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PubMed2002

Pisotriquetral joint: assessment with MR imaging and MR arthrography.

PURPOSE: To evaluate magnetic resonance (MR) imaging and MR arthrographic findings in the pisotriquetral joint (PTJ) and their contribution to assessment of PTJ osteoarthritis. MATERIALS AND METHODS: Images of 22 fresh human cadaveric PTJs were obtained with both conventional and arthrographic MR techniques. The MR appearances of all intraarticular and periarticular structures were analyzed and correlated with anatomic slices. Two readers graded visibility of anatomic structures and severity of joint abnormalities. Differences in the visibility ratings at standard MR imaging and at MR arthrography were calculated. Association between the type of pisiform insertion of ligament or muscle with cartilaginous abnormalities of the PTJ was assessed. The association between cartilaginous lesions and osteoarthritic changes was calculated. RESULTS: The tendon sheath, the fibrous capsule, and cartilaginous surfaces were better visualized at MR arthrography than at MR imaging. Pisohamate and pisometacarpal ligaments were slightly better seen on MR arthrograms. Tendons, muscles, and retinacular structures were well demonstrated at both conventional MR and MR arthrography. Cartilaginous lesions and osteophytes were easily identified and were detected more often in the pisiform bone than in the triquetral bone. Communication of the PTJ with the radiocarpal joint was noted in 18 (82%) of 22 wrists. CONCLUSION: MR imaging and/or MR arthrography allows visualization of all anatomic structures of the PTJ. MR arthrography improves visualization of findings of osteoarthritis.

Aged↗
PubMed2003

Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome.

PURPOSE: To determine the prevalence of articular cartilage lesions in patients with subacromial impingement syndrome and to assess the diagnostic effectiveness of magnetic resonance (MR) arthrography in detecting such cartilage abnormalities. MATERIALS AND METHODS: MR arthrographic images obtained in 52 consecutive patients (mean age, 45.8 years; age range, 17-73 years; 26 male and 26 female patients) were retrospectively evaluated for glenohumeral cartilage lesions. Two experienced musculoskeletal radiologists who were blinded to the arthroscopy report independently analyzed the articular cartilage. Humeral and glenoidal cartilage were assessed separately. The lesions were graded as either subtle or marked. Arthroscopic findings were the standard of reference. Sensitivity, specificity, accuracy, and interobserver agreement were calculated. RESULTS: At arthroscopy, humeral cartilage lesions were found in 15 patients (frequency, 29%). Four lesions were subtle, and 11 were marked. Cartilage lesions of the glenoid were less frequent (eight patients; frequency, 15%): Three were subtle, and five were marked. For reader 1 and reader 2, respectively, sensitivity of MR arthrography for humeral cartilage lesions was 53% and 100%, specificity was 87% and 51%, and accuracy was 77% and 65%; sensitivity for glenoidal cartilage lesions was 75% and 75%, specificity was 66% and 63%, and accuracy was 67% and 65%. Interobserver agreement for the grading of cartilage lesions with MR arthrography was fair (humeral lesions, kappa = 0.20; glenoidal lesions, kappa = 0.27). CONCLUSION: Glenohumeral cartilage lesions are found in up to one third of patients referred for MR arthrography for subacromial impingement syndrome. The performance of MR arthrography in the detection of glenohumeral cartilage lesions is moderate.

Adolescent↗
PubMed2007

Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint.

OBJECTIVE: Although central tears of the triangular fibrocartilage are easily seen on imaging, peripheral tears of the ulnar attachment are frequently missed. The aim of this study was to evaluate the accuracy of MR arthrography of the distal radioulnar joint in depiction of peripheral tears of the triangular fibrocartilage. MATERIALS AND METHODS: Forty-one patients (18 women, 23 men; mean age, 38 years; age range, 18-60 years) underwent MR arthrography and wrist arthroscopy. For MR arthrography, iopamidol (300 mg I/mL) and gadopentetate dimeglumine (4 mmol/L) were injected into the distal radioulnar joint. Consensus review of both MR arthrograms and conventional arthrograms was performed by two experienced musculoskeletal radiologists. Presence or absence of communicating and noncommunicating tears of the ulnar attachment of the triangular fibrocartilage was recorded. Arthroscopy was used as the standard of reference for determining sensitivity, specificity, and accuracy in detection of tears of the ulnar attachment. RESULTS: At MR arthrography, communicating tear of the ulnar attachment was diagnosed in three patients, noncommunicating tear in 19 patients, and normal attachment in 19 patients. Arthroscopy revealed peripheral tear of the triangular fibrocartilage in all three patients with communicating tear, in 14 of 19 patients with noncommunicating tear, and in three of 19 patients with normal attachment. The sensitivity was 85% (17/20), specificity was 76% (16/21), and accuracy was 80% (33/41). CONCLUSION: MR arthrography of the distal radioulnar joint is accurate in depiction of peripheral tears of the ulnar attachment of the triangular fibrocartilage. These tears often appear as noncommunicating tears extending from the distal radioulnar joint into the triangular fibrocartilage.

