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Sample records for arthrography

  1. Arthrography

    Medline Plus

    Full Text Available ... Site Index A-Z Direct Arthrography Arthrography is medical imaging used to help evaluate and diagnose joint ... you are pregnant and discuss any recent illnesses, medical conditions, medications you’re taking, and allergies – especially ...

  2. Arthrography

    Medline Plus

    Full Text Available ... vessel or a nerve adjacent to the joint. Injury to these structures, however, is minimal particularly when ... be detected with conventional direct arthrography. Some joint injuries cannot be detected with conventional direct arthrography including ...

  3. Arthrography

    Medline Plus

    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos News Physician Resources Professions Site Index A-Z Direct Arthrography Arthrography is ...

  4. Arthrography

    Medline Plus

    Full Text Available ... joint. Arthrography may use computed tomography (CT) scanning, magnetic resonance imaging (MRI) or fluoroscopy – a form of real- ... methods of direct arthrography examinations may also use magnetic resonance imaging (MRI) or computed tomography (CT) following contrast ...

  5. Arthrography

    Medline Plus

    Full Text Available ... Arthrography may use computed tomography (CT) scanning, magnetic resonance imaging (MRI) or fluoroscopy – a form of real- ... of direct arthrography examinations may also use magnetic resonance imaging (MRI) or computed tomography (CT) following contrast ...

  6. Arthrography

    Medline Plus

    Full Text Available ... joint. Arthrography may use computed tomography (CT) scanning, magnetic resonance imaging (MRI) or fluoroscopy – a form of real-time x- ... methods of direct arthrography examinations may also use magnetic resonance imaging (MRI) or computed tomography (CT) following contrast material ...

  7. Arthrography

    Medline Plus

    Full Text Available ... injected into the joint. Arthrography may use computed tomography (CT) scanning, magnetic resonance imaging (MRI) or fluoroscopy – ... also use magnetic resonance imaging (MRI) or computed tomography (CT) following contrast material injection into the joint. ...

  8. Arthrography

    Medline Plus

    Full Text Available ... conventional direct arthrography and may be supplemented by air to produce a double contrast CT arthrogram. CT ... tissue shows up in shades of gray and air appears black. Until recently, x-ray images were ...

  9. Arthrography

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    Full Text Available ... No special preparation is necessary before direct arthrography. Food and fluid intake do not need to be ... to iodine or x-ray contrast material, drugs, food, or environmental agents. However, the contrast material used ...

  10. Arthrography

    Medline Plus

    Full Text Available ... top of page What are the benefits vs. risks? Benefits Direct arthrography is particularly effective for detecting ... used for conventional x-rays and CT scanning. Risks Any procedure where the skin is penetrated carries ...

  11. Arthrography

    Medline Plus

    Full Text Available ... current x-ray images for diagnosis and disease management. Fluoroscopy uses a continuous or pulsed x-ray ... top of page What are the benefits vs. risks? Benefits Direct arthrography is particularly effective for detecting ...

  12. Arthrography

    Medline Plus

    Full Text Available ... CT arthrography and have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your ... and sometimes air are injected into the joint space while the radiologist observes with fluoroscopy or ultrasound. ...

  13. Arthrography

    Medline Plus

    Full Text Available ... over time. top of page What are the benefits vs. risks? Benefits Direct arthrography is particularly effective for detecting disease ... cancer from excessive exposure to radiation. However, the benefit of an accurate diagnosis far outweighs the risk. ...

  14. Arthrography

    Medline Plus

    Full Text Available ... over time. top of page What are the benefits vs. risks? Benefits Direct arthrography is particularly effective for detecting disease ... evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology ...

  15. Arthrography

    Medline Plus

    Full Text Available ... and cartilage. It may be indirect, where contrast material is injected into the bloodstream, or direct, where contrast material is injected into the joint. Arthrography may use ...

  16. Arthrography

    Medline Plus

    Full Text Available ... guide the procedure. Alternate methods of direct arthrography examinations may also use magnetic resonance imaging (MRI) or ... the injection is typically monitored by fluoroscopy, the examination also commonly involves taking radiographs for documentation. The ...

  17. Arthrography

    Medline Plus

    Full Text Available ... your procedure. top of page What does the equipment look like? The equipment typically used for this examination consists of a ... in a separate room from the scanner. Other equipment necessary for performing arthrography include a variety of ...

  18. Arthrography

    Medline Plus

    Full Text Available ... true for the shoulder in the setting of shoulder dislocation and in the hip, wrist and elbow. Exams involving x-ray imaging: No radiation remains in a patient's body after an x-ray ... Images related to Direct Arthrography Videos related to ...

  19. Arthrography

    Medline Plus

    Full Text Available ... had surgery. Some conditions, such as severe kidney disease, may prevent you from being given contrast material for having an MRI. If you are scheduled to have MR or CT arthrography and have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician about ...

  20. Arthrography of the ankle

    International Nuclear Information System (INIS)

    Arthrography was performed in 105 cases with freshly sprained ankles and signs of rupture of the anterior talofibular ligament. They were subsequently operated upon. The arthrographic films were examined retrospectively to assess the value of different criteria for the differential diagnosis between rupture of the anterior talofibular ligament and combined rupture of this and the calcaneofibular ligament. The diagnostic value of arthrography was found to be high in isolated rupture of the anterior talofibular ligament, and is acceptable in the combined ruptures. (Auth.)

  1. Arthrography of the ankle

    International Nuclear Information System (INIS)

    As part of a clinical prospective investigation 102 patients with fresh ankle injuries underwent ankle arthrography and surgery for rupture of the lateral ligaments of the ankle. Three hypotheses concerning the improvement of the arthrographic diagnosis of rupture of the calcaneofibular ligament were tested. Two were rejected. Improvement in the diagnostic specificity was possible by combining arthrography with a stress inversion test, but the sensitivity of this combination was low. It was demonstrated that absence of peroneus sheath filling was a better diagnostic sign with good rather than with poor recess filling. (Auth.)

  2. Arthrography of the ankle joint

    Energy Technology Data Exchange (ETDEWEB)

    Crespi Porro, R.; Zellner, A.; Puricelli, G.; Quaglia, R.; Chelazzi, G.

    1984-02-01

    Arthrography of the ankle joint was first carried out by Johnson and Palmer at the Military Hospital in Stockholm in 1940. Arthrography can be used for judging the integrity of the articular cartilage, of osteochondritis dissecans, arthritis or adhesive capsulitis. The literature shows, however, that more than 95% of the patients on whom this examination has been performed has suffered from acute trauma.

