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PubMed1991

[Contribution of echogradient magnetic resonance imaging in the study of subacromial diseases. Surgical and arthrographic correlations].

Fifteen asymptomatic volunteers and 300 patients with suspected lesions of the rotator cuff were examined with T2*- and proton density-weighted gradient echo (T2*-Rho-GEI) MRI sequences (500-700 ms/30 ms/30 degrees) with a 0.5 T (GE-CGR) system and an adapted surface coil. For the patients, the findings were compared with those of arthrography in 130 cases and of surgery in 42 cases. For the operated patients, T2*-Rho-GEI and arthrography allowed correctly diagnosing 31 complete ruptures (CR). However, surgical exploration of the ruptures showed that T2*-Rho-GEI showed the actual extent of the rupture and the degree of tendon retraction better than arthrography. T2*-Rho-GEI also provides information about the thickness and trophicity of the remaining cuff and on local muscle trophicity. T2*-Rho-GEI allows directly evaluating the tendon of the long head of the biceps both in its extra-articular and its intra-articular parts. In 3 cases of complete cuff rupture, MRI allowed detecting 3 associated lesions of the anterior labrum, which had not been suspected on the clinical examination and had not been demonstrated by conventional arthrography. Lastly, out of 12 cases of deep incomplete rupture (n = 12) correctly diagnosed with MRI, 5 had been undetected on arthrography. Similarly, 8 cases of inflammatory alterations suspected with T2*-Rho-GEI and confirmed by surgery had not been recognized with arthrography. For the non-operated patients, T2*-Rho-GEI and arthrography had corresponding results for the diagnosis of CR (8 cases), of DIR (6 cases) and of intact cuff (6 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Analysis of complications following double contrast arthrotomography of the temporomandibular joint].

Temporomandibular joint (TMJ) arthrography is a valuable diagnostic method to evaluate the pathology of soft tissue components of the TMJ. However, arthrography is more or less invasive technique. The aim of this study was to investigate the sort and content of injury following TMJ arthrography. The symptoms before and after the arthrography were compared. In 90 joints that underwent TMJ arthrography, complications such as pain and/or trismus were encountered in 39 joints within one month. Twenty six patients complained of the change of pain conditions including the discomfort. The most common one was the pain on mouth opening. In every joint the pain disappeared within one month without any treatment. There was a high frequency of exacerbated pain in patients with some pain before the arthrography. The change of the degree of maximum opening was recognized in 11 patients. The duration of that condition was somewhat longer than that of pain conditions. In 5 joints with late clicking, 3 developed closed lock. Other complications were swelling, disability of mastication, eczema, hearing impairment and facial paresthesia. All the symptoms disappeared within 1 week without any treatment. From these results it was suggested that TMJ arthrography has low possibility of severe damage to the TMJ although there is some possibility of injury to the bone and soft tissue by arthrographic procedures.

Arthrography↗
PubMed2004

A comparison of radiographic and scintigraphic techniques to assess aseptic loosening of the acetabular component in a total hip replacement.

BACKGROUND: The diagnosis of a loose total hip prosthesis is often established with use of radiographic and nuclear medicine techniques, but there is controversy about the relative utility of plain radiography, subtraction arthrography, nuclear arthrography, and bone scintigraphy. In this retrospective study, we evaluated the sensitivity, specificity, and interobserver reliability of these imaging modalities in patients suspected of having aseptic loosening of the acetabular component. METHODS: From 1994 to 1999, eighty-six consecutive patients with pain after a total hip arthroplasty were evaluated for possible loosening of the components. The imaging evaluation included plain radiography followed by a one-day protocol that included bone scintigraphy, subtraction arthrography, and nuclear arthrography. For this study, two experienced nuclear medicine physicians and two experienced radiologists, all of whom were blinded with respect to the clinical pretest data and the clinical outcome, retrospectively interpreted the diagnostic images. The sensitivity and the specificity of each imaging modality were established by comparing the findings obtained with each technique with those found at surgery or during the subsequent clinical course of the patient. Interobserver variability was determined with the intraclass correlation coefficient. RESULTS: Plain radiography had a sensitivity of 85% (95% confidence interval, 71 to 94) and a specificity of 85% (95% confidence interval, 66 to 96) in detecting aseptic loosening of the acetabular component, but it had only fair interobserver variability (intraclass correlation coefficient, 0.37). For subtraction arthrography, the sensitivity was 72% (95% confidence interval, 57 to 84), the specificity was 70% (95% confidence interval, 50 to 86), and there was good interobserver variability (intraclass correlation coefficient, 0.71). For nuclear arthrography, the sensitivity was 57% (95% confidence interval, 41 to 71), the specificity was 67% (95% confidence interval, 46 to 84), and there was fair interobserver variability (intraclass correlation coefficient, 0.24). For bone scintigraphy, the sensitivity was 83% (95% confidence interval, 69 to 92), the specificity was 67% (95% confidence interval, 46 to 84), and there was moderate interobserver variability (intraclass correlation coefficient, 0.43). CONCLUSIONS: Plain radiography had the highest diagnostic accuracy in the evaluation of aseptic loosening of the acetabular component. The diagnostic accuracy was increased when plain radiography was combined with bone scintigraphy or subtraction arthrography. However, we found considerable interobserver variability in image interpretation, even with experienced radiologists and nuclear medicine physicians.