Adolescent↗
PubMed1982

Prosthetic hip replacements: plain films and arthrography for component loosening.

Component loosening of prosthetic hip replacements was evaluated solely by plain films in 56 patients and solely by arthrography in 49. Radiographic results and surgical findings were compared in all cases. Arthrography was associated with fewer errors. For acetabular component loosening, there were 11% fewer errors made by arthrography (26% versus 15%). However, for femoral component loosening, the number of errors decreased by only 3% (15% versus 12%). The errors associated with evaluation of the acetabular component were predominately false-positive, both on plain films and arthrography. For femoral component evaluation, plain films and arthrography were predominately associated with false-negative errors.

Adolescent↗
PubMed1978

Findings at arthroscopy and arthrography in knee injuries.

The diagnostic accuracy of arthroscopy and arthrography was investigated. A total of 135 patients were examined by the two methods. All were operated on and 90 of them were analyzed in detail, the X-ray examinations being done at this hospital. In 82 patients arthroscopy gave correct information. In eight (9 per cent) the diagnosis was incorrect, in most cases a rupture of the posterior horn of the medial meniscus being overlooked. Arthrography gave accurate preoperative information in 52 patients, but in 38 (42 per cent) the diagnosis was inaccurate. This difference in correlation with the operation findings between arthroscopy and arthrography was highly significant (P less than 0.001), and it is concluded that endoscopy gives more complete and more useful preoperative information than arthrography. Arthrography, however, remains a valuable diagnostic tool, as arthroscopy cannot be performed in every patient with knee symptoms.

Adolescent↗
PubMed1982

[A clinical study on arthrography of the elbow joint (author's transl)].

There are many patients who visit a clinic with some complaints at the elbow joint. In such cases, it is customary to evaluate radiographs in making diagnosis. However, it is often difficult to interpret the X-ray films due to structural complexity of the elbow joint. Although in some cases arthrography is performed, there is neither standard technique nor standard method of projection established, hence the evaluation of the arthrogram is often quite difficult. The purpose of this paper thereby is to study the role of the arthrography of the elbow joint as a diagnostic tool second to plain X-rays. The technique must be simple and interpretation of it must be easy as well. It also should provide much diagnostic informations. The author firstly set a standard procedure of the elbow joint arthrography and a standard series of radiographic projections which suffice the above-mentioned conditions. Secondly, analysis of the procedure was done and the normal arthrograms were shown using cadavers. Thirdly, the author performed this procedure in 250 patients who have various disorders in the elbow joint. Finally, the clinical significance of this procedure as a diagnostic tool to elbow joint diseases was discussed. The results are as follows: 1. One ml of positive contrast medium in a child or 2 ml in an adult was injected through postero-lateral puncture of the radio-brachial joint. Three X-ray films--A-P, lateral, 45 degrees ulnar oblique--were obtained. 2. It was found that the arthrograms taken by this procedure can give informations which cannot be obtained by plain X-rays. 3. This procedure of arthrography is very useful as a diagnostic tool in many occasions i.e. in making correct diagnosis in trauma of children such as fracture, dislocation and ligamentous injury; in finding the existence, the location and the grade of synovitis; in finding the location and the size of a tumor; in finding the precise location of the abnormal shadow at the elbow joint; in deciding the level of the osteotomy in cubitus varus deformity; in evaluating derangement, tardy ulnar palsy and joint instability due to osteochondritis, etc. 4. By the analysis of the arthrograms in 250 patients it was shown that this procedure of arthrography gives significant clinical informations.

Adult↗
PubMed1996

MR arthrography: is it worthwhile?

