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PubMed1993

Lack of correlation between site of wrist pain and location of noncommunicating defects shown by three-compartment wrist arthrography.

OBJECTIVE: Communicating defects shown by wrist arthrography often correlate poorly with the location of the patient's symptom(s). No study of wrist arthrography in which noncommunicating defects have been isolated, described, and correlated with the site of patients' symptoms has been reported. The aim of this study was to correlate the site(s) of patients' pain and the location(s) of noncommunicating defects shown by wrist arthrography. MATERIALS AND METHODS: One hundred noncommunicating capsular defects and incomplete defects of the interosseous ligaments and triangular fibrocartilage in 82 patients were identified from 462 three-compartment wrist arthrograms. Correlation between the sites of pain and sites of the noncommunicating defect was described as: (1) exact correlation, (2) ulnar/radial side correlation, (3) ambiguous correlation, or (4) no correlation. Statistical analysis was performed for each type of defect separately, in aggregate for patients who had more than one defect, and by separate analysis using patients' age (less than or greater than 30 years old). RESULTS: Capsular defects were detected in 65 patients, incomplete perforations of the triangular fibrocartilage in 28 patients, and incomplete defects of the scapholunate and lunotriquetral ligament in three patients each. No statistically significant correlation was found between individual defects and symptoms or between the site(s) of symptoms and patterns of multiple noncommunicating defects. Further, age did not influence the degree of correlations (chi 2 = 0.000-0.476, p values = 0.49-1.00). CONCLUSION: Attribution of patient's symptoms to noncommunicating defects shown by wrist arthrography is not reliable. Cases in which site-specific arthrographic defects directly correlate may be fortuitous. Additional studies will be necessary to determine the future role of wrist arthrography in the evaluation of the painful wrist.

Adult↗
PubMed2004

Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior (SLAP) lesions of the shoulder with emphasis on the classification of SLAP lesions. MATERIALS AND METHODS: Two hundred sixty-five MR arthrograms including 68 MR arthrograms of patients with arthroscopically proven SLAP lesions of the shoulder and 197 MR arthrograms of patients with an intact superior labrum and biceps anchor were retrospectively reviewed in random order. MR arthrography was performed using triplanar T1-weighted spin-echo sequences and a coronal oblique T2-weighted fast spin-echo sequence. MR arthrograms were evaluated by two radiologists with agreement by consensus, and the results were compared with arthroscopic findings. RESULTS: Of 68 SLAP lesions, seven (10%) were arthroscopically classified as type I, 41 (60%) as type II (including 20 type II lesions with coexisting Bankart lesions [29%]), 14 (21%) as type III, and six (9%) as type IV. Compared with arthroscopy as the gold standard, MR arthrography showed a sensitivity of 82% and a specificity of 98% for the overall detection of SLAP lesions. MR arthrographic grading and arthroscopic grading were concurrent in 45 (66%) of 68 arthroscopic diagnoses. Of the surgically confirmed SLAP lesions, involvement of the biceps insertion and SLAP type II lesions with coexisting Bankart lesions were assessed correctly in 75% and 95% of cases, respectively. CONCLUSION: MR arthrography is a highly effective method for the detection of SLAP lesions, but this technique is limited in the classification of different types of SLAP lesions. However, for preoperative planning MR arthrography provides accurate information about the stability of the biceps insertion and the presence of associated anteroinferior labral injuries.

Adolescent↗
PubMedDate not supplied

CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint.

OBJECTIVE: To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. MATERIALS AND METHODS: Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. RESULTS: The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. CONCLUSION: CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.

Adult↗
PubMed2000

Arthrography of the foot and ankle. Ankle and subtalar joint.

Arthrography is the intra-articular injection of contrast media. This article reviews the normal and pathologic findings of standard arthrography and MR imaging arthrography of the ankle and subtalar joint. Standard arthrography is used primarily after acute ankle sprains, whereas MR imaging arthrography is used for staging and detecting osteochondritis dissecans of the talus, anterolateral soft tissue impingement, and chronic lateral ankle instability.

Ankle Injuries↗
PubMed2001

The role of radiocarpal injection arthrography and magnetic resonance imaging in the diagnosis of triangular fibrocartilage complex injuries.

OBJECTIVE: To investigate the radiocarpal joint injection arthrography and magnetic resonance imaging for diagnosis of the triangular fibrocartilage complex (TFCC) injuries. METHODS: Thirteen cases whose main complaints were ulnar wrist pain were given radiocarpal joint arthrography and eight of them were also given magnetic resonance imaging for evaluating the integrity of the triangular fibrocartilage complex. RESULTS: Ten of thirteen cases presented the leakage of contrast medium to distal radioulnar joint from the radiocarpal joint, in whom, 8 were demonstrated triangular fibrocartilage tear on magnetic resonance imaging, and 3 located at radial side, 2 at central, 3 at ulnar side. One of three cases which were demonstrated without the leakage of contrast medium in arthrography were displayed with marked TFCC tear on magnetic resonance imaging. CONCLUSIONS: The wrist arthrography can provide a definite diagnosis for triangular fibrocartilage disruption with higher sensitivity. magnetic resonance imaging not only demonstrates the site of triangular fibrocartilage disruption as the same value as wrist arthrography, but also displays the other related bony and soft tissues changes.