Acetabulum↗
PubMedDate not supplied

Comparison of conventional and computed arthrotomography with MR imaging in the evaluation of the shoulder.

To compare conventional arthrography and computed arthrotomography (CAT) with magnetic resonance (MR) imaging in the evaluation of the shoulder, we studied 18 patients who underwent conventional double contrast arthrography and CAT, and T1-, balanced, and T2-weighted MR imaging. The arthrograms were independently reviewed by two of the authors and the MR images were independently reviewed by three other authors in a systematic fashion with the aid of a prewritten evaluation form. The findings were compared among reviewers and between imaging methods. We found MR comparable to conventional arthrography in the evaluation of the rotator cuff; however, MR also enabled evaluation of tendonitis, which could not be accomplished with conventional arthrography. Because of MR's superior soft tissue imaging capability, we were able to stage the impingement syndrome. Magnetic resonance also allowed evaluation of the glenoid labrum and capsuloligamentous structures and assessment of instability in a fashion similar to CAT. In most cases, information obtained from MR equaled or exceeded that obtained from conventional arthrography and CAT. With refinement in technique and increased experience, we believe that MR may replace arthrography in the evaluation of the shoulder.

Adolescent↗
PubMedDate not supplied

Imaging techniques for the evaluation of glenohumeral instability.

The ability to image lesions associated with glenohumeral instability has evolved significantly over the past 2 decades. In the past, several imaging techniques ranging from conventional radiography to computerized axial arthrography and, most recently, to magnetic resonance imaging have been used to depict various labral abnormalities. In most instances, conventional radiography remains the initial imaging study for evaluating the patient with persistent shoulder pain and instability. Recently, however, magnetic resonance arthrography has been firmly established as the imaging modality of choice for demonstrating specific soft tissue abnormalities associated with glenohumeral instability. This article will review the role of various imaging modalities including conventional radiography, conventional arthrography, computerized axial arthrography, magnetic resonance imaging, and magnetic resonance arthrography. Emphasis will be placed on the role of magnetic resonance arthrography as it pertains to the lesions associated with glenohumeral instability. A thorough discussion of the appearance of normal anatomic structures, anatomic variations that mimic abnormality, and the various lesions associated with glenohumeral instability will be provided.

Arthrography↗
PubMed1998

Evaluation of imaging in loosening of hip arthroplasty in 326 consecutive cases.