Magnetic resonance (MR) arthrography is possible in any joint in which standard arthrography is performed. The diagnostic potential of this technique is optimized in the assessment of complex anatomical structures and intra-articular abnormalities that are difficult to visualize on conventional MR images. This paper presents the most common applications of MR arthrography in the shoulder, hip, knee, ankle, elbow and wrist, and explores the clinical indications in which MR arthrography adds the greatest benefit compared to standard arthrography and conventional MR imaging. Arthrographic MR images are most valuable in the evaluation of glenoid and acetabular labra, tendons of the rotator cuff, post-operative menisci, osteochondral fractures and loose bodies.

Humans↗
PubMed2002

Effects of iodinated contrast and field strength on gadolinium enhancement: implications for direct MR arthrography.

PURPOSE: To optimize direct magnetic resonance (MR) arthrography by determining the effect of dilution of gadolinium in iodinated contrast, saline, or albumin on T1-weighted, T2-weighted, and gradient-recalled echo (GRE) images, and the effect of scanner field strength. MATERIALS AND METHODS: Gadopentetate dimeglumine was diluted into normal saline, albumin, or iodinated contrast (0.625 mmol/liter to 40 mmol/liter). Samples were scanned at 1.5T and 0.2T. Signal intensity was measured using T1-weighted spin-echo (SE), T2-weighted SE, and two- and three-dimensional GRE (20 degrees-75 degrees flip angle) sequences. Graphical analysis of signal intensity vs. gadolinium concentration was performed. RESULTS: Albumin had no effect on gadolinium contrast. Dilution of gadolinium in iodinated contrast decreased signal intensity on all sequences compared to samples of identical concentration diluted in saline at both 1.5T and 0.2T: with a 2 mmol/liter gadolinium solution at 1.5T, signal was decreased by 26.1% on T1-weighted images, 31.7% on GRE20 images, and 28.9% on GRE45 images, and the T2 value decreased by 71.1%; at 0.2T, signal was decreased by 23.5% on T1-weighted images. On all sequences, the peak signal shifted to the left (lower gadolinium concentration) when diluted in iodinated contrast. Peak signal was also seen at different gadolinium concentrations on different sequences and field strength: at 1.5T, peak in saline/iodine was 2.5/0.625 mmol/liter on T1-weighted images, and 2.5/1.25 mmol/liter on GRE20 and GRE45 sequences. At 0.2T, peak in saline/iodine was 0.625-2.5/1.25 mmol/liter on T1-weighted images, 0.625-2.5/1.25 on GRE45 images, 2.5-10.0/1.25-5.0 mmol/liter on GRE65 images, and 1.25-5.0/0.625-1.25 mmol/liter on GRE75 images. CONCLUSION: Dilution of gadolinium in iodinated contrast results in decreased signal on T1-weighted, T2-weighted, and GRE images compared to dilution in saline or albuminfor both 1.5-T and 0.2-T scanners; if gadolinium is diluted in iodinated contrast for MR arthrography, a lower concentration should be used because the peak is shifted to the left. The use of iodinated contrast should be minimized, as it may diminish enhancement and lower the sensitivity and specificity of MR arthrography. Optimal gadolinium concentration for MR arthrography is dependent on scanner field strength and a broader range of gadolinium concentration can be used to provide maximal signal at low field strength.

Arthrography↗
PubMed1986

Arthrography of the ankle joint in chronic instability.

Papers on arthrography of injuries of the lateral ligaments of the ankle relate mainly to recent distortion of the joint. Arthrography performed at a later stage after injury generally is considered useless. In fact, changes in chronic instability are observed; they are subtle and consist either of small recesses adjacent to the lateral malleolus or communication of the joint with the peroneal tendon sheaths. Arthrography was assessed in 61 cases of recurrent lateral sprains of the ankle more than 2 weeks after acute injury; 38 were considered as positive. Twenty-five patients had operative evaluation, with four false negative and one false positive results. Small recesses adjacent to the lateral malleolus or opacification of the peroneal tendon sheaths are sequelae of an acute sprain with tear of the anterior talofibular and/or the calcaneofibular ligaments. Although false negative results occur, arthrography is useful in the preoperative assessment of chronic ankle instability.

Adolescent↗
PubMed1987

[Arthrography--expanded diagnosis in capsule-ligament injuries of the upper ankle joint].

