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PubMed1991

Arthrographic evaluation of the internal derangement of temporomandibular joint.

From a functional point of view, the temporomandibular joint(TMJ) is one of the most important joints in the body. Optimal radiographic visualization is becoming increasingly important to medical and dental specialists as abnormal TMJ derangements are becoming better understood. Because the most common TMJ arthropathy is the internal derangement of TMJ, arthrography of the temporomandibular joint is widely performed in clinical practice. From January 1986 to December 1990, twenty temporomandibular joint arthrographies were performed in patients with symptoms of pain, clicking and dysfunction. We report our findings on these twenty patients who were examined by arthrography, which was conducted due to internal derangements related to meniscal dysfunction.

Adolescent↗

PubMed1990

[Value of diagnostic measures in soft tissue diseases and soft tissue lesions of the shoulder joint].

Calcifying tendinitis, acute tendinitis, frozen shoulder, rotator cuff rupture, subluxation of the gleno-humeral joint and injury of the biceps tendon are commonly classed under the blanket term "peri-arthropathy of the shoulder". It is now possible to make a precise diagnosis of these shoulder disorders by means of a clinical examination supported by X-ray examination, ultrasonography, arthrography, computed tomography (CT), magnetic resonance imaging (MRI) and arthroscopy. Calcifying tendinitis is diagnosed by consideration of the patient's history, followed by clinical examination and X-ray examination. Acute tendinitis is a clinical diagnosis, as is frozen shoulder. Ruptures of the rotator cuff can be detected by ultrasonography, which is a screening method; such ruptures can also be detected by arthrography. The localization and extent of the defect are best estimated by arthroscopy. Shoulder instability is another clinical diagnosis. Bony defects of the humeral head (Hill-Sachs lesion) or the glenoid rim are revealed by computed tomography (CT). CT arthrography reveals the presence of any Broca-Hartman lesion in the anterior inferior part of the anterior capsular mechanism. Rupture, subluxation or luxation of the biceps tendon are diagnosed either by clinical examination or by arthroscopy. Knowledge of the sensitivity, specificity and accuracy of the diagnostic procedures makes it possible to carry them out in a standardized, logical sequence. Arthroscopy allows a decidedly more accurate diagnosis than any of the other methods, but as it is an invasive procedure it should be kept until last when diagnosis of disorders of the gleno-humeral joint is required.

Arthroscopy↗

PubMed1986

Ultrasonography in the investigation of loose hip prostheses.

Twenty-two patients with severe pain in the hip on weight-bearing after prosthetic replacement were investigated by radiography, arthrography, scintigraphy and ultrasonography to determine the accuracy of these diagnostic methods in detecting loosening of infective or mechanical origin. In two cases, ultrasonography revealed superficial infections that were resolved with antibiotic therapy. Of the remaining 20 cases, 12 involved a deep infection and in 8 the loosening was of mechanical origin. In the deep infections, standard radiography provided a diagnosis in 66% of cases, arthrography in 75% and scintigraphy in 83%, while ultrasonography detected the deep infection in all 12 cases. In the patients with mechanical mobilization, arthrography and ultrasonography were 100% accurate. Since ultrasonography is able to detect discrete or diffuse lesion of the soft tissues around a prosthesis it should be included among the methods used to screen patients with painful hips after prosthetic replacement.

Aged↗

PubMed1978

Arthrographic demonstration of pigmented villonodular synovitis of the knee.

Arthrography of the knee is most frequently used for diagnosis of conditions affecting the cartilage and menisci. In a 40-year-old man with pigmented villonodular synovitis, arthrography demonstrated a characteristic pattern of multiple filling defects. Arthrography may prove to be as useful for diagnosis of synovial lesions as for other intraarticular lesions.

Adult↗

PubMed1982

Radiographic and arthroscopic findings in the equine stifle.

The radiographic and arthroscopic findings in the equine stifle were compared. Survey radiography, contrast arthrography, and arthroscopy were performed on both stifles of 10 horses. Nine of the horses were euthanatized to evaluate the effects of the techniques on the joints. Techniques for double-contrast arthrography and arthroscopy were developed, and the findings were compared. Survey radiography identified only osseous structures. Double-contrast arthrography of the femoropatellar joint demonstrated articular surfaces of the trochlea, patella, and joint capsule. Those of the femorotibial joint defined the medial meniscus but not the lateral meniscus. On arthroscopy of the femoropatellar joint, intra-articular structures could be readily visualized. In the femorotibial sacs, structures were more difficult to identify. Gross examination of the stifle joint at necropsy revealed no overt effects of arthroscopy.

Animals↗

PubMed1982

[Value of special roentgen studies of lesions of external ligaments of the upper ankle joint].