Between 1989 and 1995, 326 hip arthroplasties were surgically revised in our clinic because of loosening. For evaluation of loosening, we used history, clinical examination, radiographs, bone scans and arthrography with digital subtraction technique. In 130 cases (40%), surgery was planned by plain radiographs. In 116 cases (89%) a correct diagnosis of loosened components was made. Of the 72 patients (22%) with an additional bone scan, 87% (63 patients) had a correct diagnosis. Fifty-four patients (17%) with different findings were examined by hip arthrography; in 83% (45 patients) the diagnosis was confirmed intraoperatively. In 93% (65 patients) of 70 patients (21%) with bone scans and arthrography, surgery confirmed the diagnosis. Sensitivity for loosening of the socket was 61% by bone scan and 85% by digital subtraction arthrography; specificity was 75% in each case. Sensitivity for loosening of the stem was 71% by bone scan and 65% by digital subtraction arthrography; specificity was 80% and 88%, respectively. Our results showed that in most cases of suspected loosening of total hip arthroplasties, analysis of plain radiograph series can lead to an accurate diagnosis in 85%-90%. In cases of uncertainty, we suggest the additional use of digital subtraction arthrography, which has a similarly high diagnostic quality. Because of the low sensitivity of nuclide bone scanning (about 60%) and its dependence on prosthetic material and fixation, we do not recommend primary scintigraphy. It can be helpful in problematic cases with additional questions like activity of ectopic bone formation.

Adult↗
PubMed2002

Shoulder instability: accuracy of MR imaging performed after surgery in depicting recurrent injury--initial findings.

PURPOSE: To analyze a series of postoperative magnetic resonance (MR) images obtained in patients with recurrent signs or symptoms of instability in whom subsequent surgical correlation was performed to determine the accuracy in diagnosing recurrent injury. MATERIALS AND METHODS: The authors identified 24 patients who underwent MR imaging after shoulder instability surgery and had recurrent instability requiring repeat surgery. Twelve nonenhanced MR images and six indirect and six direct MR arthrograms were retrospectively reviewed with consensus to determine the presence or absence of recurrent labral or rotator cuff tear. Operative reports were reviewed to confirm the presence or absence of labral or rotator cuff tear. The mean interval between initial surgery and MR imaging was 10 months. The mean interval until repeat surgery was 2 months. RESULTS: Overall, the accuracy of postoperative MR imaging was 79% in depicting recurrent labral tear and 88% in depicting recurrent rotator cuff tear. Indirect MR arthrography had 100% accuracy for recurrent labral tear detection, whereas direct MR arthrography and nonenhanced MR imaging had accuracies of 67% and 75%, respectively. Direct MR arthrography was more sensitive, 100% versus 71%, but less specific, 60% versus 80%, than nonenhanced MR imaging in depicting recurrent labral tears. Direct MR arthrography had 100% accuracy in depicting rotator cuff tear, whereas both indirect MR arthrography and nonenhanced MR imaging had 83% accuracy. CONCLUSION: MR imaging, indirect MR arthrography in particular, appears to be an accurate means of evaluating the shoulder following instability surgery.

Adult↗
PubMed2002

MR imaging of the metacarpophalangeal joints of the fingers: part II. Detection of simulated injuries in cadavers.

PURPOSE: To evaluate and compare conventional magnetic resonance (MR) imaging and MR arthrography in the diagnosis of the most common traumatic metacarpophalangeal (MCP) joint injuries, which were created surgically in cadavers. MATERIALS AND METHODS: Injuries to various MCP joint structures were surgically created randomly in 28 fingers of seven human cadaveric hands. Injuries to the main collateral ligaments (CLs) (n = 12), accessory CL (n = 15), sagittal band (n = 14), transverse fibers of the extensor hood (n = 5), first annular pulley (n = 16), deep transverse metacarpal ligament (DTML) (n = 5), and palmar plate (n = 10) were analyzed. Conventional MR images and MR arthrograms were evaluated, with differences in interpretation resolved in consensus. The sensitivities, specificities, and accuracies of both MR imaging methods were determined, and the differences were tested for significance by using the McNemar test. RESULTS: Sensitivity was 28.6%-93.8% with conventional MR imaging versus 50.0%-93.3% with MR arthrography. Specificity was 66.7%-100% with conventional MR imaging versus 83.3%-100% with MR arthrography. Although the MR arthrographic results usually were higher, the differences were not significant. The kappa values for interobserver agreement were 0.314-0.638 for conventional MR imaging versus 0.364-1.00 for MR arthrography. Sensitivity for the detection of lesions of the main and accessory CLs and the first annular pulley was slightly higher than that for the detection of lesions of the extensor hood, DTML, and palmar plate structures. CONCLUSION: MR imaging and MR arthrography enable the diagnosis of simulated MCP joint injuries. MR arthrography does not have a significant advantage over conventional MR imaging.