Arthrography was performed in 563 cases of ankle injury to determine its diagnostic information. No complications occurred in our study. Experiences are described and indications for arthrography are pointed out. Stress radiography using a sophisticated apparatus and reproducible amounts of pressure does not have the diagnostic accuracy of arthrography. Arthrography of the ankle joint makes it possible to diagnose ligament rupture and classify injuries by negative stress radiography.

Ankle Injuries↗
PubMed2000

MR arthrography of the shoulder and hip after fluoroscopic landmarking.

PURPOSE: To describe a technique for intra-articular injection in the MR suite after conventional fluoroscopic landmarking in order to streamline MR arthrography. DESIGN AND PATIENTS: This technique was performed on 33 consecutive patients referred for MR arthrography of the shoulder to evaluate the glenoid labrum and on 15 consecutive patients referred for MR arthrography of the hip to evaluate the acetabular labrum. The patients were landmarked in the fluoroscopy suite, followed by a conventional MR examination. The intra-articular injection was then performed on the MR table and the MR arthrographic sequences obtained. RESULTS: One of the 48 injections was extra-articular, requiring a second injection. The other injections were performed without incident, and the average total procedure time for all injections was 10 min. CONCLUSIONS: This technique is a reliable method of streamlining intra-articular injections when performing conventional MR imaging prior to the MR arthrographic portion of the examination. It shortens the total MR examination time by eliminating a visit to the fluoroscopy suite in the middle of the MR study, and its use of a straight anterior approach for both the shoulder and hip joints should be familiar to most people who perform conventional arthrography.

Adolescent↗
PubMed1998

Indirect MR arthrography of anterior shoulder instability in the ABER and the apprehension test positions: a prospective comparative study of two different shoulder positions during MRI using intravenous gadodiamide contrast for enhancement of the joint fluid.

OBJECTIVE: The value of MRI for the evaluation of anterior shoulder instability can be enhanced by shoulder positions that stress the stabilising structures. The ABER position is one that has been described in combination with intra-articular gadopentetate dimeglumine arthrography. We believe that MRI in the Apprehension test position with 90 degrees abduction and maximal tolerable external rotation provides maximum tension on the anterior stabilising structures and with this technique it is sufficient to use indirect gadodiamide arthrography following intravenous injection of the contrast medium. The purpose of this study was to make a prospective comparative evaluation of the ABER and Apprehension test positions when using indirect arthrography with intravenous gadodiamide administration in shoulders with anterior instability. DESIGN AND PATIENTS: Sixteen patients with persistent anterior instability after recurrent shoulder dislocations were examined in an open MRI unit (0.2 T) following 0.1 mmol/kg of intravenous gadodiamide. Oblique axial T1-weighted imaging was used for analysis. Operative findings were used for correlation. RESULTS: Both the ABER and the Apprehension test position were useful techniques in detecting capsulolabral pathology and Hill-Sachs lesions. The Apprehension test position produced significantly better gadodiamide-enhanced joint fluid in the region of pathology in both the capsulolabral lesion and the Hill-Sachs lesion. It also visualised the size of the Hill-Sachs lesion significantly better than did the ABER position. CONCLUSION: MRI examination of anterior shoulder instability in the Apprehension test position was more beneficial than examination in the ABER position in visualising capsulolabral and Hill-Sachs lesions when using indirect arthrography.

Adolescent↗
PubMed2005

Assessment of intra-articular volume of the wrist: a comparative study between CT-arthrography and dissection.

The aim of this study was to compare the intra-articular volumes of the wrist's joint measured by CT-arthrography and by dissection on ten cadavers. A good correlation was found between CT-arthrography and dissection in the assessment of the intra-articular volume of both wrist joints. A volume of 1.34 (+/-0.46) milliliter and 0.97 (+/-0.32) milliliter were found by Ct-arthrography for the radiocarpal and midcarpal joints, respectively. Dissection of the same wrists gives a volume of 1.24 (+/-0.33) and 0.90 (+/-0.21) for the radiocarpal and midcarpal joints, respectively. The knowledge of normal wrist-joint volume is a major prerequisite to evaluate carpal instability without ligaments' tears. We believe that CT-arthrography could be helpful in evaluating patients with suspected carpal instability.

