) was injected into both radiocarpal and midcarpal joints. The following sequences were acquired on a 1.5T scanner: coronal T1-weighted SE, coronal fat-saturated T1-weighted SE, coronal T1-/T2*-DESS-3D, and sagittal T2*-weighted MEDIC. MRI results were compared with arthroscopic findings using statistical analysis (SEN = sensitivity, SPE = specificity, PPV = positive predictive value, NPV = negative predictive value, ACC = accuracy). RESULTS: In comparison to arthroscopy as the accepted diagnostic gold standard, the following results were found for MR arthrography. Detection of TFCC lesions: SEN 97.1 %, SPE 96.4 %, PPV 97.1 %, NPV 96.4 %, ACC 96.8 %. Detection of complete tears of the scapholunate ligament: SEN 91.7 %, SPE 100 %, PPV 100 %, NPV 99.1%, ACC 99.2%. Detection of partial tears: SEN 62.5 %, SPE 100 %, PPV 100 %, NPV 94.8 %, ACC 95.2 %. Detection of cartilage defects: SEN 84.2 %, SPE 96.2 %, PPV 80 %, NPV 97.1 %, ACC 94.4 %. In total, only three lesions of the lunotriquetral ligament were present. CONCLUSION: Direct MR arthrographic imaging is well suited for detecting intraarticular lesions of the wrist. The presented diagnostic results of MR arthrography are superior to the results of unenhanced MRI reported in the literature. Direct MR arthrography as a reliable diagnostic tool is strongly recommended if lesions of the scapholunate ligament and the triangular fibrocartilage complex are suspected. In contrast, an attitude of caution must be adopted in diagnosing lesions of the articular cartilage of the wrist.

Adolescent↗
PubMed1994

[Application possibilities of MR arthrography in diseases of the shoulder joint].

In a prospective study possible indications for MR arthrography of the shoulder were evaluated. 37 patients were examined before and after intraarticular administration of a 2-mmolar solution of Gd-DTPA. MR arthrography was performed if there was no joint effusion and/or an uncertain finding concerning the rotator cuff or the capsulolabral complex on plain MR images. MR arthrography leads to a better demonstration of labrum pathology in 11/22 patients and to a superior delineation of the capsuloligamentous apparatus in 20/22 cases. In 9/15 patients with impingement lesions MR arthrography allowed a differentiation of severe tendinitis from partial and small full-thickness tears of the rotator cuff. MR arthrography of the shoulder joint enhances the accuracy of MR in case of an uncertain finding on plain MR images.

Adolescent↗
PubMed2003

Indirect magnetic resonance arthrography: applications in sports imaging.

Indirect magnetic resonance (MR) arthrography is an imaging tool with several advantages over both direct MR arthrography and unenhanced musculoskeletal magnetic resonance imaging. It is based upon the idea that paramagnetic contrast agents injected intravenously into the plasma compartment ultimately will perfuse the articular space. Advantages of indirect MR arthrography include enhancement of both intra-articular and extra-articular pathology without the need for an invasive, fluoroscopically guided arthrogram, as well as high sensitivity for reinjury in postoperative patients. Some potential disadvantages of this technique are enhancement of normal vascular tissues and difficulty in making a diagnosis dependent upon joint space distension in the absence of an effusion. Important technical issues when performing indirect arthrography include choosing an appropriate delay between contrast injection and imaging, as well as the potential use of patient exercise to improve image quality. In sports medicine, indirect MR arthrography is most useful in and about small joints such as the wrist and ankle; in articulations with potential internal derangements, as well as bony or osteochondral injuries; and in injured joints that have been altered surgically.

Arthrography↗
PubMed2000

Comparison of double-contrast CT arthrography image quality with nonionic contrast agents: isotonic dimeric iodixanol 270 mg I/mL and monomeric iohexol 300 mg I/mL.