Adult↗
PubMed2003

Capsulo-labro-ligamentous lesions of the shoulder: evaluation with MR arthrography.

PURPOSE: The aim of the study was to analyse the accuracy of MR arthrography in the evaluation of capsulo-labro-ligamentous lesions of the shoulder in patients with glenohumeral joint instability. MATERIALS AND METHODS: From 1999 to 2001 fifty-eight patients with glenohumeral joint instability were studied by MR arthrography. Twenty-seven patients underwent surgical repair: 11 by arthroscopic and 16 by arthrotomic approach. All shoulder evaluations were performed with T1 and T2 weighted axial, coronal and sagittal oblique images, before and after intra-articular injection of gadolinium contrast. RESULTS: Forty capsulo-ligamentous lesions (including 14 capsular ruptures with extravasation of the contrast medium) were detected by MR arthrography. Fifty-two labral tears (36 of the anterior, 13 of the superior and 3 of the posterior glenoid labrum) were identified: 11 out of 52 were not recognized before gadolinium contrast injection. Five rotator cuff tears were identified, one of which was not shown in the pre-injection examination. Surgical results confirmed the MR arthrographic findings in 25/27 patients. In one case MR arthrography did not recognize a SLAP lesion; in another case it identified a tear of the capsule but not of the glenoid labrum. CONCLUSIONS: In many cases of subacute glenohumeral joint lesions with intracapsular fluid, MR may accurately evaluate capsulo-labral-ligamentous lesions. Indeed, the examination of lesions is limited by the absence of the natural contrast determined by fluid; in such cases, intra-articular injection of gadolinium contrast is necessary. MR arthrography evaluates the degree of capsulo-labro-ligamentous tears and may guide the surgical approach.

Adolescent↗
PubMed1989

Arthrography in the evaluation of congenital dislocation of the hip.

To assess the value of intraoperative arthrography, 48 preoperative hip arthrograms of 35 children under 18 months of age treated for congenital dysplasia of the hip were reviewed. The frequency of the common arthrographic observations was assessed and was compared with the findings observed from the plain roentgenograms, and with the pathoanatomy seen at the time of open reduction. Arthrography proved reliable in identifying the depth of reduction (medial dye column, 100%), the configuration of the osteocartilaginous structures (96%), and the presence of potentially obstructing soft tissue (limbus, 98%, and ligamentum teres, 78%). Arthrography was less reliable in discerning psoas contracture (36%), despite its presence at all open reductions. Arthrography proved reliable in outlining the inverted limbus that can obstruct closed reduction. Because ossification of the femoral head was frequently eccentric, the center edge (CE) angle of Wiberg was calculated from arthrography more accurately than from roentgenograms.

Acetabulum↗
PubMed1995

[Intravenous MR arthrography of the knee].

A study was undertaken to determine whether or not intravenous MR arthrography can be used in clinical practice. Forty patients with internal derangement of the knee (11-68 years old) were imaged with MRI before and after intravenous injection of Gd-DTPA. In all knees there was enhancement of joint fluid, regardless of the amount of fluid. The peak enhancement of joint fluid was reached at 30 minutes after the administration of the contrast agent. The contrast between joint fluid and meniscus/cartilage was higher in MR arthrography than in proton density images. There was an increase in contrast between grade III lesions in the meniscus and intact meniscus on MR arthrography. It was concluded that intravenous MR arthrography can be a useful alternative to intra-articular arthrography.

Adolescent↗
PubMed1995

[Magnetic resonance arthrography. Preliminary experience in study technic and main diagnostic applications].

In the study of osteoarticular conditions, MRI makes a definite diagnostic improvement, even though some problems are still to be solved. Thus, on the basis of their arthrographic experience, the authors experimentally applied this technique to MRI, to assess the actual feasibility of MR arthrography. Forty-three patients were selected to undergo MR examinations after the intraarticular injection of 15-20 ml paramagnetic contrast agent (Gd-DTPA), with 0.25% saline solution. Before MR arthrography every patient underwent a baseline MR arthrography exam. Normal anatomy was better depicted with MR arthrography. In all cases, even small lesions and other structural changes missed at baseline MRI were demonstrated. Therefore, in agreement with previous arthrographic and CT arthrographic reports, we believe MR arthrography to be a simple technique improving MR diagnostic capabilities in selected cases.