The advantage of special radiological investigations after damage of the external tendon of the ankle joint is absolutely certain. Clinical findings, functional x-ray pictures, and for some cases arthrography of the ankle joint render the correct diagnosis. Merely functional x-ray pictures will not always be sufficient, although sometimes this has been pretended. Experiences are described and indications for arthrography are pointed out. Arthrography certainly is the most accurate method for investigations of lesions of the external tendon of the ankle joint. Nevertheless it should only be performed for special cases and after critical interpretation of the functional x-ray pictures, because it is a rather invasive method.

Ankle Injuries↗

PubMed1981

Evaluation of the cruciate ligaments by CT.

Delineation of the cruciate ligaments in 112 patients using the computed tomography under arthrographic conditions was reported. Special position were used allowing for the demonstration of both cruciate ligaments in their complete lengths. In 6.2% of the examinations a reliable demonstration of the cruciates was not possible for technical reasons. Demonstration of normal cruciate ligaments in CT arthrography was described and normal values were tabulated. Recent cruciate ligament injuries were seldom examined by CT arthrography since the clinical symptoms were mostly unequivocal. The old ruptures of the ACL were divided into 4 different types: Type I: Rupture of the femoral origin that adjoins the PCL. Type II: Attenuation of the intraligamentary ruptured ligament with a preservation of origin and insertion. Type III: Complete rupture with shrinking and retraction of the fragments. Type IV: Osseous involvement of the femoral origin or tibial insertion. In 36 old cruciate ligament ruptures, the sensitivity of this method of investigation was 97%, the specificity 100%. After reconstructive surgery, CT arthrography allows for an objective analysis of the operative results and permits the comparison of different techniques of surgical repair.

Humans↗

PubMed1980

[Significance of double-contrast arthrographic for the assessment of a meniscus lesion (author's transl)].

On-target and hence successful treatment can be effected only if the diagnosis of a lesion of the meniscus is established beyond doubt. In the present study the authors tested retrospectively the significance of arthrography for the assessment of a meniscus lesion, basing their evaluation on the surgical findings, and examined the diagnostic problems involved in internal lesions of the knee, following knee surgery. The study utilized the results of 279 cases of double-contrast arthrography; 76 of these patients were operated upon. Complete agreement between arthrography and surgical findings was obtained in 73.5% of the patients. This figure increases to 81.5% when we disregard insignificant diagnostic factors. No complications were seen in any of the outpatient examinations.

Cartilage, Articular↗

PubMed1994

[Magnetic resonance of the cartilages of the large joints].

MRI of the articular cartilage requires a careful technical approach since this structure is very thin, with a peculiar internal architecture between the supporting matrix and the cell component. On MR images the normal articular cartilage has a zonal appearance. To optimize the variables for best visualization of the internal architecture of the hyaline articular cartilage, an ex vivo and in vivo study was carried out. Accurate T1 and T2 relaxation times of the articular cartilage were obtained with a particular mixed sequence and then used to create isocontrast intensity graphs. The latter allowed, in all pulse sequences (SE and GRE), the best combination of TR, TE and FA to optimize signal differences between cartilage areas. A trilaminar pattern was demonstrated, with a superficial and a deep hypointense areas, in all sequences, together with an intermediate area which was moderately hyperintense on SE images and markedly hyperintense on GRE images. In the current literature, MRI appears to have been widely used to investigate hyaline cartilage conditions. In many series, the technique proved its efficacy in assessing both acute (traumatic cartilage fractures, osteochondritis dissecans, arthritis) and chronic (arthrosis, chondromalacia patellae, Hoffa's disease, synovial plica syndrome) conditions of the articular cartilage. T2-weighted sequences (both SE and GRE) are widely known as the most accurate in assessing cartilage conditions, which depends mainly on the arthrographic effect of synovial fluid on T2-weighted images. Of late, also MR arthrography, especially MR arthrography after the i.v. administration of Gadolinium, has emerged as an outstanding technique to investigate articular cartilage conditions. On the basis of MR arthrography findings, some authors suggested a classification of osteochondritis dissecans, arthrosis and chondromalacia patellae on MR images. MR stages seem to be closely correlated with the histologic classification suggested for these conditions.

Cartilage Diseases↗

PubMed1993

Magnetic resonance imaging in the diagnostic management of diseases of the knee.

Magnetic resonance imaging (MRI) of the knee is fast assuming a major role in evaluating disorders of the knee. The major advantage of MRI is that it is a totally non-invasive procedure with superior soft tissue contrast resolution and multi-planar capabilities. In contrast to arthrography, intra-articular as well as extra-articular structures in the knee can be evaluated by MRI. Indications include studying abnormalities of the menisci, ligament, patella and quadriceps mechanisms, articular cartilage, bone, bursa and other soft tissue. A review of the literature comparing MRI to arthrography and arthroscopy of the knee, especially in relation to meniscal injuries and anterior cruciate ligament tears, shows wide ranges in the accuracy rates of MRI. There are pitfalls in the interpretation of meniscal tears on MRI like normal variants, tears at the free edge and healed or previously repaired tears. Arthrography remains a useful diagnostic modality in some of these settings.

