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PubMed1987

MR imaging of the shoulder: diagnosis of rotator cuff tears.

Twenty-five patients with known or suspected tears of the rotator cuff in 26 shoulders underwent MR imaging. All patients also underwent arthrography or surgery. MR visualized abnormalities consistent with a tear in 20 of the 22 tears diagnosed by arthrography or surgery. In most cases, tears were seen as regions of increased signal intensity within the cuff on long-TR pulse sequences, although two cases simply showed an almost complete absence of normal cuff. The MR appearance of the two cases with partial tears was similar to that of full-thickness tears. Of the four cases with normal arthrograms, one case had MR findings consistent with a tear. We conclude that MR has good potential for the noninvasive diagnosis of rotator cuff tears. Its ultimate role in this diagnosis must await prospective studies comparing its accuracy with that of sonography, CT, and arthrography.

Adult↗
PubMed1998

Triangular fibrocartilage of wrist: presentation on high resolution ultrasonography.

This study consisted of two parts. Part I is for detection of the normal triangular fibrocartilage by high resolution ultrasonography and Part II is a preliminary study to evaluate high resolution ultrasonography in the diagnosis of tears of the triangular fibrocartilage. Normally, the triangular fibrocartilage was seen in all cases in Part I as an inverse triangular structure of homogeneous hyperechogenicity on transverse and oblique sagittal scans at the level of the distal radioulnar joint. At its waist it measured from 2.3 to 4.2 mm (mean, 3.0 +/- 0.5 mm) on oblique sagittal scan and from 2.5 to 3.7 mm (mean, 3.2 +/- 0.4 mm) on transverse scan. Under normal conditions, the triangular fibrocartilage is thicker than 2.5 mm on both transverse and oblique sagittal sections with a confidence level of 95%. In Part II, eight of the 47 wrists were found to be hypoechoic in the triangular fibrocartilage region, which proved to be tears by arthrography. Six cases showed a homogeneous hyperchoic triangular fibrocartilage measuring from 1.8 to 2.8 mm (mean, 2.3 +/- 0.5 mm) in transverse section and from 0 to 2.2 mm (mean 1.2 +/- 1.1 mm) in oblique sagittal section; five of these proved to be tears by arthrography. In contrast, 33 wrists had a homogeneous hyperechoic triangular fibrocartilage measuring from 2.5 to 4 mm (mean, 3.1 +/- 0.4 mm) and 2.5 to 4.2 mm (mean, 3.1 +/- 0.6 mm) on transverse and oblique sagittal sections, respectively; 27 proved to be normal triangular fibrocartilage by arthrography. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 68.4%, 96.4%, 92.9%, 81.8%, and 85.1%, respectively. HRUS can display the normal triangular fibrocartilage as a homogeneous hyperechoic and inverted triangular structure. The torn triangular fibrocartilage appears as a hypoechoic region or as thinning (< 2.5 mm) of the hyperechoic structure on either transverse or oblique sagittal section. HRUS has an acceptable accuracy in the diagnosis of triangular fibrocartilage tear.

Adolescent↗
PubMed2000

[Capsular retraction of shoulder: prospective study of imaging benefits in 20 patients].

PURPOSE: To evaluate the contribution of principal imaging techniques in diagnosis and treatment in adhesive capsulitis of the shoulder. MATERIALS AND METHODS: In 20 patients presenting adhesive capsulitis of shoulder since mean of 6,7 months, the following examinations were performed: radiographies, angioscintigraphy, MRI as well as an opaque arthrography and a bursography associated with corticosteroid injection. Patients were followed during one year. RESULTS: The opaque arthrography was to affirm the adhesive capsulitis for the inclusion of the patients. Radiographies (patchy demineralization) and scintigraphy (hyperfixation) were often pathological. In MRI, T1 fat-saturated sequences after contrast injection almost always showed enhancement of the articular capsula, the synovia, the miscellaneous bone or the sub-acromial bursa. The latter was often modified and retracted at bursography. In 19 of 20 cases, a functional improvement was observed after the opacifications. CONCLUSION: Therapeutic effect of both arthrography and bursography is almost proved. Post contrast MRI confirms presence of vascular troubles in all the shoulder structures even at this advanced stage.

Adult↗
PubMed2000

[Wrist trauma: diagnostic imaging].