  3. Arthrography of the ankle sprains

    International Nuclear Information System (INIS)

    Ankle arthrography, by direct puncture of joint cavity, is considered to be a simple and accurate diagnostic method for a precise evaluation of ligamentous injury. Forty-seven cases of ankle arthrography were successively performed in the patients of acute ankle sprains. The purpose of this study is to demonstrate how ankle arthrography can delineate the pathologic anatomy in such cases. The results are as follows: 1. Thirty cases among forty seven revealed the findings of ligament tears. 2. For better diagnostic accuracy, the arthrography should be performed within 72 hrs. after injury. 3. The anterior talofibular ligament tears were the most common (twenty-nine cases) of all and seventeen of them revealed tears without association of any other ligament tears. 4. There were ten cases of calcaneofibular ligament tears and nine of them were associated with anterior talofibular ligament tears. 5. Three cases of anterior tibiofibular and one deltoid ligament tears were demonstrated

  4. Direct MR arthrography of plica synovialis mediopatellaris

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Y.; Murakami, R.; Yamamoto, K.; Ichikawa, T. [Tama-Nagayama Hospital, Nippon Medical School (Japan). Dept. of Radiology; Tajima, H.; Kumazaki, T. [Nippon Medical School Hospital, Tokyo (Japan). Dept. of Radiology; Mase, Y. [Tama-Nagayama Hospital, Nippon Medical School (Japan). Dept. of Orthopedic Surgery

    2001-05-01

    Objective: To evaluate the efficacy of direct MR arthrography for diagnosing plica synovialis mediopatellaris (PSM). Material and Methods: Twenty-two knees of 19 patients were examined by direct MR arthrography. In 19 of those knees, field-echo T2*-weighted transaxial images were obtained with intra-articular administration of 40 ml of saline (direct MR arthrography). In the other 3 knees, T1-weighted transaxial images were obtained with intra-articular administration of 40 ml of gadopentetate dimeglumine. Conventional MR images were evaluated prior to direct MR arthrography in 12 of the 22 knees. The results of direct MR arthrography and conventional MR imaging were compared with the arthroscopic findings. Results: Direct MR arthrography demonstrated 17 of 19 PSMs proved on arthroscopy. The features of 16 PSMs on direct MR arthrography corresponded accurately with the arthroscopic classification. Conventional MR demonstrated only 3 plicae. Conclusion: Direct MR arthrography enabled accurate diagnosis of PSMs and could replace diagnostic arthroscopy.

  5. Arthrography of the knee joint

    Energy Technology Data Exchange (ETDEWEB)

    Keyl, W.; Jaeger, M.

    1981-10-01

    The standardized examination technique and the clinical problems of the arthrographic mehtod applied on the knee joint is explained by the results obtained in 3000 examinations. Whereas the accuracy of the knee-joint arthrography provides a high degree in cases of meniscus lesions, computer tomography presents in chondral and capsular ligament lesions, and sonography in popliteal cysts better diagnostic information; but in any case arthroscopy gains more and more importance in knee-joint diagnostics.

  6. Arthrography of the equine shoulder joint

    International Nuclear Information System (INIS)

    Techniques and normal radiographic anatomy for positive and double contrast shoulder arthrography in horses were evaluated. General anaesthesia was used for most radiographic projections of the shoulder. The mediolateral projection provided the most information during arthrography, although the supinated mediolateral view occasionally allowed better definition of the cartilage surfaces on the medial aspects of the humeral head. The craniocaudal mediolateral oblique and caudocranial projections provided limited additional information. Water soluble non-ionic contrast agents, such as metrizamide and iohexol, were suitable for shoulder arthrography; iohexol resulted in less synovitis and lameness. Arthrography in cases of osteochondrosis and osteochondritis dissecans allowed better evaluation of cartilage attachment to subchondral bone, better evaluation of the length and depth of cartilage lesions and more accurately defined the site and shape of osteocartilaginous free bodies. Cartilage thickening without detachment from the subchondral bone could only be determined by arthrography. Although these thick cartilage regions may later dissect from the subchondral bone, most cases where the cartilage was firmly adherent were not candidates for surgical debridement and carried a favourable prognosis. The determination of a free flap by arthrography indicated the need for surgery. Extensive humeral and glenoid cavity lesions were better defined by arthrography, allowing a rational decision between surgical debridement or euthanasia. Using arthrography, evaluation of the size and patency of the communicating canal to a subchondral cystic defect better separated cases with long, narrow and poorly patent canals for conservative rather than surgical therapy

  7. Shoulder distention arthrography as a treatment modality

    International Nuclear Information System (INIS)

    18 patients with painful stiff shoulder joint were underwent shoulder distension arthrography as a treatment modality, followed by physical therapy. Range of motion of shoulder joint was evaluated at 1 week and 4 weeks after arthrography. The results were as follows; 1. Arthrographic findings were decreased volume of joint cavity, obliteration of axillary recess, small subscapularis bursa, serrated capsular margin and non-filling of biceps tendon sheath. In 3 cases, rotator cuff tear was found. 2. Range of motion of shoulder joint was improved after distension arthrography. 3. In 3 patients have rotator cuff tear, range of motion was not improved

  8. Multidetector spiral CT arthrography of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Lecouvet, Frederic E. [Departments of Radiology and Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Hippocrate Avenue 10/2942, 1200 Brussels (Belgium)], E-mail: frederic.lecouvet@uclouvain.be; Simoni, Paolo; Koutaissoff, Sophie; Vande Berg, Bruno C.; Malghem, Jacques; Dubuc, Jean-Emile [Departments of Radiology and Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Hippocrate Avenue 10/2942, 1200 Brussels (Belgium)

    2008-10-15

    Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings.

  9. MR arthrography of the ankle joint

    International Nuclear Information System (INIS)

    Due to its superior soft tissue contrast conventional MRI is the imaging method of choice in the evaluation of ankle joint disorders. Conventional MR imaging can accurately demonstrate normal or acutely injured ligaments; however, in subacute and chronic injury joint fluid necessary for delineation of injured ligaments is absent and MR arthrography should be performed. MR arthrography uses the intraarticular injection of contrast material to distend the joint, yielding improved discrimination of intraarticular structures. This joint distension with MR arthrography is also helpful in the staging of osteochondritis dissecans, since in cases of unstable lesions tracking of contrast material into the interface can be more easily demonstrated. Finally, high contrast and joint distension by MR arthrography improves the detection of intraarticular loose bodies, which often require surgery. MR artrography, although invasive, may provide additional information in various ankle joint disorders. (orig.)