RATIONALE AND OBJECTIVES: The authors evaluated the image quality on delayed CT arthrography images with the use of the nonionic dimeric contrast agent, iodixanol 270 mg I/mL, compared with iohexol 300 mg I/mL. METHODS: A total of 132 patients with shoulder pain were included in a randomized, parallel, double-blind study. Sixty seven patients received iodixanol and 65 patients received iohexol. Patients underwent two CT-arthrography examinations: the first was performed 20 to 30 minutes after contrast injection and the second, 50 to 70 minutes after contrast injection. Data from 31 patients were excluded from the efficacy analysis. The overall quality of CT arthrography images was graded into four categories: excellent, good, moderate, and bad. RESULTS: The overall quality of delayed CT arthrography images was significantly better in the iodixanol group (P = 0.001, alpha = 0.05). On the first CT examination, image quality was good or excellent in 88% of the cases in the iodixanol group and in 96.1% in the iohexol group. The results on the delayed CT arthrography examination indicated that image quality was good or excellent in 88% of the cases when iodixanol was used and in 63.5% when iohexol was used. CONCLUSIONS: The overall quality of delayed images was significantly better with iodixanol than with iohexol.

Adult↗
PubMedDate not supplied

Magnetic resonance arthrography of the canine stifle joint: technique and applications in eleven military dogs.

The stifle joints of eleven military working dogs were evaluated using conventional magnetic resonance (MR) imaging and MR arthrography. A protocol optimizing MR imaging of the canine stifle joint is discussed, as well as potential uses for administration of intra-articular gadolinium. The technique for performing MR arthrography is described, and post-contrast image findings are reviewed. MR arthrography was performed by using an intra-articular injection of diluted gadolinium. Consistently good quality images were obtained, and no complications were clinically detected following MR arthrography. Cranial cruciate ligament abnormalities were seen in six dogs, meniscal abnormalities were visualized in nine menisci, and synovitis and medial ligament strain were seen in eight dogs. Surgical and post-mortem confirmation of these findings is discussed in seven dogs. Although MR arthrography adds an invasive procedure to conventional MR imaging, it can provide useful information on pathologic changes in the canine stifle joint.

Animals↗
PubMed2004

Cartilage thickness in cadaveric ankles: measurement with double-contrast multi-detector row CT arthrography versus MR imaging.

PURPOSE: To test the accuracy of double-contrast multi-detector row computed tomographic (CT) arthrography for measurement of cartilage thickness in cadaveric ankles and to compare this technique with three-dimensional (3D) fat-suppressed spoiled gradient-echo in the steady state (FS-SPGR) magnetic resonance (MR) imaging. MATERIALS AND METHODS: Five cadaveric ankles were used. In the ankle specimens, five to nine 1.5-mm-diameter holes were drilled across the joint traversing the tibial subchondral bone, tibial articular cartilage, talar dome cartilage, and talar subchondral bone. The ankle specimens were obtained and used according to institutional policies. Each ankle specimen was imaged first by using 3D FS-SPGR MR imaging with a 1.5-T magnet and then by using double-contrast arthrography followed by CT with a four-detector row scanner (ie, double-contrast multi-detector row CT arthrography). The section thickness used for CT scanning was 1.0 mm reconstructed in 0.5-mm intervals. The MR and CT images obtained in the five specimens were then downloaded to a workstation, where a measurement tool was used to measure the cartilage thickness at each hole. The physical measurement of cartilage thickness at each hole was used as the reference standard with which the MR imaging and CT measurements were compared. Linear regression and correlation analyses were performed by using a statistical computer program. RESULTS: Double-contrast arthrography followed by multi-detector row CT, as compared with 3D FS-SPGR MR imaging, enabled more accurate measurement of the physical cartilage thickness in the ankle (P < .001). CONCLUSION: In this study of five cadaveric ankles, multi-detector row CT arthrography was more accurate than 3D FS-SPGR MR imaging for measurement of articular cartilage thickness in the ankle.

Adult↗
PubMed2005

Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries.