Wrist injury is common throughout life and, although history and physical examination provide important information regarding the type of lesion, a radiological study is essential to determine a specific diagnosis. Conventional radiography plays a central role in the wrist injuries but the diffusion of more sensitive methodics offers new possibilities. Our purpose is to evaluate the role of computed tomography (CT), magnetic resonance (MR) and arthrography in wrist trauma. We retrospectively examined the images of 45 patients with wrist injuries: in every patients a radiological examination in 4 standard projections was executed while in 25, 9 and 11 patients CT,MR and arthrography were performed. On the basis of our findings we think that conventional radiography is often sufficient for diagnosis of bone lesions even if CT sometimes is required to detect subtle fractures. MR has an high sensitivity not only for abnormalities of soft tissues, including interosseous ligaments and triangular fibrocartilage, but also bony abnormalities such as occult fractures and early osteonecrosis. Arthrography still remains the best procedure for evaluating lesions of triangular fibrocartilage and intercarpal ligaments especially in a preoperative phase.

Adolescent↗
PubMed2004

[The effects of arthrographically detected femoral head lateralization and soft tissue interposition during closed reduction of developmental dislocation of the hip on mid-term results].

OBJECTIVES: In a prospective, non-randomized evaluation of patients who underwent surgery under general anesthesia for developmental dislocation of the hip (DDH) at or below 18 months of age, we assessed the mid-term effects of arthrographically documented femoral head lateralization and soft tissue interposition under the acetabular labrum during reduction without opening the hip joint capsule. METHODS: The study included 31 unstable hips of 21 children (mean age 12 months; range 4 to 18 months). After the iliopsoas and adductor longus tendons were sectioned by a medial approach, hip joint arthrography was performed. According to the criteria of Tönnis, all the patients had grade 2 arthrographic reduction and the hip joint capsule was left intact. The mean follow-up was 6.5 years (range 3 to 9.5 years). RESULTS: Avascular necrosis of the femoral head (AVN), redislocation, and secondary operation were seen in 42%, 19%, and 29%, respectively. The physeal plate was involved in nearly half of the hips with AVN. The occurrence of AVN was less in hips treated at the age of below one year. Complications were more frequent in cases in which more than one intraarticular soft tissue obstacles had been documented by arthrography. Avascular necrosis and redislocation were more commonly encountered in hips in which the medial pool size of contrast material exceeded 7 mm than those with sizes between 3 to 7 mm. CONCLUSION: Our mid-term complication rates suggest that the hip joint capsule be opened in order to achieve an anatomical reduction through eliminating intraarticular obstacles when arthrography shows lateralization of the femoral head, soft tissue interposition, and medial pooling of the contrast material following closed reduction of DDH.

Arthrography↗
PubMed1991

[X-ray diagnosis of ligament lesions of the superior ankle joint].

Nearly 40 years after ankle arthrography was first introduced, the anterior and inversion stress views of the ankle are still widely preferred as a noninvasive method of evaluating ligament injuries in the upper ankle. We consider the stress test, bilaterally performed using a standardized stress apparatus, as a basic examination by which to differentiate between slight and severe sprain. Intensive muscle splinting due to painful swelling can sometimes be treated by injection of local anesthetic. Like many authors, we perform ankle arthrography in cases where there is a significant difference between the clinical findings and the stress test. The technique of ankle arthrography can be readily learned and is extremely accurate in delineating the extent of ligamentous injury produced by moderate or severe ankle sprains. It can be performed in any X-ray department.

Ankle Injuries↗
PubMedDate not supplied

The Leclercq test in diagnosis of tear in the rotator cuff.

The authors report their experience in using the Leclercq test to diagnose tear in the rotator cuff of the shoulder. When positive, this test consists in a radiographic demonstration of reduction in the subacromial space in opposing abduction of the shoulder. Twenty-five patients affected with chronic painful shoulder and suspected lesion of the rotator cuff were submitted to the Leclercq test and subsequently to arthrography in order to evaluate the conditions of the cuff. In all of the cases where the cuff was whole, and arthrography normal, the Leclercq test was negative. When lesion of the cuff was revealed by arthrography, the test was positive in 75% of the cases considered globally, and in 92% of the cases with complete tear in the rotator cuff.

Adult↗
PubMed1991

Rotator cuff pathology. Arthroscopic assessment and treatment.