  10. Multidetector spiral CT arthrography of the shoulder

    International Nuclear Information System (INIS)

    Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings

  11. Anterior approach for knee arthrography

    International Nuclear Information System (INIS)

    Objective. To develop a new method of magnetic resonance arthrography (MRA) of the knee using an anterior approach analogous to the portals used for knee arthroscopy.Design. An anterior approach to the knee joint was devised mimicking anterior portals used for knee arthroscopy. Seven patients scheduled for routine knee MRA were placed in a decubitus position and under fluoroscopic guidance a needle was advanced from a position adjacent to the patellar tendon into the knee joint. After confirmation of the needle tip location, a dilute gadolinium solution was injected.Results and conclusion. All the arthrograms were technically successful. The anterior approach to knee MRA has greater technical ease than the traditional approach with little patient discomfort. (orig.)

  12. Arthrography

    Medline Plus

    Full Text Available ... do not need to be restricted, unless a sedative will be given. You should inform your physician ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ...

  13. Arthrography

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    Full Text Available ... a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. ... Dense bone absorbs much of the radiation while soft tissue, such as muscle, fat and organs, allow more ...

  14. Arthrography

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    Full Text Available ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed regularly by a physician with ... not responsible for the content contained on the web pages found at these links. About Us | Contact ...

  15. Arthrography

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    Full Text Available ... Contact your doctor if they persist after two days. Vigorous exercise is not recommended for at least ... your level of joint discomfort over the following days or weeks. This information may be helpful to ...

  16. Arthrography

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    Full Text Available ... ear) implant some types of clips used for brain aneurysms some types of metal coils placed within ... may distort images of the facial area or brain, so the radiologist should be aware of them. ...

  17. Arthrography

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    Full Text Available ... material directly into the joint. In some cases, ultrasound may be used to guide the procedure. Alternate ... imaging modalities such as x-ray, CT and ultrasound. top of page How is the procedure performed? ...

  18. Arthrography

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    Full Text Available ... imaging (MRI) or fluoroscopy – a form of real-time x-ray. Your preparation may vary depending on ... Some implanted devices require a short period of time after placement (usually six weeks) before being safe ...

  19. Arthrography

    Science.gov (United States)

    ... the skin around the joint is cleansed with antiseptic and is often covered with a sterile surgical ... period is necessary. You may resume your usual activities and normal diet immediately after the exam. On ...

  20. Arthrography

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    Full Text Available ... a comment, please complete the following form: Comment: E-mail: Area code: Phone no: Images × Image Gallery ... Recommend RadiologyInfo to a friend Send to (friend's e-mail address): From (your name): Your e-mail ...

  1. Arthrography

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    Full Text Available ... iodine and is less likely to cause side effects or an allergic reaction. The radiologist should also ... the area. After the local anesthetic has taken effect, a longer needle is then inserted into the ...

  2. Arthrography

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    Full Text Available ... will be asked to maintain your position without movement as much as possible. You will usually be ... update the technique standards used by radiology professionals. Modern x-ray systems have very controlled x-ray ...

  3. Arthrography

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    Full Text Available ... magnetic field is not harmful in itself, implanted medical devices that contain metal may malfunction or cause problems during an MRI exam. Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of ... is not a medical facility. Please contact your physician with specific medical ...

  4. Arthrography

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    Full Text Available ... in order to hold still for the procedure. Parents should ask about this beforehand and be made ... intercom. Many MRI centers allow a friend or parent to stay in the room as long as ...

  5. Arthrography

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    Full Text Available ... like a photographic negative). Today, most images are digital files that are stored electronically. These stored images ... standards used by radiology professionals. Modern x-ray systems have very controlled x-ray beams and dose ...

  6. Arthrography

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    Full Text Available ... through the body, recording an image on photographic film or a special detector. Different parts of the ... recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most ...

  7. Arthrography

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    Full Text Available ... discomfort. In some cases, local anesthetic medications or steroids may be injected into the joint along with ... some cases, additional medications, such as anti-inflammatory steroids, may be injected into the joint along with ...

  8. Arthrography

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    Full Text Available ... ionizing radiation. Instead, radio waves redirect alignment of hydrogen atoms that naturally exist within the body while ... any chemical changes in the tissues. As the hydrogen atoms return to their usual alignment, they emit ...

  9. Arthrography

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    Full Text Available ... the sides (open MRI). Open units are especially helpful for examining larger patients or those with claustrophobia. ... following days or weeks. This information may be helpful to your physician in determining the causes of ...

  10. Arthrography

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    Full Text Available ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ... very rare occasions, a few patients experience side effects from the contrast material, including nausea and local ...

  11. Arthrography

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    Full Text Available ... atoms return to their usual alignment, they emit energy that varies according to the type of body ... which they come. The MR scanner captures this energy and creates a picture of the tissues scanned ...

  12. Arthrography

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    Full Text Available ... clothing that might interfere with the x-ray images. Women should always inform their physician and x-ray ... of which shows a thin slice of the body. The images can then be studied from different angles by ...

  13. Arthrography

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    Full Text Available ... magnetic field of the MRI unit, metal and electronic items are not allowed in the exam room. ... tell the technologist if you have medical or electronic devices in your body. These objects may interfere ...

  14. Arthrography

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    Full Text Available ... or x-ray contrast material, drugs, food, or environmental agents. However, the contrast material used for an ... are also screened for safety in the magnetic environment. Children will be given appropriately sized earplugs or ...

  15. Arthrography

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    Full Text Available ... pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to ... See the Safety page for more information about pregnancy and x-rays. Though MRI does not use ...

  16. Arthrography

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    Full Text Available ... the exam. On very rare occasions, a few patients experience side effects from the contrast material, including nausea and local pain. Similarly, patients are very rarely allergic to the contrast material ...

  17. Arthrography

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    Full Text Available ... related pain or inflammation and provide physicians additional information about possible sources of joint pain. top of ... the baby. See the Safety page for more information about pregnancy and x-rays. Though MRI does ...

  18. Arthrography

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    Full Text Available ... of some joints, bruising of neighboring bones and injuries to ligaments outside the joint. top of page This page was reviewed on June 10, 2015 ... View full size with caption Pediatric Content ...

  19. Arthrography

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    Full Text Available ... a physician specially trained to supervise and interpret radiology examinations, will often use fluoroscopy or ultrasound to ... a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a ...

  20. Arthrography

    Medline Plus

    Full Text Available ... claustrophobia. Newer open MRI units provide very high quality images for many types of exams; however, older ... MRI units may not provide this same image quality. Certain types of exams cannot be performed using ...

  1. Arthrography

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    Full Text Available ... images for evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology professionals. Modern x-ray systems have very controlled x-ray beams and dose ...