Arthroscopy↗

PubMed1977

Arthroscopy: its role in treating nontraumatic and traumatic lesions of the knee.

Arthroscopy of the knee is a useful adjunct in the diagnosis and treatment of intra-articular disease. We reviewed 178 patients who had arthroscopy at Duke from November 1972 to May 1975. Anesthesia was either general or local with a block of the infrapatellar fat pad and the infrapatellar branch of the saphenous nerve. This experience demonstrated that arthroscopy was relatively rapid, increased the accuracy of diagnosis from 70% by clinical assessment alone to 96%, and influenced the management of the knee in 55% of the cases. In many instances, arthroscopy demonstrated major pathologic conditions not readily noted by prior arthrography, multiple roentgenograms, or physical examination. Arthroscopy does not eliminate the need for arthrography, although frequency of arthrography diminished as arthroscopic technics were mastered and equipment improved. Arthroscopy is valuable in the management of most knee problems. The surgeon undertaking the procedure must have adequate instruction and a wide and continued usage in order to become and remain adept.

Adolescent↗

PubMed1996

[Imaging of external instabilities of the patella. State of the art].

External femoropatellar instability is a dynamic abnormality from various origins: osseous, cartilaginous or musculotendinous; X-rays films cannot give a precise enough description of this phenomenon. Attention is drawn by anterior pain or a sensation of instability. Clinical analysis distinguishes between permanent, traumatic or transient dislocations which are now more frequently discovered as part of a femoro-patellar syndrome with or without cartilage involvement. Conventional imaging, CT-scan and MR imaging are based on faultless techniques. Lateral views precisely report femoropatellar architectural abnormalities and patellar instability. Skyline views are able to quantify the various parts of the dysplasia. Dynamic tests increase the sensitivity of the plain films. But the main shortcoming of these techniques is the lack of visualization of the initial patellar engagement in the trochlea. The femoropatellar component of the knee arthrography visualizes rather large cartilaginous lesions. CT-scan, better than skyline views, allows examining the patellar bone without interference with the trochlea (extended knee), during the engagement (15 degrees flexed knee) and after the engagement (30 degrees flexed knee). However, the examination technique varies from one author to another according to his own pathophysiologic understanding. With the bicondylar plane reference, the reliability of the CT-scan measurements are better than skyline views. Like the dynamic tests during the beginning of the patellar engagement at 15 degrees, flexion is more sensitive than those at 30 degrees. Finally, CT-scan arthrography demonstrates thinner cartilaginous lesions than conventional arthrography. Presently the main contribution of MR imaging consists of detecting transient patellar dislocation that a single clinical examination cannot differentiate from other internal knee disorders. MR imaging is more precise in analyzing the cartilaginous structure. Kinematic MR imaging, still in an experimental stage, offers a new approach to the dynamic study of the patellar tracking.

Humans↗

PubMed1996

Sonographic signs of complete rotator cuff tears.

BACKGROUND: To evaluate the usefulness of high resolution ultrasound (HRUS) in the examination of complete rotator cuff tear (RCT). METHODS: A prospective study of 157 patients with sonographic examination of shoulder was performed. All of them complained of chronic shoulder pain and were referred by clinician for suspicion of RCT. Their age ranged from 30 to 76 years. The ultrasonic scanners we used were Acuson 128 XP 10 with 7MHz linear transducer, or Diasonics VST master series using 10MHz linear transducer. Examination positions included external rotation of shoulder for scanning biceps tendon and subscapularis tendon, and internal rotation for supraspinatus tendon and lateral scan of infraspinatus tendon and teres minor tendon. Sonographic criteria of complete RCT included 1. complete absence of rotator cuff (RC); 2. focal thinning of RC; 3. focal hypoechoic cleft of RC; 4. focal depression of RC; and 5. heterogeneous hypoechoic RC with subdeltoid bursa fluid. Arthrography was performed after sonography examination on the same day. RESULTS: Among 49 complete RCTs diagnosed by sonography, 46 were proved to be complete RCT by arthrography; only 3 were false positive. In 108 patients with normal rotator cuff diagnosed by sonography, 104 had compatible results with arthrography; only 4 patients turned out to be complete RCT. The sensitivity, specificity, positive predictive values, negative predictive values and accuracy were 92%, 97.2%, 93.9%, 96.3% and 95.5%, respectively. CONCLUSIONS: HRUS can directly demonstrate the morphological changes of RC. It has a high sensitivity and specificity in the diagnosis of complete RCT, and can be used as a firstline screening modality for complete RCT in patients with chronic shoulder pain.