Ankle Joint↗
PubMed1993

Comparison of the diagnostic accuracy of positive-contrast arthrography and arthrotomy in evaluation of osteochondrosis lesions in the scapulohumeral joint in dogs.

During a 6-year-period (1985-1991), 120 positive-contrast arthrograms were made in 70 dogs to evaluate osteochondrosis lesions in the scapulohumeral joint. In 76 shoulders, the arthrographic findings were compared with surgical or histopathologic findings to evaluate the accuracy of the arthrographic technique. Positive-contrast arthrography was found to be accurate in evaluation of the status of the articular cartilage. In revealing discontinuity of the articular cartilage, the results of arthrography were false-negative in 4 shoulders (58/66; accuracy, 88%). In detecting thick cartilage covering a subchondral defect, the results of positive-contrast arthrography were false-positive in 4 joints (6/11; accuracy, 55%). In detecting fragmentation of the cartilage, arthrography provided false-negative results in 4 joints (7/11; accuracy, 64%). This technique enabled detection of joint mice, especially within the bicipital tendon sheath (no false-positive results). Arthrography failed to reveal joint mice within the caudal pouch in 2 joints (15/17; accuracy, 88%). Joint effusion also could be evaluated and was correlated with synovitis, degenerative joint disease, and loose or detached cartilage flaps. Postarthrography complications were not observed with this technique.

Animals↗
PubMed2006

Anterior-inferior labral lesions of recurrent shoulder dislocation evaluated by MR arthrography in an adduction internal rotation (ADIR) position.

PURPOSE: To introduce and evaluate the usefulness of the adduction internal rotation (ADIR) position in MR arthrography for discriminating the following subtypes of Bankart lesions: classic Bankart lesions, anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions, and Perthes lesions. MATERIALS AND METHODS: The study group consisted of 25 patients who had been referred for MR arthrography of the shoulder and then underwent arthroscopy due to recurrent episodes of shoulder dislocation. MR arthrography was performed in three different positions: neutral, abduction external rotation (ABER), and ADIR. The authors evaluated the statistical significance of the method's discriminative diagnostic ability for the subtypes of Bankart lesions according to the position changes. RESULTS: Twenty-three patients had the following single or complex labral lesions: classic Bankart (N = 8), ALPSA (N = 3), complex classic Bankart/ALPSA (N = 8), and complex ALPSA/Perthes (N = 4). Two patients had no visible anteroinferior labral lesions. The performance of ADIR positioning for differentiating ALPSA lesions was superior to the neutral or ABER positioning. The difference of the discriminative lesion detection ability was statistically significant (P <.01) only for detecting ALPSA lesions in the ADIR position. CONCLUSION: MR arthrography in the ADIR position provides high accuracy for the diagnosis of ALPSA lesions, and complements routine MR arthrography when used to diagnose labroligamentous lesions in patients with recurrent shoulder dislocations.

Adolescent↗
PubMed1996

MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.

OBJECTIVE: The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI and MR arthrography. DESIGN: Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. RESULTS: The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. CONCLUSION: MR arthrography provided additional information for evaluating the degree of UCL injury.

Adolescent↗
PubMed2001

Indirect MR arthrography of the shoulder in detection of rotator cuff ruptures.

The aim of this study was to compare the efficacy of indirect MR arthrography images obtained following intravenous contrast injection and conventional MR imaging in the diagnosis of rotator cuff tears. Twenty-four patients with clinically suspected rotator cuff disease were examined. Conventional MR images and post-contrast indirect MR arthrography images were obtained. All images were evaluated in a blinded fashion by two musculoskeletal radiologist. Results were than analyzed depending on surgical output. The correlation coefficient (Spearman rank correlation test) and the kappa values for agreement between surgery and imaging techniques were calculated. The correlation coefficients between indirect MR arthrography and surgery for reader 1 and reader 2 were 0.9137 and 0.9773, respectively. Whereas the agreement between conventional MR imaging and surgery was moderate (n = 0.383-0.571), the agreement between indirect MR arthrography and surgery was excellent (n = 0.873-0.936). We suggest the use of indirect MR arthrography technique when conventional MR images are equivocal in diagnosis of rotator cuff disease.

Adolescent↗
PubMed2005

Ankle MR arthrography: how, why, when.

MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography may facilitate the evaluation of patients with suspected intra-articular pathology in whom conventional MR imaging is not sufficient for an adequate diagnosis and be useful for therapy planning. MR arthrography is valuable in the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography is a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in cases in which an invasive procedure is contraindicated or when fluoroscopy is not available.

Ankle Injuries↗
PubMed1979

Grey scale ultrasonography and arthrography in evaluation of popliteal cysts.