  2. Arthrography

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    Full Text Available ... include a variety of needles, syringes and a water-soluble contrast material. top of page How does ... have very controlled x-ray beams and dose control methods to minimize stray (scatter) radiation. This ensures ...

  3. Arthrography

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    Full Text Available ... which may be sent to a laboratory for analysis. Aspiration is typically performed when an infection is ... images for evaluation. National and international radiology protection organizations continually review and update the technique standards used ...

  4. Arthrography

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    Full Text Available ... imaging small internal structures, thus allowing for better evaluation of diseases or conditions within the joint. It ... joint and becomes clearly visible during x-ray evaluation, allowing the radiologist to assess the anatomy and ...

  5. Arthrography

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    Full Text Available ... medical imaging. Fluoroscopy makes it possible to see bones, joints and internal organs in motion. When iodine ... within the joint, such as cartilage, ligaments and bones, and allows them to be evaluated by the ...

  6. Arthrography

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    Full Text Available ... radiologist should also know if you have any serious health problems or if you have recently had surgery. Some conditions, such as severe kidney disease, may prevent you from being given contrast material ...

  7. Arthrography

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    Full Text Available ... Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos News Physician ... minimize radiation exposure to the baby. See the Safety page for more information about pregnancy and x- ...

  8. Arthrography

    Medline Plus

    Full Text Available ... You may apply ice to the joint to reduce swelling if it is bothersome. A mild over-the-counter analgesic can be taken for pain. These symptoms usually disappear after 48 hours. Contact ...

  9. Arthrography

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    Full Text Available ... and send a signed report to your primary care or referring physician , who will discuss the results ... assistance. A Word About Minimizing Radiation Exposure Special care is taken during x-ray examinations to use ...

  10. Arthrography

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    Full Text Available ... which may be sent to a laboratory for analysis. Aspiration is typically performed when an infection is ... possible charges you will incur. Web page review process: This Web page is reviewed regularly by a ...

  11. Arthrography

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    Full Text Available ... a powerful magnetic field, radiofrequency pulses and a computer to produce detailed pictures of organs, soft tissues, ... The images can then be examined on a computer monitor, printed or copied to CD. MRI does ...

  12. Arthrography

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    Full Text Available ... types of clips used for brain aneurysms some types of metal coils placed within blood vessels nearly all cardiac defibrillators and pacemakers You should tell the technologist if you have medical or electronic devices in your ... quality images for many types of exams; however, older open MRI units may ...

  13. Arthrography

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    Full Text Available ... allergies – especially to contrast materials. Leave jewelry at home and wear loose, comfortable clothing. You may be ... Jewelry and other accessories should be left at home if possible, or removed prior to the MRI ...

  14. Arthrography

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    Full Text Available ... Radiology (ACR) and the Radiological Society of North America (RSNA), comprising physicians with expertise in several radiologic ... Site Map Copyright © 2016 Radiological Society of North America, Inc. (RSNA). To help ensure current and accurate ...

  15. Arthrography

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    Full Text Available ... evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology ... the possible charges you will incur. Web page review process: This Web page is reviewed regularly by ...

  16. Arthrography

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    Full Text Available ... the causes of chronic joint pain and what therapies may be effective. It is also recommended that ... vessel or a nerve adjacent to the joint. Injury to these structures, however, is minimal particularly when ...

  17. Arthrography

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    Full Text Available ... a form of radiation like light or radio waves. X-rays pass through most objects, including the ... does not utilize on ionizing radiation. Instead, radio waves redirect alignment of hydrogen atoms that naturally exist ...

  18. Arthrography

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    Full Text Available ... X-rays are a form of radiation like light or radio waves. X-rays pass through most ... pressure or even pain when the needle is advanced into the joint. Inform the radiologist performing the ...

  19. Arthrography

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    Full Text Available ... of joint pain. top of page How should I prepare? No special preparation is necessary before direct ... than one hour. top of page What will I experience during and after the procedure? You will ...

  20. Arthrography

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    Full Text Available ... the body absorb the x-rays in varying degrees. Dense bone absorbs much of the radiation while ... is further reviewed by committees from the American College of Radiology (ACR) and the Radiological Society of ...

  1. Arthrography

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    Full Text Available ... of gray and air appears black. Until recently, x-ray images were maintained as hard film copy (much like a photographic negative). Today, most images are digital files that are stored electronically. These stored images ... x-ray images for diagnosis and disease management. Fluoroscopy uses ...

  2. Arthrography

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    Full Text Available ... allergy to iodine or x-ray contrast material, drugs, food, or environmental agents. However, the contrast material ... are not limited to: artificial heart valves implanted drug infusion ports artificial limbs or metallic joint prostheses ...

  3. Arthrography

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    Full Text Available ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ... imaging: There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit ...

  4. Arthrography

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    Full Text Available ... material. top of page How does the procedure work? X-rays are a form of radiation like ... Contact your doctor if they persist after two days. Vigorous exercise is not recommended for at least ...

  5. Arthrography

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    Full Text Available ... a table on which the patient lies. The traditional MRI unit is a large cylinder-shaped tube ... the causes of chronic joint pain and what therapies may be effective. It is also recommended that ...

  6. Arthrography

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    Full Text Available ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ... the causes of chronic joint pain and what therapies may be effective. It is also recommended that ...

  7. Arthrography

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    Full Text Available ... during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review and update the technique standards ...

  8. Arthrography

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    Full Text Available ... physician and technologist if they may be pregnant. Children younger than teenagers may need to be sedated ... also screened for safety in the magnetic environment. Children will be given appropriately sized earplugs or headphones ...

  9. Arthrography

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    Full Text Available ... information, consult your radiologist. The computer workstation that processes the imaging information is located in a separate ... in contact with the patient. A computer then processes the signals and generates a series of images, ...

  10. Arthrography

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    Full Text Available ... the area being examined by making it appear dark (or by electronically reversing the image contrast to ... understanding of the possible charges you will incur. Web page review process: This Web page is reviewed ...

  11. Arthrography

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    Full Text Available ... if they may be pregnant. Children younger than teenagers may need to be sedated in order to ... imaging: There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit ...

  12. Arthrography

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    Full Text Available ... MRI scanners are air-conditioned and well-lit. Music may be played through the headphones to help ... evaluation. National and international radiology protection organizations continually review and update the technique standards used by radiology ...

  13. Arthrography

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    Full Text Available ... of the radiation while soft tissue, such as muscle, fat and organs, allow more of the x- ... the area. After the local anesthetic has taken effect, a longer needle is then inserted into the ...

  14. Arthrography

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    Full Text Available ... imaging: There is always a slight chance of cancer from excessive exposure to radiation. However, the benefit ... physician. To locate a medical imaging or radiation oncology provider in your community, you can search the ...