Aged↗
PubMed1982

Computed tomography in the preoperative evaluation of masses arising in or near the joints of the extremities.

Knowledge of the precise anatomical relationship of a mass lesion to a joint is helpful in the preoperative planning of surgery. We have evaluated this relationship in 23 patients with a variety of benign and malignant lesions related to the knee and other major joints. In 15 patients, the lesion-joint relationship was assessed by routine computed tomographic (CT) scans followed within 24 hours by arthrography. In nine of these 15 patients, CT demonstrated that the lesion either was remote from the joint or clearly invaded it, and arthrography could have been avoided in these patients. In six patients, the CT findings were indeterminate and further evaluation by arthrography was indicated. CT scans limited to the joint area and obtained immediately after arthrography were available in 14 patients. In general, postarthrography CT did not add significant information to that provided by prearthrography CT scans or by arthrography. However, it may be helpful in occasional cases in which arthrography is not definitive.

Adolescent↗
PubMed1993

MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material.

OBJECTIVE: After surgical resection or repair of a torn meniscus, the healed area may have areas of abnormal signal intensity on MR images. Consequently, routine MR imaging is not reliable for detecting recurrent meniscal tears. As a result, we studied the efficacy of MR imaging with intraarticular contrast material (MR arthrography) for detecting recurrent tears of the meniscus. SUBJECTS AND METHODS: Thirty-seven patients who previously had a meniscal tear treated by either meniscal resection or repair had conventional MR imaging and MR arthrography with 40-50 ml of a 1:100 solution of gadopentetate dimeglumine in saline. All patients had arthroscopy shortly after the MR studies. Follow-up arthroscopic surgery was performed within an average of 6.6 weeks after the MR arthrograms. The routine MR images and MR arthrograms were reviewed separately and randomly, and these results were compared with the arthroscopic findings. Meniscal morphology, signal intensity, and the presence of joint fluid tracking into recurrent tears were evaluated. RESULTS: The overall accuracy in diagnosing recurrent meniscal tears in the post-operative meniscus was 66% when conventional MR imaging was used and 88% when MR arthrography was used. In patients who had only minimal meniscal resection, both methods had an accuracy of 89%. In patients who had more extensive meniscal resection, accuracy was 65% with conventional MR imaging and 87% with MR arthrography. In four patients who had only a small meniscal remnant, the accuracy was 50% with routine MR imaging and 100% with MR arthrography. On conventional MR images, the presence of an effusion tracking into a meniscal tear had a sensitivity and positive predictive value of 90% for detection of recurrent meniscal tears; however, the sensitivity was only 41%. CONCLUSION: Our results show that the sensitivity of MR imaging in detecting meniscal tears after surgery varies with the extent of the resection. Sensitivity was considerably improved when intraarticular contrast material was used. MR arthrography should be considered as an alternative to arthroscopy in patients who have had resection or repair of the meniscus.

Adolescent↗
PubMed1998

[Clinical and nuclear magnetic resonance tomography diagnosis of glenoid labrum injuries].

PURPOSE: Clinical and radiological evaluation of labral tears remains challenging. It has been shown that intravenous administration of contrast agents 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 diagnosis of glenoid labrum tears. METHODS: 28 patients with clinically suspected labral injuries were prospectively investigated (1.5 Tesla, flexible surface coil). A native MR exam of the shoulder (transverse and oblique-coronar orientation, T1-weighted spin-, proton density- and T2*-weighted gradient echo sequences) and indirect MR arthrography (transverse and oblique-coronar orientation, fat-suppressed T1-weighted spin-echo sequences, 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. Additionally sensitivity evaluation of clinical tests for investigation of labral tears were performed. RESULTS: Indirect MR-Arthrography improved delineation of the glenoid labrum and hyaline cartilage significantly (p < 0.05). Sensitivity and specificity of indirect MR arthrography in diagnosis of labral injuries were 90% and 89% respectively, compared to 79% and 67% of the native MR exam. The reliability of the checked clinical tests is not sufficient enough to determine labral lesions (predictive value between 50 and 70%). CONCLUSION: Indirect MR-arthrography is a promising non-invasive technique in the evaluation of the glenoid labrum.