PURPOSE: To retrospectively evaluate the accuracy of magnetic resonance (MR) arthrography in the classification of anteroinferior labroligamentous injuries by using arthroscopy as the reference standard. MATERIALS AND METHODS: Ethical committee approval and informed consent were obtained. MR arthrograms obtained in 205 patients, including a study group of 104 patients (74 male and 30 female; mean age, 28.2 years) with arthroscopically proved labroligamentous injuries and a control group of 101 patients (65 male and 36 female; mean age, 31.4 years) with intact labroligamentous complex, were reviewed in random order. MR arthrograms were analyzed for the presence and type (Bankart, anterior labral periosteal sleeve avulsion [ALPSA], Perthes, glenolabral articular disruption [GLAD], or nonclassifiable lesion) of labroligamentous injuries by two radiologists in consensus. Results were compared with arthroscopic findings. Sensitivity, specificity, accuracy, and corresponding 95% confidence intervals for the detection and classification of anteroinferior labroligamentous lesions with MR arthrography were calculated. RESULTS: At arthroscopy, 104 anteroinferior labroligamentous lesions were diagnosed, including 44 Bankart lesions, 22 ALPSA lesions, 12 Perthes lesions, and three GLAD lesions. Twenty-three labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. Nineteen (83%) of these 23 lesions were also nonclassifiable at MR arthrography. With arthroscopy used as the reference standard, labroligamentous lesions were detected and correctly classified at MR arthrography with sensitivities of 88% and 77%, specificities of 91% and 91%, and accuracies of 89% and 84%, respectively. Bankart, ALPSA, and Perthes lesions were correctly classified in 80%, 77%, and 50% of cases, respectively. The three GLAD lesions were all correctly assessed. CONCLUSION: MR arthrography is accurate in enabling classification of acute and chronic anteroinferior labroligamentous injuries, although correct interpretation of Perthes lesions remains difficult.

Adolescent↗
PubMed1989

Computed arthrotomography as an adjunct to pediatric arthrography.

Computed arthrotomography was compared with conventional arthrography in ten cases and with both pluridirectional arthrotomography and conventional arthrography in five cases. Six elbows, five hips, three ankles, and one wrist were examined. Indications included pain, locking, congenital hip dislocation, posttraumatic joint deformity, and postinfectious joint deformity. Compared with conventional arthrography, computed arthrotomography provided additional information in ten of 15 (67%) cases and provided the same information in four cases. Arthrography and computed arthrotomography were complementary in one case. Compared with pluridirectional arthrotomography, computed arthrotomography provided additional information in two of five (40%) cases. In the remaining three cases, computed arthrotomography and pluridirectional arthrotomography provided equal information. In no case did pluridirectional arthrotomography provide additional information. Computed arthrotomography was useful in demonstrating loose bodies, differentiating air bubbles from loose bodies, and determining the intra- or extraarticular location of ossific densities. Computed arthrotomography appears to be a useful adjunct to arthrography in detecting loose bodies and in evaluating anatomically complex cases.

Adolescent↗
PubMed1994

Chronic ankle instability: evaluation with MR arthrography, MR imaging, and stress radiography.

PURPOSE: To compare the efficacy of conventional magnetic resonance (MR) imaging, MR arthrography, and stress radiography in the detection of lateral collateral ligament abnormalities in patients with chronic ankle instability. MATERIALS AND METHODS: Seventeen patients with chronic lateral ankle instability underwent stress radiography, MR imaging, and MR arthrography after intraarticular injection of gadopentetate dimeglumine. Imaging findings were correlated with surgical findings. RESULTS: The anterior talofibular (ATF) ligament was torn in 14 patients, and the calcaneofibular (CF) ligament was torn in 10. MR arthrography was more accurate and sensitive in the detection of ATF tears than was MR imaging or stress radiography (P < or = .05). Associated injuries were detected with both MR imaging and MR arthrography. CONCLUSION: MR arthrography is a sensitive technique for detecting and staging tears of the lateral collateral ligaments.

Adult↗
PubMed1995

Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography.

PURPOSE: To determine whether magnetic resonance (MR) arthrography of the elbow can demonstrate precisely an ulnar collateral ligament (UCL) abnormality in the throwing athlete. MATERIALS AND METHODS: Forty college-level and professional throwing athletes (age range, 18-40 years) underwent saline-enhanced MR arthrography of their injured elbows. MR findings were compared with the surgical findings. RESULTS: Saline-enhanced MR arthrography was positive in 24 of 26 individuals with UCL tear confirmed at the time of surgery. Eighteen (95%) of 19 complete UCL tears and six (86%) of seven partial UCL tears were diagnosed with MR arthrography. Two false-negative findings and no false-positive findings were obtained. CONCLUSION: Saline-enhanced MR arthrography of the elbow is a new application of a previously described technique used in the shoulder. It is useful for demonstration of subtle and gross UCL abnormalities in the throwing athlete.