  15. Arthrography

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    Full Text Available ... include a variety of needles, syringes and a water-soluble contrast material. top of page How does ... injection. If you have not been sedated, no recovery period is necessary. You may resume your usual ...

  16. Arthrography

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    Full Text Available ... other physician will be available for immediate assistance. A Word About Minimizing Radiation Exposure Special care is ... encourage linking to this site. × Recommend RadiologyInfo to a friend Send to (friend's e-mail address): From ( ...

  17. Arthrography

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    Full Text Available ... should also know if you have any serious health problems or if you have recently had surgery. ... and send a signed report to your primary care or referring physician , who will discuss the results ...

  18. Arthrography

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    Full Text Available ... imaging (MRI) or computed tomography (CT) following contrast material injection into the joint. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. ...

  19. Arthrography

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    Full Text Available ... As a result, bones appear white on the x-ray, soft tissue shows up in shades of gray and air appears black. Until recently, x-ray images were maintained on large film sheets (much ...

  20. Arthrography

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    Full Text Available ... MRI centers allow a friend or parent to stay in the room as long as they are also screened for safety in the magnetic environment. Children will be given appropriately sized earplugs or headphones ...

  1. Arthrography

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    Full Text Available ... your doctor if there’s a possibility you are pregnant and discuss any recent illnesses, medical conditions, medications ... if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy ...

  2. Arthrography

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    Full Text Available ... include a variety of needles, syringes and a water-soluble contrast material. top of page How does ... current x-ray images for diagnosis and disease management. Fluoroscopy uses a continuous or pulsed x-ray ...

  3. Arthrography

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    Full Text Available ... the magnet. Some MRI units, called short-bore systems , are designed so that the magnet does not ... standards used by radiology professionals. Modern x-ray systems have very controlled x-ray beams and dose ...

  4. Arthrography

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    Full Text Available ... doctor if they persist after two days. Vigorous exercise is not recommended for at least 24 hours ... is also recommended that you refrain from vigorous exercise of the joint for about two weeks. top ...

  5. Arthrography

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    Full Text Available ... current x-ray images for diagnosis and disease management. Fluoroscopy uses a continuous or pulsed x-ray ... and send a signed report to your primary care or referring physician , who will discuss the results ...

  6. Arthrography

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    Full Text Available ... This page was reviewed on June 10, 2015 Send us your feedback Did you find the information ... to this site. × Recommend RadiologyInfo to a friend Send to (friend's e-mail address): From (your name): ...

  7. Arthrography

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    Full Text Available ... items, which can distort MRI images removable dental work pens, pocket knives and eyeglasses body piercings In most cases, an MRI exam is safe for patients with metal implants, except for a ...

  8. Arthrography

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    Full Text Available ... most often used to identify abnormalities within the: shoulder elbow wrist hip knee ankle The procedure is also used to help diagnose persistent, unexplained joint pain or discomfort. In some cases, local anesthetic medications ...

  9. Arthrography

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    Full Text Available ... MRI) or fluoroscopy – a form of real-time x-ray. Your preparation may vary depending on which imaging ... a joint often uses a special form of x-ray called fluoroscopy to guide and evaluate the injection ...

  10. Arthrography

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    Full Text Available ... allowing the radiologist to assess the anatomy and function of the joint. Although the injection is typically ... images help physicians evaluate alterations in structure and function of a joint and help to determine the ...

  11. Arthrography

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    Full Text Available ... evaluate and diagnose joint conditions and unexplained pain. It is very effective at detecting disease within the ligaments, tendons and cartilage. It may be indirect, where contrast material is injected ...

  12. Arthrography

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    Full Text Available ... Foreign bodies near and especially lodged in the eyes are particularly important. Dyes used in tattoos may ... be asked to remove jewelry, removable dental appliances, eye glasses and any metal objects or clothing that ...

  13. Arthrography

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    Full Text Available ... are also screened for safety in the magnetic environment. Children will be given appropriately sized earplugs or ... dose possible while producing the best images for evaluation. National and international radiology protection organizations continually review ...

  14. Patient perception of magnetic resonance arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Robbins, M.I.; Anzilotti, K.F. Jr.; Katz, L.D.; Lange, R.C. [Dept. of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT (United States)

    2000-05-01

    Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients' perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection.Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including ''pain'', ''needles'', ''complications'', and ''discovery of results that would lead to surgery''. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain.Results. While many patients expressed fear of ''pain'' and ''needles'', after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected.Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort. (orig.)

  15. MR arthrography of the ankle joint; MR-Arthrographie des Sprunggelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S.; Rand, T.; Breitenseher, M.; Ba-Ssalamah, A.; Schick, S.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, AKH-Wien (Austria)

    1999-01-01

    Due to its superior soft tissue contrast conventional MRI is the imaging method of choice in the evaluation of ankle joint disorders. Conventional MR imaging can accurately demonstrate normal or acutely injured ligaments; however, in subacute and chronic injury joint fluid necessary for delineation of injured ligaments is absent and MR arthrography should be performed. MR arthrography uses the intraarticular injection of contrast material to distend the joint, yielding improved discrimination of intraarticular structures. This joint distension with MR arthrography is also helpful in the staging of osteochondritis dissecans, since in cases of unstable lesions tracking of contrast material into the interface can be more easily demonstrated. Finally, high contrast and joint distension by MR arthrography improves the detection of intraarticular loose bodies, which often require surgery. MR artrography, although invasive, may provide additional information in various ankle joint disorders. (orig.) [Deutsch] Aufgrund des ausgezeichneten Weichteilkontrastes ist die konventionelle MRT die bildgebende Methode der Wahl in der Beurteilung von Sprunggelenkserkrankungen. Die konventionelle MRT kann zuverlaessig normale und akut verletzte Ligamente darstellen. Im subakuten und chronischen Stadium der Verletzung fehlt jedoch oft die Gelenksfluessigkeit die fuer eine exakte Abgrenzung der verletzten Ligamente notwendig ist. Die MR-Arthrographie sollte in diesen Faellen durchgefuehrt werden, da die intraartikulaere KM-Applikation den Gelenksraum distendiert mit verbesserter Unterscheidbarkeit intraartikulaerer Strukturen. Diese Gelenksdistension mit der MR-Arthrographie ist auch in der Stadiumbeurteilung der Osteochondritis dissecans hilfreich, da in Faellen von instabilen Laesionen eine KM-Umspuelung des Dissekats leichter dargestellt werden kann. Schliesslich verbessert die MR-Arthrographie aufgrund des hohen Kontrastes und der Gelenksdistension auch den Nachweis von