Adolescent↗

PubMed1995

Synovial hemangioma: imaging features in eight histologically proven cases, review of the literature, and differential diagnosis.

OBJECTIVE: This study was undertaken to describe the imaging characteristics of synovial hemangioma, with the goal of improving the disappointing rate (22%) of clinical diagnosis of this condition. A review of the literature and the differential diagnosis of intra-articular lesions, including synovial osteochondromatosis and pigmented villonodular synovitis, are also presented. PATIENTS: The subjects of the study were 8 patients (4 males, 4 females; age range: 5-47 years; mean age: 19 years) with histologically confirmed synovial hemangioma involving the knee (n = 7) or wrist (n = 1). We retrospectively examined the imaging studies performed in these patients, including plain radiography (n = 8), magnetic resonance imaging (MRI; n = 4), angiography (n = 3), arthrography (n = 2), and contrast-enhanced computed tomography (CT; n = 2). RESULTS: Plain radiographs showed a soft tissue density suggesting either joint effusion or a mass in all patients. Phleboliths and bone erosions on plain films in four patients with extra-articular soft tissue involvement pointed to the correct diagnosis. Angiography, showing fine-caliber, smooth-walled vessels, contrast pooling in dilated vascular spaces, and early visualization of venous structures, was diagnostic in two patients. Neither arthrography nor CT yielded specific enough findings. MRI was consistently effective in allowing the correct diagnosis to be made preoperatively, showing an intra-articular or juxta-articular mass of intermediate signal intensity on T1-weighted images and of high signal intensity of T2- or T2*-weighted images with low-signal channels or septa within it. A fluid-fluid level was found in two patients with a cavernous-type lesion. CONCLUSION: Despite the limited nature of this study, it shows clearly that MRI is the procedure of choice whenever an intra-articular vascular lesion such as synovial hemangioma is suspected. Nonetheless, phleboliths and evidence of extra-articular extension of plain radiographs point to angiography as an effective procedure of first resort because it can be combined with embolotherapy.

Adolescent↗

PubMed1987

High resolution computed tomography of knee menisci.

Sixty four menisci in 22 patients were examined by non-contrast high resolution computed tomography (CT). Fifty four menisci were imaged on a GE 8800 CT scanner. The other 10 were imaged on a GE 9800 CT scanner. Nineteen menisci were shown to be torn on arthrography and/or arthroscopy--12 medially and 7 laterally. The remaining menisci were normal. When the meniscal CTs were reviewed collectively by three observers without knowledge of arthrographic or arthroscopic results, sensitivity was 63%, specificity was 93%, and accuracy was 84%. Although only 10 menisci were imaged on the GE 9800 scanner, the sensitivity in this subset of scans was 83%, the specificity 100%, and the accuracy was 90%. These results suggest that noncontrast CT cannot replace arthrography or arthroscopy, but it is possible that images obtained on the GE 9800 or comparable CT scanner may be accurate enough to be used for screening of meniscal tears in selected patients.

Adult↗

PubMed2004

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale.

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band-the spiral GHL-was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images.

Aged↗

PubMed1989

The radiographic and surgical evaluation of meniscal dysfunction of the temporomandibular joint.

A retrospective study of 106 patients who underwent temporomandibular joint surgery for meniscal dysfunction was conducted. The patients were evaluated by tomography and arthrography of the temporomandibular joint and abnormalities of the hard and soft tissue structures were determined by these investigations and compared directly with the findings at surgical examination. Tomography had a high degree of correlation with bony pathology as did arthrography with meniscal displacement. The arthrogram also frequently revealed the presence of meniscal scarring associated with the head of condyle in long-standing cases, but gave an incidence of 3% false/positive findings of a perforation of the meniscus.

Adult↗

PubMed1986

Radiographic and surgical evaluation of internal derangements of the temporomandibular joint.

A prospective study of 287 patients who underwent temporomandibular surgery for disc dysfunction was conducted. The patients were evaluated by combinations of polydirectional tomography, microfocus magnification, and arthrographic radiographic modalities. Abnormalities of the hard and soft tissue structures of the joints were determined radiographically and compared with the findings of surgical examination. Polydirectional tomography and microfocus magnification compared favorably with each other, as well as in their ability to show the actual abnormalities. Arthrography had a high degree of correlation with actual pathologic disc alterations, except for the 15% incidence of false-positive findings of perforation. The combination of either polydirectional tomography or microfocus magnification with arthrography is recommended for complete evaluation of the painful temporomandibular joint that shows evidence of limited range of motion.

Adolescent↗