Adult↗
PubMed1998

[Clinical and diagnostic imaging of labrum lesions in the hip joint].

Labral lesions are common findings in residual hip dysplasia, indicating biomechanical decompensation of the hip joint. MR-Arthrography has shown an excellent accuracy of over 90% to detect these lesions. Nevertheless, so far clinical sings, radiological diagnosis and therapeutical consequences are not well known. In a prospective study, patients suspicious for labral lesions were evaluated using a standard clinical protocol, including history, clinical signs, radiography and MR-Arthrography. Clinical signs were tested by six criteria and two provocation tests. In 11% patients clinical suspicious was wrong. Best agreement with MR-Arthrography was found for "knife sharp" groin pain (100%), impingement test (100%) and painful giving way (83%). 35% of patients showed minor (grade 2) and 52% severe (grade 3 and 4) dysplasia. Independent from grade of dysplasia, no or only slight arthrosis (grade 0 and 1) was found in 64% of patients. In 16% a single acetabular cyst could be detected on radiographs, which all could be identified as intraosseous ganglia on MR-Arthrography. Labral lesions type A (post traumatic) were found in 23% of the patients with only no or minor dysplasis (grade 1 and 2), whereas labral lesions type B (dysplastic) were found in 67% of the patients with severe dysplasia (grade 3 and 4). Clinical signs for labral lesions are typical but can also be observed in other pathologies of the hip joint. Based on the findings of this study, we recommend radiographic evaluation for dysplasia and MR-Arthrography in patients with clinical suspicion for labral lesions of the hip joint.

Acetabulum↗
PubMed2002

MR imaging of the metacarpophalangeal joints of the fingers: part I. Conventional MR imaging and MR arthrographic findings in cadavers.

PURPOSE: To demonstrate the normal anatomy of the metacarpophalangeal (MCP) joints of the fingers with magnetic resonance (MR) imaging and MR arthrography in cadavers. MATERIALS AND METHODS: MR images of 20 MCP joints of the fingers of five fresh human cadaveric hands in the extended and flexed positions were obtained before and after arthrography. The MR appearances of all articular and periarticular structures were analyzed and compared with those seen on anatomic sections. Two readers independently graded the visibility of these structures. Interobserver agreement was tested by using the kappa statistic. RESULTS: The main collateral ligaments could be best evaluated on the transverse images of flexed fingers. The accessory bands of the collateral ligament complex were best seen on the transverse images of extended fingers. Sagittal MR images were best for evaluating the palmar plate and the capsule. MR arthrography improved the visualization of all articular and periarticular structures. The kappa values related to conventional MR imaging findings at all sequences, 0.42-0.71, indicated moderate to substantial agreement. The kappa values for the MR arthrographic sequences, 0.59-0.74, were slightly higher than those for the nonenhanced sequences. CONCLUSION: Conventional MR imaging and MR arthrography enable accurate visualization of the important anatomic structures of the MCP joints. MR arthrography enhances visualization of the intraarticular elements.

Aged↗
PubMed1992

SLAP lesions of the glenoid labrum: CT arthrographic and arthroscopic correlation.

Tears in the superior part of the glenoid labrum in the anterior and posterior directions (SLAP, superior labrum anterior, posterior) result from injuries that place excessive stress on the tendon of the long head of the biceps brachii muscle. The intimate relationship of the tendon and the superior glenoid labrum promotes injury to the latter structure. Four types of SLAP lesions are seen at arthroscopy. Images from 17 patients with surgically proved SLAP lesions who had undergone preoperative computed tomographic (CT) arthrography were retrospectively reviewed to evaluate the value of CT arthrography in the detection and accurate depiction of these labral injuries. The authors compared the findings at videotaped arthroscopic surgery with those from CT arthrography and found that abnormalities of the labral-capsular apparatus could be detected with CT arthrography in 16 of the 17 patients. Furthermore, the CT arthrographic criteria developed during this review helped determine the type of tear in 15 of the 17 patients. CT arthrography appears to be useful in the evaluation of patients with suspected SLAP lesions.

Adult↗
PubMedDate not supplied

Evaluation of recurring meniscal tears with gadolinium-enhanced magnetic resonance imaging: a randomized, prospective study.