  16. MR and CT arthrography of the wrist.

    Science.gov (United States)

    Cerezal, Luis; de Dios Berná-Mestre, Juan; Canga, Ana; Llopis, Eva; Rolon, Alejandro; Martín-Oliva, Xavier; del Piñal, Francisco

    2012-02-01

    The study of the wrist represents a major diagnostic challenge because of its complex anatomy and the small size of individual structures. Recent advances in imaging techniques have increased our diagnostic capabilities. However, 3T magnets, multichannel specific wrist coils, and new MRI sequences have not restricted the indications of arthrographic imaging techniques (CT arthrography and MR arthrography). Distension of the different wrist compartments at CT arthrography and MR arthrography significantly improves the diagnostic accuracy for triangular fibrocartilage (TFC) complex injuries and carpal instability. Dedicated multichannel wrist coils are essential for an adequate study of the wrist, but the placement of these coils and the positioning of the wrist are also important for proper diagnosis. The development of dynamic multislice CT studies allows a diagnostic approach that combines dynamic information and the accurate assessment of ligaments and the TFC complex. New advances in arthroscopy have changed the anatomical description of the TFC with a functional division in the proximal and distal TFC complex, and they have allowed a better characterization of lesions of the TFC complex with subclassification of Palmer 1B and 1D lesions and description of new lesions not included in the Palmer classification, such as capsular injuries. PMID:22447235

  17. A Simple Technique for Shoulder Arthrography

    International Nuclear Information System (INIS)

    Purpose: To present a systematic approach to teaching a technique for arthrography of the shoulder. Using an adhesive marker-plate with radiopaque coordinates, precise sites for puncture can be identified and the need for fluoroscopic guidance obviated. Material and Methods: Forty-six glenohumeral arthrograms were performed in 45 patients; in 1 case involving examination of both shoulders. The stages of the technique are described in detail, as are the fundamental aspects of achieving an effective glenohumeral injection. Pain intensity was measured in all patients using a verbal description scale. Results: Shoulder arthrography was successful in all cases. Average time taken for the procedure was 7 min, with no difference in the respective times required by an experienced radiologist and a resident. The procedure was well tolerated by most patients, with slight discomfort being observed in a very few cases. Conclusion: The arthrographic technique used in this study is simple, safe, rapid, and reproducible, and has the advantage of precise localization of the site for puncture without need for fluoroscopic guidance. The procedure described in this study can be of help in teaching residents and can reduce the learning curve for radiologists with no experience in arthrographic methods. It also reduces the time of exposure to fluoroscopy Keywords: Arthrography, joint, shoulder

  18. Tears of the Supraspinatus Tendon: Assessment with Indirect Magnetic Resonance Arthrography in 67 Patients with Arthroscopic Correlation

    NARCIS (Netherlands)

    P. van Dyck; J.L. Gielen; J. Veryser; J. Weyler; F.M. Vanhoenacker; F. van Glabbeek; W. de Weerdt; M. Maas; H.J. van der Woude; P.M. Parizel

    2009-01-01

    Background: Magnetic resonance (MR) arthrography is generally regarded as the gold standard for shoulder imaging. As an alternative to direct MR arthrography, the less invasive indirect MR arthrography technique was proposed, offering logistic advantages because fluoroscopic or ultrasonographic guid

  19. Arthrography in sport injuries of the knee joint

    International Nuclear Information System (INIS)

    The arthrography is one of the most important diagnostic methods of sport injuries of the knee joint. The examination must give an exact information to the surgeon; a good technique and standard X-rays are an absolute postulate. The submitted examinations are based on 6687 arthrographies during a period of 5 years. The arthrography should not be carried out before the acute symptomatology has ceased, usually after an interval of 2-3 weeks. Most frequently are the meniscus injuries by rotary traumas of the knee-joint. Football as the most popular sport is responsible for more than 50% of the injuries, followed by skiing, handball and jogging. (orig.)

  20. Diagnosis of triangular fibrocartilage complex injury using arthrography and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Kiyonobu; Soejima, Osamu; Naito, Masatoshi [Fukuoka Univ. (Japan). School of Medicine

    2001-09-01

    Twenty patients (twenty-one wrists) with chronic ulnar wrist pain who had undergone radiocarpal arthrography and MRI before arthroscopic examination were evaluated to determine the usefulness of these preoperative diagnostic procedures (arthrogrphy and MRI) for the detection of triangular fibrocartilage complex (TFCC) injury. Based on the arthroscopic findings, the sensitivity and specificity of arthrography were 63% and 100% respectively for detecting TFCC lesions, while they were 68% and 50% respectively for MRI. Although no significant superiority was observed between arthrography and MRI in this study, further improrumchts in the preoperative diagnostic procedures are still needed in order to more accurately detect TFCC injuries. (author)

  1. A Severe Case of Arthrographis kalrae Keratomycosis

    Directory of Open Access Journals (Sweden)

    Siti Roszilawati Ramli

    2013-01-01

    Full Text Available A 52-year-old man with diabetes developed a unilateral central corneal ulcer after accidental foreign body inoculation. He complained of pain and loss of visual acuity in the injured eye, which displayed redness and edema and eventually discharged pus. A corneal scraping from the left eye orbit revealed fungal elements, and cultures of the material grew a fungus. The isolate was identified as Arthrographis kalrae based on gross and microscopic morphologies. The patient received amphotericin B intravenously and itraconazole orally. The wound healed following surgical intervention, but the patient lost the use of his left eye.

  2. Arthrography of the ankle joint in chronic instability

    International Nuclear Information System (INIS)

    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. (orig.)

  3. Arthrography of the ankle joint in chronic instability

    Energy Technology Data Exchange (ETDEWEB)

    Dory, M.A.

    1986-05-01

    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.

  4. The significance of preoperative shoulder arthrography in painful arc patients

    International Nuclear Information System (INIS)

    Preoperative shoulder arthrography was performed on 34 patients with painful arc syndromes. Rotator cuff rupture was diagnosed in 20 cases. Out of these the arthrography correctly showed rupture in 17 cases, while in one case rupture was not seen and two examinations were unsuccessful. Rotator cuff rupture was found in 14 cases at operation. Of these, arthrography had been negative in eight cases and in six cases the rupture had merely been suspected. Sensitivity of shoulder arthrography in showing rotator cuff rupture was thus 85%, specificity 57% and accuracy 74%. The biceps tendon was intact in all cases with rotator cuff rupture. S-called ''bicipital leakage'' was seen in four cases, but its significance remains unclear. (orig.)

  5. Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations.