Arthrography↗
PubMed2005

Prospective evaluation of two different injection techniques for MR arthrography of the hip.

The aim of the study was to evaluate prospectively the technical feasibility and discomfort of two different injection techniques for MR arthrography of the hip. Sixty-one consecutive patients undergoing MR arthrography of the hip (68 hips) were randomly injected either at the femoral head (36 hips) or the femoral neck (32 hips). The patients rated discomfort during and 0-72 h after arthrography using a visual analogue scale (VAS, 0="did not feel anything", 100="unbearable"). The volume injected, the distance between the needle tract and the neurovascular bundle, the duration of the procedure and the extra-articular contrast leakage were measured. No significant differences were found for the volume injected, the distance between the needle tract and the neurovascular bundle, or the procedure duration. Volume of extra-articular contrast leakage was statistically significantly different (head 1+/-2 cm(3), neck 3+/-5 cm(3), P=0.024). The VAS score for needle advancement was significantly different (head 25+/-20, neck 19+/-23, P=0.031). No significant differences were found for the VAS score regarding delayed discomfort. Before the examination the arthrography-related discomfort was overestimated by 74% (50/68), correctly anticipated by 22% (15/68) and underestimated by 4% (3/68) of the patients. MR-related discomfort was overestimated by 32% (22/68), correctly anticipated by 57% (39/68) and underestimated by 10% (7/68) of the patients. Both hip puncture techniques were well tolerated. The neck injection technique produced less discomfort and was associated with greater extra-articular contrast leakage.

Adolescent↗
PubMed1991

Internal derangement of the temporomandibular joint: an audit of clinical findings, arthrography and surgical treatment.

Forty seven patients who underwent double contrast video-arthrography followed by surgery for internal derangement of the temporomandibular joint were reviewed retrospectively. Of the 50 joints assessed, arthrography demonstrated 39 (78%) with irreducible meniscal displacement and 11 (22%) with reducible displacement. Clinical findings were found to be unreliable in demonstrating the degree of internal derangement: 49% of irreducible meniscal displacements presented with clicking and only 20% with loss of click. The importance of video-arthrography is emphasised. Surgery for internal derangement proved successful. It is proposed that patients who have clinical evidence suggestive of irreducible meniscal displacement and have disabling symptoms should undergo early video-arthrography and be offered surgical correction.

Adolescent↗
PubMed2006

Magnetic resonance arthrography.

For decades, fluoroscopic arthrography was the only method available to image a joint with contrast enhancement. Advances in CT led to the natural development of CT arthrography. Development of MRI and its capability for multiplanar imaging led to direct magnetic resonance arthrography (MRA). This technique has been performed since 1987 and has surpassed CT arthrography in popularity in the United States. Indirect MRA developed subsequently to offer a less invasive alternative. This article presents an overview of direct MRA and addresses joint-specific issues regarding direct MRA. An overview of indirect MRA also is provided.

Arthrography↗
PubMed1995

Lymphatic filling in arthrography following total hip replacement.

The significance of lymphatic filling at hip arthrography on prosthetic hips is uncertain. Clearly if lymphatic opacification has a direct relationship to loosening, this could lead to increased surgical exploration. Ninety-one patients were studied to determine whether opacification of lymphatics during hip arthrography correlated with loosening of the prosthetic hip. Plain radiographs were evaluated and a total of 92 hip arthrograms were assessed retrospectively. Radiological evidence of prosthetic loosening at hip arthrography was present in 61 patients. Fifty-three patients subsequently had surgical exploration and 50 were confirmed to have loose and/or infected components. In only 18 of these patients had lymphatic filling been demonstrated at arthrography. No evidence of loosening was seen in 23 patients; however, lymphatic opacification occurred in 10 of these arthrograms. This study does not demonstrate any correlation between prosthetic loosening, either with or without infection, and filling of the nearby lymphatic vessels. This finding contradicts an earlier report in the literature.

Adult↗
PubMed1998

Elbow arthrography.

Elbow arthrography provides useful information that is not available with noninvasive imaging. This article describes normal elbow anatomy as seen by arthrography. Technical aspects of arthrography with regard to radiographs and CT and MR imaging are reviewed. Indications for MR arthrography include identification of loose bodies, chondral and osteochondral fractures, collateral ligament tears, and synovial and capsular abnormalities.

Arthrography↗