The results of 50 operative arthroscopies for impingement syndrome were reviewed. Preoperative arthrography was correlated with arthroscopic findings, which were pathologically graded. Results of arthroscopic surgery were assessed. Preoperative arthrography predicted 78% of the complete tears of the rotator cuff and only 25% of the partial tears. Of 40 shoulders followed for at least one year postoperatively, 87.5% had satisfactory results. Arthrography was not as reliable as arthroscopy in predicting partial tears of the rotator cuff. Arthroscopy permitted detailed intraarticular and subacromial visualization and classification of partial and complete tears of the rotator cuff. The early results of arthroscopic acromioplasty and debridement are comparable to those obtained with open operations.

Adolescent↗
PubMed1990

Imaging of the temporomandibular joint.

Both arthrography and MR imaging are of proven value in the evaluation of internal derangements of the TMJ. Arthrography provides the advantages of a dynamic display of joint mechanics and the easy detection of disc perforation. Its disadvantages include its technical difficulty and its poor visualization of the disc in the medial-lateral plane. MR imaging of the TMJ provides excellent soft-tissue detail and more readily demonstrates medial and lateral displacements of the disc. Unfortunately, perforations of the disc or ligaments are not usually visualized, and bony detail is not seen as well as on plain radiographs or computed tomography. In addition, real-time dynamic imaging of joint mechanics is not readily available. Currently, the choice of imaging modality is based on the specific diagnostic question, and availability of arthrography and MR imaging.

Arthrography↗
PubMed1989

[Strategies for the use of complementary tests in menisco-ligamentous pathology of the knee].

In patients with menisco-ligamentous pathology of the knee, the paraclinical examinations available to physicians and surgeons are standard radiography, arthrography, arthroscopy and magnetic resonance imaging (MRI). The use of these methods on whether the lesions are recent or chronic. Standard radiography and arthrography are sufficient to evaluate chronic lesions, arthroscopy and MRI being reserved to cases with complex laxity. For recent lesions standard radiography must systematically be performed. Arthrography is unreliable, being hampered by haemarthrosis and pain. Arthroscopy may be hazardous and can only be used in patients without peripheral lesions of the articular capsule and ligaments. MRI is sometimes useful, notably in cases with unrecognized post-traumatic haemarthrosis and in children as it avoids hospitalization. In this article, the various situations encountered are analyzed and a strategy for the use of paraclinical examinations is offered.

Arthrography↗
PubMed1989

[Arthrographic semeiotics of traumatic capsular and ligamentous pathology of the tibiotarsal articulation].

One-hundred and fifty-five patients with recent trauma were submitted to arthrography of the ankle joint in order to evaluate the actual diagnostic value of the methodology. Arthrography clearly demonstrated the single ligaments (anterior talo-fibular, calcaneal-fibular, posterior talo-fibular, and deltoid) and the capsular damage or rupture. The technical factors affecting the quality of the examinations are discussed. Arthrographic accuracy was 94.2%, with 92.7% sensitivity and 100% specificity. Arthrography of the ankle joint proved to be a quick and low-cost method providing good diagnostic results and no complications, thus allowing better preoperative planning in capsular and ligament injuries.

Adolescent↗
PubMed1987

[Synergistic joint diagnosis].

Many methods are useful in the diagnosis of diseases of the joints. Noninvasive methods deserve preference; invasive techniques such as arthrography and arthroscopy are second choice, after noninvasive methods have been applied. The synergic combination of the two last-named methods has proved successful. Arthrography, performed before arthroscopy in the operation theatre, supplements arthroscopy findings and extends the diagnostic value of the arthroscopic findings, in a similar manner as the combination of computed tomography and arthrography.

Arthrography↗
PubMed1987

[Prostaglandin E2 liberation in the synovial fluid induced by organo-iodinated contrast media. Interrelations with the genesis of post-arthrographic pain].

RCM have been observed to cause--during arthrography--the appearance of a slow onset painful symptomatology with the clinical characteristics of a slight and transient acute arthritis. These substances are supposed to set in a production of humoral mediators of inflammation with algogenic action--PGE2 in particular. During arthrography of the knee the release of synovial fluid PGE2 after RCM introduction was studied. Two RCM were compared: meglumine iothalamate and iopamidol. Twenty patients underwent arthrography of the knee: synovial fluid PGE2 concentration was measured both before and 15' after RCM introduction with 125I-RIA method. Results show a significant increase in PGE2 concentration after both iothalamate (p less than 0.0001) and iopamidol (p less than 0.01) --especially in iothalamate--treated patients (p less than 0.01). A physiopathologic mechanism about post-arthrographic pain and, more generally, about RCM toxicity is thus hypothesized.