BACKGROUND: Magnetic resonance imaging has been shown to be of questionable accuracy in detecting recurrent meniscal tears after previous resection or repair. PURPOSE: To compare the accuracy of nonenhanced magnetic resonance imaging with that of intraarticular contrast-enhanced direct magnetic resonance arthrography and intravenous contrast-enhanced indirect magnetic resonance arthrography for detection of recurrent meniscal tears. STUDY DESIGN: Prospective cohort study. METHODS: Forty-one patients who had previous meniscal tears treated by resection or repair but who were experiencing recurrent knee symptoms were prospectively randomized into one of three groups: conventional magnetic resonance imaging, indirect arthrography, and direct arthrography. The interpretations of two musculoskeletal radiologists were compared with the findings of an arthroscopic procedure performed 2 to 14 weeks later. RESULTS: Conventional imaging had a sensitivity of 57.9%, specificity of 80%, and overall accuracy of 62.5%. Intravenous contrast improved the sensitivity to 90.9%, specificity to 100%, and overall accuracy to 93.8%; intraarticular contrast had a sensitivity of 91.7%, specificity of 100%, and an overall accuracy of 92.9%. CONCLUSIONS: We demonstrated an increased accuracy of intravenous or intraarticular contrast-enhanced magnetic resonance arthrography in detecting recurrent meniscal tears. Both contrast routes demonstrated similar accuracy, a finding not previously reported.

Adult↗
PubMed1989

Lateral meniscal lesions in patients with clinically suspected medial lesions.

Double-contrast arthrography and arthroscopy were performed in a prospective study on 46 consecutive patients clinically suspected of having a medial meniscal tear only. At arthrography, 38 torn medial menisci were found; four of them were, however, false-positive and another false-negative as compared with arthroscopic examination. Moreover, seven unsuspected lateral meniscal tears were diagnosed at both arthrography and arthroscopy. The diagnostic accuracy of the double-contrast arthrography was well above the clinical accuracy, and we conclude that arthrography is a reliable method for diagnosing both medial and lateral tears.

Arthrography↗
PubMed1997

[Isolated lesions of the subscapularis tendon and internal malpositions of the biceps tendon. Apropos of 45 cases].

Our series consists of 45 lesions of the subscapularis tendon investigated by arthrography and CT arthrography. Arthrography demonstrated opacification of the subacromial bursa in 24% of cases, internal malposition of the long head of biceps in 46% of cases and direct signs of a lesion of the subscapularis tendon in 91% of cases. CT arthrography showed incomplete transverse avulsion in 18% of cases and complete transverse avulsion in 82% of cases. The biceps was dislocated in 35% of cases, and subluxed in 11% of cases. The subscapularis muscle was infiltrated by fat in 46% of cases. Isolated lesions of the subscapularis can be difficult to diagnose clinically and are more frequent than generally thought. CT arthrography must therefore be requested at the slightest doubt, as the intraoperative search for a lesion of the subscapularis tendon is sometimes difficult.

Adult↗
PubMed2005

Intraarticular lesions in traumatic anterior shoulder instability: a study based on the results of diagnostic imaging.

BACKGROUND: Diagnostics of intraarticular lesions is important in the treatment of traumatic anterior shoulder instability. PATIENTS AND METHODS: We studied 30 patients: 26 men and 4 women. For all patients preoperative examinations involved arthrography, CT arthrography, MR arthrography, and 3D-CT. RESULTS: The articular capsule adhered to the margin of the glenoid in only 3 cases. In the remaining 27 patients, the joint capsule was detached, showing medial translation. Hill-Sachs lesions were present in 24 cases. Bankart lesions were detected in all cases, and they extended over 2-5 h. Osseous Bankart lesions were detected in 13 cases. MR arthrography revealed the articular labrum in all cases, but AIGHL in only 16 cases. Bankart lesions were found in all cases. When the patients were divided according to the frequency of dislocation, there was a correlation between both distance of the detached joint capsule and visualization of AIGHL and the frequency of dislocation. INTERPRETATION: From this study, the frequency of dislocation was higher in the patients with severe detachment of the joint capsule, in whom AIGHL could not be visualized by MR arthrography.

Adolescent↗