Adolescent↗
PubMed1999

Legg-Calvé-Perthes disease: MR imaging evaluation during manual positioning of the hip--comparison with conventional arthrography.

PURPOSE: To evaluate the use of magnetic resonance (MR) imaging during manual positioning of the hip, or multipositional MR imaging, in an open-magnet configuration to study femoral head containment, articular congruency, and femoral head deformity in Legg-Calvé-Perthes disease. MATERIALS AND METHODS: In 12 children with advanced Legg-Calvé-Perthes disease, multipositional MR imaging and conventional arthrography were compared in the assessment of containment, femoroacetabular congruency, and femoral head deformity. Images of the hips in several positions were compared subjectively and objectively. RESULTS: MR imging correlated well with arthrography for overall subjective assessment of severity of disease (r = 0.71, P = .01), with good interobserver agreement (kappa = 0.65, P < .001). MR images demonstrated all cases of hinge abduction shown arthrographically. However, MR imaging failed to depict one case of femoral head flattening. MR imaging correlated well with arthrography in the objective evaluation of joint fluid and lateral subluxation (r = 0.80, P < .01). MR imaging correlated poorly with arthrography in the measurement of sphericity of the femoral head. CONCLUSION: Multipositional MR imaging with an open-magnet configuration was comparable to arthrography for demonstration of femoral head containment and congruency of the articular surfaces of the hip. In the evaluation of deformity, it performed less well.

Arthrography↗
PubMed1989

Rotator cuff tears: prospective comparison of MR imaging with arthrography, sonography, and surgery.

Thirty-eight patients with suspected rotator cuff tears were examined at 1.5 T by using a loop-gap resonator surface coil. The MR findings were compared prospectively in a blinded fashion with the results from double-contrast arthrography in all 38 patients, high-resolution sonography in 23 patients, and surgery in 16 patients. In the total group of 38 patients, MR imaging detected 22 of 22 tears and 14 of 16 intact cuffs as determined by arthrography. In the 16 surgically proved cases, MR and arthrography showed identical results, with 92% sensitivity in the diagnosis of 12 tears and 100% specificity in the diagnosis of four intact cuffs. In a subgroup of 23 patients, sonography detected nine of 15 tears and seven of eight intact cuffs as determined by comparison with arthrography. In 10 surgically proved cases, sonography was 63% sensitive in the diagnosis of eight rotator cuff tears and 50% specific in the diagnosis of two intact cuffs. For the diagnosis of rotator cuff tears, MR imaging is comparable to arthrography in both sensitivity and specificity. In this study, sonography was not as accurate in the diagnosis of rotator cuff tears as were the other two techniques. These results suggest that MR imaging should be considered the noninvasive test of choice for patients with suspected rotator cuff disease.

Arthrography↗
PubMed1990

K-edge digital subtraction arthrography of the painful hip prosthesis: a feasibility study.

K-edge energy subtraction radiography is a method for detecting the presence of iodinated contrast material by subtracting two digital radiographs produced by X-ray beams with energies above and below the iodine K edge. We performed a feasibility study on the application of K-edge energy digital subtraction arthrography (KEDSA) to painful hip prostheses. During arthrography, loosening of the prosthesis is implied if contrast material is seen dissecting around the prosthesis, an often difficult detection task because of adjacent prosthesis metal or cement. In conventional arthrography a preliminary mask image is thus used from which films obtained after injection of iodinated contrast material are subtracted. Movement by the patient during this process may preclude subsequent subtraction. With KEDSA, since multiple image pairs may be obtained after the injection of contrast material, the problem of patient motion is virtually eliminated. A conventional X-ray tube operating between 55 and 65 kVp was alternately filtered by iodine and cerium filters to produce the KEDSA images. The apparatus was capable of producing a subtracted image within 3 sec. The technique was applied to phantoms and to six patients immediately after hip arthrography that had been positive for prosthesis loosening. Although of lower spatial resolution, the KEDSA images were, in all cases, positive for loosening in a pattern consistent with the conventional arthrographic images. KEDSA was shown to be successful in detecting extraarticular contrast material. During a single study, subtraction in various imaging planes as well as postexercise subtraction imaging can be accomplished-techniques not heretofore possible in routine subtraction arthrography.

Aged↗