Arthrography↗
PubMed1993

[Meniscal lesions].

The polymorphism and richness of arthrographic imaging and MRI of meniscal lesions require a perfect understanding of the anatomy of the menisci and the mechanisms of production of the lesions. Arthrography remains the reference diagnostic investigation with a good sensitivity and excellent spatial resolution. However, it is an invasive and operator-dependent technique. MRI of the knee, a non-invasive and independent method, allows the diagnosis of the majority of meniscal lesions. By using specific surface coils and appropriate sequences, MRI constitutes complete imaging technique allowing examination of all anatomical structures of the knee in all planes. Once MRI becomes more widely available, it should replace arthrography in the majority of clinical situations. The indications for arthrography will then be confined to contraindications of MRI.

Aging↗
PubMed1993

Coexistence of calcific tendinitis and rotator cuff tear: an arthrographic study.

A prospective evaluation of the coexistence of calcific tendinitis and tear of the rotator cuff demonstrated by arthrography was made in patients presenting with shoulder pain. Patients were X-rayed using conventional views and impingement views. Eighty-one patients (mean age 61.2 years) with calcific tendinitis underwent arthrography. Arthrography showed 22 partial or complete tears of the rotator cuff. A small rather than a large amount of calcification was more likely to be associated with a rotator cuff tear (p = 0.005). The coexistence of calcific tendinitis with rotator cuff tear is not uncommon, especially in older age groups.

Calcinosis↗
PubMed1981

[Invasive and non-invasive radiologic diagnosis of talofibular ligament lesions (author's transl)].

A report is given on 413 patients having experienced a supination trauma. All these patients were submitted to radiography according to the technics of Böhler. Arthrographies of the ankle joint were additionally effected in 105 patients because of indistinct findings of the Böhler radiographs. The arthrography of the ankle joint proves to be an examination method bearing few risks and producing most reliable results provided that it is executed within 24 hours after the traumatic incident. The findings of arthrography of the ankle joint are presented and discussed.

Ankle Injuries↗
PubMed2006

Axial oblique MR imaging of the intrinsic ligaments of the wrist: initial experience.

OBJECTIVE: To evaluate two separate MR sequences acquired in the axial oblique plane, parallel to the long axis of the scapholunate (SL) and lunotriquetral (LT) ligaments, to determine whether the addition of these sequences to the standard MR wrist examination improves visualization of the intrinsic ligaments, and the evaluation of their integrity. To our knowledge, this plane has not been described in the literature previously. DESIGN AND PATIENTS: In total we evaluated 26 patients with chronic wrist pain or instability, referred for MR imaging following assessment by an orthopedic surgeon or physiatrist. All patients underwent initial conventional tri-compartment wrist arthrography, which served as the reference standard. This was immediately followed by MR arthrography, in the standard coronal and true axial planes, as well as in the axial oblique plane. The SL and LT ligaments were initially assessed for the presence or absence of tear, using the standard coronal and true axial sequences, and subsequently re-evaluated with the addition of the axial oblique planes. RESULTS: A total of ten intrinsic ligament tears were identified with conventional arthrography: six SL and four LT tears. Five of the six SL tears were identified on the standard sequences. All six were diagnosed with the addition of the oblique sequences. There were three false-positive SL tears identified using standard MR imaging, and two false-positives with the addition of the oblique sequences. No LT tear was identified on standard sequences, whereas all four were confidently seen with the addition of oblique images. No false-positives of the LT ligament were recorded with either standard or axial oblique sequences. CONCLUSION: The study suggests that the addition of axial oblique MR sequences helps identify tears to the intrinsic ligaments of the wrist, particularly the LT ligament. In addition, the axial oblique images assist in localization of the tear.

Adolescent↗
PubMed1996

Current status of imaging of articular cartilage.

Various imaging methods have been applied to assessment of articular cartilage. These include standard radiography, arthrography, CT, CT arthrography, ultrasonography, and MR imaging. Radiography remains the initial musculoskeletal imaging method. However, it is insensitive to early stages of cartilage abnormalities. MR imaging has great potential in the assessment of articular cartilage, although high-quality scans are required because imaging signs of cartilage abnormalities may be subtle. The potential and limitations of various sequences and techniques are discussed, including MR arthrography. The role of the other imaging methods in assessment of articular cartilage appears to be limited.

Cartilage Diseases↗