    Science.gov (United States)

    Lecouvet, Frédéric E; Simoni, Paolo; Koutaïssoff, Sophie; Vande Berg, Bruno C; Malghem, Jacques; Dubuc, Jean-Emile

    2008-10-01

    Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings.

  6. Combined nuclear and digital subtraction contrast arthrography in painful knee prosthesis

    International Nuclear Information System (INIS)

    The evaluation of a painful knee prosthesis remains a difficult problem for both orthopaedic surgeons and radiologists. We have compared digital subtraction arthrography with nuclear-arthrography in 7 patients with a painful knee prosthesis. Three patients showed a loose tibial component, demonstrated by both digital subtraction and nuclear arthrography. All 3 underwent revision of their prosthesis. One patient had an equivocal digital subtraction arthrogram and negative nuclear arthrogram, while both studies were negative in the 3 remaining patients. Nuclear arthrography is a simple procedure and can provide useful additional information when combined with digital subtraction arthrography. (orig.)

  7. Epinephrine enhanced double contrast knee arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jae Mun; Choi, Byung Ihn [Capital Armed Forces General Hospital, Seoul (Korea, Republic of)

    1981-12-15

    It is well known that double contrast knee arthrography is useful in diagnosis of meniscal lesion and other knee pathology. But intra-articular structures become less well delineated shortly after injection into the knee joint with water soluble contrast media because of rapid absorption and dilution of the injected media. This limits the time when sharply detailed arthrograms are obtained and precludes repeat delayed arthrogram without reinjection of contrast media. In order to overcome this major disadvantage, the authors used epinephrine which has vasoconstrictive effect and is expected to reduce fluid movement across the synovial membrane temporarily. The authors attempted to compare epinephrine enhanced double contrast arthrographic group, epinephrine (+) group, to the double contrast arthrographic group without epinephrine, epinephrine (-) group, by statistical evaluation. Each group consisted of 35 cases and 7 lateral films of knee joint were taken sequentially 2, 6, 10, 15, 20, 30, and 60 minutes after injection of contrast media, and were assessed by 5 certified radiologist. The results were as follows: 1. The differences of mean score of quality between epinephrine (+) group and epinephrine (-) group was statistically significant at every time interval (p value<0.01 at 2 minutes, p<0.001 at all other time interval). Epinephrine (+) group was superior to the epinephrine (-) group in quality of film. 2. Numbers of cases above score of 2 which was considered to be of diagnostic quality in evaluating meniscal lesions were larger in epinephrine (+) group than epinephrine (-) group at every time interval. And the differences between two groups was highly significant statistically (p,0.001). 3. Only 43% of cases was above score of 2 at 10 minutes in epinephrine (-) group, but 97% at 10 minutes and 80% at 20 minutes respectively in epinephrine (+) group. Therefore duration for adequate study of arthrogram is prolonged more than two times epinephrine (+) group. 4

  8. Arthrography of the ankle - diagnostic method in ligamental injuries

    International Nuclear Information System (INIS)

    Results were analyzed of 143 arthrographies in patients with severe distortions of the ankle: 97 men and 46 women at mean age 34,3 years. Arthrography was realized by Gordon's original technique. The following X-ray diagnostic features were considered evidential for demonstration of the ligamental apparatus of the joint: 1. Extracapsular presence of contrast matter beneath and aside for the lateral maleolus with spread in cranial direction; 2. 'effluence' of contrast matter around the medial maleolus in the antero-posterior roentgenogram; 3. Absence of contrast-matter-free zone on lateral roentgenography. The author's arthrographic interpretations were confirmed on the subsequent operative correction

  9. Biceps tendon disorders: ultrasound, MR imaging and MR arthrography

    International Nuclear Information System (INIS)

    Ultrasound and MR imaging are competitive imaging modalities for the diagnosis of pathologic conditions of the biceps tendon. MR imaging has substantial advantages over ultrasound because biceps tendon lesions are most commonly located in the proximal part where lesions are hidden under the acromion for ultrasound assessment. The value of MR arthrography is substantiated by the capability to assess associated diagnoses which are otherwise difficult to assess. Associated diagnoses include full- and partial thickness tears of supraspinatus and subscapularis tendons, pulley lesions, and adhesive capsulitis (frozen shoulder). Moreover, MR arthrography is the method of choice for the assessment of superior labral anterior posterior (SLAP) lesions. (orig.)

  10. Ultrasonography and arthrography in rotator cuff lesions: algorithmic approach

    International Nuclear Information System (INIS)

    Twenty-six patients with chief complaint of shoulder pain who underwent both ultrasonographic examination and arthrography of the shoulder were analyzed. Ten out of 12 cases with clinical impression of frozen shoulder, showed normal findings on the ultrasonographic examination of the shoulder. Among these ten cases, nine cases showed adhesive capsulitis and one case showed rotator cuff tear on arthrography. Among six cases with the clinical impression of rotator cuff tear, five cases showed rotator cuff tear and one case showed combined calcific tendinitis and adhesive capsulitis on ultrasonographic examination. In arthrography, four cases of rotator cuff tear, one case of calcific tendinitis and biceps tendinitis and one case of normal finding were diagnosed. For the remaining eight cases in the ultrasonographic examination, normal finding or biceps tendinitis were found and for the remaining of the cases in arthrography adhesive capsulitis were found. With the above results, we recommend that the shoulder ultrasonography as the first line diagnostic modality for a patient with chief complaint of shoulder pain

  11. Adhesive capsulitis of the shoulder: MR arthrography

    International Nuclear Information System (INIS)

    Adhesive capsulitis is a clinical syndrome involving pain and decreased joint motion caused by thickening and contraction of the joint capsule. The purpose of this study is to describe the MR arthrographic findings of this syndrome. Twenty-nine sets of MR arthrographic images were included in the study. Fourteen patients had adhesive capsulitis diagnosed by physical examination and arthrography, and their MR arthrographic findings were compared with those of 15 subjects in the control group. The images were retrospectively reviewed with specific attention to the thickness of the joint capsule, volume of the axillary pouch (length, width, height(depth)), thinkness of the coracohumeral ligament, presence of extra-articular contrast extravasation, and contrst filling of the subcoracoid bursa. Mean capsular thickness measured at the inferior portion of the axillary pouch was 4.1 mm in patients with adhesive capsulitis and 1.5 mm in the control group. The mean width of the axillary pouch was 2.5 mm in patients and 9.5 mm in controls. In patients, the capsule was significantly thicker and the axillary pouch significantly narrower than in controls (p<0.05). Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch (sensitivity 93%, specificity 80%) and a pouch narrower than 3.5 mm (sensitivity 93%, specificity 100%) were useful criteria for the diagnosis of adhesive capsulitis. In patients with this condition, extra-articular contrast extravasation was noted in six patients (43%) and contrast filling of the subcoracoid bursa in three (21%). The MR arthrographic findings of adhesive capsulitis are capsular thickening, a low-volume axillary pouch, extra-articular contrast extravasation, and contrast filling of the subcoracoid bursa. Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch and a pouch width of less than 3.5 mm are useful diagnostic imaging characteristics