Ultrasonography will reliably detect popliteal cysts of clinically significant size and improvements in ultrasound imaging have enhanced the value of ultrasound in relation to arthrography in the assessment of cyst rupture. Forty-eight knees in 25 patients suspected of having a popliteal cyst were examined by ultrasonography followed immediately by arthrography. Popliteal cysts were demonstrated in 40% (19/48) by ultrasound and in 46% (22/48) by arthrogram. Arthrography detected small cysts not seen with ultrasound, but altrasonic scanning showed cysts which did not fill on arthrography. A ruptured cyst or deep venous thrombosis was suspected in 10 patients. Rupture was confirmed in two patients by arthrography, in both of whom soft tissue changes and attenuation of the distal margin of the cysts were shown by ultrasound.

Cysts↗
PubMedDate not supplied

The use of noncontrast magnetic resonance imaging in evaluating meniscal repair: comparison with conventional arthrography.

The objective of this study was to investigate whether new and different specialized fast spin-echo techniques could be used to accentuate signal within the site of meniscal repair, obviating the need for intra-articular contrast. With the use of the frequency-selective fat suppression technique, we were able to accentuate fluid in the repair site because of the inherent extended dynamic contrast range of the technique. We performed a blinded study to correlate specialized magnetic resonance imaging (MRI) sequences with standard contrast arthrography, which was used as a standard of reference. Thirty-six patients (36 meniscal repairs) agreed to have MRI followed by contrast arthrography of the affected knee, irrespective of their clinical symptoms. We found that MRI had a very high correlation with arthrography in assessing meniscal repair, with statistical significance. In eight cases that had a second-look arthroscopy, we were able to see that MRI proved to be more accurate than arthrography in discriminating partial or complete healing. This is the first report to show that specialized noncontrast MRI sequences are more effective in evaluating the physiological state of the repaired meniscus, without artifactual distention of the joint recesses by contrast and air. Noncontrast MRI can obviate the need for arthrography in assessment of meniscal repair.

Adolescent↗
PubMed1997

[Indirect MR arthrography in the diagnosis of lesions of the labrum glenoidale].

PURPOSE: It has been shown that intravenous administration of contrast media produces an MR arthrographic effect without the need for intraarticular injection. This is the first study evaluating this new technique of indirect MR arthrography in the diagnosis of glenoid labrum tears. METHODS: 28 patients with clinically suspected labral injuries were prospectively investigated (1.5 Tesla, flexible surface coil). A plain MR examination of the shoulder (transverse and oblique-coronal orientation, T1-weighted spin- [TE/TR 15/675], proton density- and T2*-weighted gradient echo [TE/TR/Flip 14,32/600/30 degrees] sequences) and indirect MR arthrography (transverse and oblique-coronal orientation, fat-suppressed T1-weighted spin-echo sequences [TE/TR 15/675], intravenous injection of gadopentetate dimeglumine [0.1 mmol/kg], followed by 10-15 min of joint movement) were performed. Results were confirmed by arthroscopy and/or open surgery. RESULTS: Indirect MR arthrography significantly improved delineation of the glenoid labrum and hyaline cartilage (p < 0.05). Sensitivity and specificity of indirect MR arthrography in the diagnosis of labral injuries were 90% and 89%, compared to 79% and 67% of the native MR examination. CONCLUSION: Indirect MR arthrography is a promising non-invasive technique in the evaluation of the glenoid labrum.

Adult↗
PubMed1999

Indirect MR arthrography of the unexercised glenohumeral joint in patients with rotator cuff tears.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic utility of indirect MR arthrography of the unexercised glenohumeral joint in patients with rotator cuff tears confirmed by arthroscopy or arthrotomy as the gold standard. METHODS: Twenty-six patients underwent conventional MR imaging and indirect MR arthrography of the stationary glenohumeral joint using a wrap-around surface coil. Unenhanced T1-weighted spin echo/T2-weighted fast spin echo sequences and T1-weighted gradient echo sequences, adding spectral fat suppression after intravenous administration of contrast medium, were performed in the oblique coronal and oblique sagittal planes. Images were analyzed by three experienced radiologists in consensus. Levels of diagnostic confidence were evaluated using a four-point scale of diagnostic certainty. RESULTS: Performing indirect MR arthrography of the unexercised shoulder leads to a diagnostically efficient enhancement of joint fluid (120% at 4 minutes and 145% at 8 minutes after intravenous injection of gadodiamide). In terms of soft tissue delineation, characterization of rotator cuff tears was significantly improved by using enhanced fat-suppressed T1-weighted gradient echo sequences compared with conventional MR imaging. CONCLUSIONS: Indirect MR arthrography without glenohumeral joint exercise in the diagnosis of rotator cuff tears is feasible and represents a more convenient and less time-consuming alternative to indirect MR arthrography after joint exercise.

Adult↗