  12. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction

    Energy Technology Data Exchange (ETDEWEB)

    Strobel, Klaus [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Kantonsspital Luzern, Roentgeninstitut/Nuklearmedizin, Luzern (Switzerland); Steurer-Dober, Isabelle; Huellner, Martin W.; Sol Perez Lago, Maria del; Veit-Haibach, Patrick; Tornquist, Katharina [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Silva, Angela J. da [Advanced Molecular Imaging, Philips Healthcare, San Jose, CA (United States); Bodmer, Elvira; Wartburg, Urs von; Hug, Urs [Lucerne Cantonal Hospital, Division of Hand and Plastic Surgery, Lucerne (Switzerland)

    2014-03-15

    To evaluate the feasibility and performance of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. This prospective study included 28 wrists of 27 patients evaluated with SPECT/CT arthrography and MR arthrography. Iodine contrast medium and gadolinium were injected into the distal radioulnar and midcarpal joints. Late-phase SPECT/CT was performed 3.5 h after intravenous injection of approximately 650 MBq {sup 99m}Tc-DPD. MR and SPECT/CT images were separately reviewed in relation to bone marrow oedema, radionuclide uptake, and tears in the scapholunate (SL) and lunotriquetral (LT) ligaments and triangular fibrocartilage complex (TFCC), and an overall diagnosis of ulnar impaction. MR, CT and SPECT/CT imaging findings were compared with each other, with the surgical findings in 12 patients and with clinical follow-up. The quality of MR arthrography and SPECT/CT arthrography images was fully diagnostic in 23 of 28 wrists (82 %) and 25 of 28 wrists (89 %), respectively. SPECT/CT arthrography was not diagnostic for ligament lesions due to insufficient intraarticular contrast in one wrist. MR and SPECT/CT images showed concordant findings regarding TFCC lesions in 22 of 27 wrists (81 %), SL ligament in 22 of 27 wrists (81 %) and LT ligament in 23 of 27 wrists (85 %). Bone marrow oedema on MR images and scintigraphic uptake were concordant in 21 of 28 wrists (75 %). MR images showed partial TFCC defects in four patients with normal SPECT/CT images. MR images showed bone marrow oedema in 4 of 28 wrists (14 %) without scintigraphic uptake, and scintigraphic uptake was present without MR bone marrow oedema in three wrists (11 %). Regarding diagnosis of ulnar impaction the concordance rate between CT and SPECT/CT was 100 % and reached 96 % (27 of 28) between MR and SPECT/CT arthrography. The sensitivity and specificity of MR, CT and SPECT/CT arthrography were 93 %, 100 % and 100 %, and 93 %, 93 % and 93

  13. Arthrography of the TMJ. Indications, technique and interpretation

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Triebel, H.J.; Jend-Rossmann, I.

    1986-09-01

    Articular dysfunction of the TMJ with anterior displacement of the disc ('internal derangement') is an entity which has been separated from other types of the 'myofascial pain syndromes' and which can be treated conservatively or by surgery. Arthrography of the TMJ has contributed greatly to an understanding of normal and abnormal function and, in many cases, it can provide a diagnosis. On the basis of our experience with 80 investigations we discuss technical problems and the clinical indications. The indications for arthrography are in the pre-operative diagnosis, when clinical findings are uncertain, in order to demonstrate perforation, in order to confirm a suspected diagnosis and to assist in prosthetic treatment.

  14. Rotator cuff tears noncontrast MRI compared to MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Yoon, Young Cheol [Sungkyunkwan University, School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of); Jung, Jee Young [Chungang University School of Medicine, Department of Radiology, Chungang University Hospital, Seoul (Korea, Republic of); Yoo, Jae Chul [Sungkyunkwan University, School of Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2015-12-15

    To compare the accuracy of indirect magnetic resonance arthrography and noncontrast magnetic resonance imaging for diagnosing rotator cuff tears. In total, 333 patients who underwent noncontrast magnetic resonance imaging or indirect magnetic resonance arthrography were included retrospectively. Two musculoskeletal radiologists evaluated the images for the presence of supraspinatus-infraspinatus and subscapularis tendon tears. The overall diagnostic performance was calculated using the arthroscopic findings as the reference standard. Statistical differences between the diagnostic performances of the two methods were analyzed. Ninety-six and 237 patients who underwent noncontrast magnetic resonance imaging and indirect magnetic resonance arthrography were assigned into groups A and B, respectively. Sensitivity for diagnosing articular-surface partial-thickness supraspinatus-infraspinatus tendon tear was slightly higher in group B than in group A. Statistical significance was confirmed by multivariate analysis using the generalized estimating equation (p = 0.046). The specificity for diagnosing subscapularis tendon tear (85 % vs. 68 %, p = 0.012) and grading accuracy (57 % vs. 40 %, p = 0.005) was higher in group B than in group A; the differences were statistically significant for one out of two readers. Univariate analysis using the generalized estimating equation showed that the accuracy for diagnosing subscapularis tendon tear in group B was higher than in group A (p = 0.042). There were no statistically significant differences between the diagnostic performances of both methods for any other parameters. Indirect magnetic resonance arthrography may facilitate more accurate diagnosis and grading of subscapularis tendon tears compared with noncontrast magnetic resonance imaging. (orig.)

  15. Computed arthrography: Its role in the screening of joint diseases in pediatric radiology

    Energy Technology Data Exchange (ETDEWEB)

    Paille, P.; Quesnel, C.; Baunin, C.; Railhac, J.J.

    1988-07-01

    The purpose of this study was to analyse the accuracy of combined arthrography and computed tomography in pediatric radiology. 23 patients were selected and the joints studied (n = 25) were: Elbow (1), shoulder (2), knee (8) and hip (14). The contribution of computed arthrography varies according to the joint and the disease concerned. Osteochondritis dissecans of the knee appears to be the best indication.

  16. Lumbar intraspinal juxtafacet cysts: MR imaging and CT-arthrography

    International Nuclear Information System (INIS)

    Purpose: To present data on the MR imaging appearance of lumbar intraspinal juxtafacet cysts (JFC) and to assess the importance of additional CT arthrography. Material and Methods: Twenty-eight patients (16 women, 12 men) with a mean age of 64 years (range: 43-82), who underwent MR imaging because of radicular pain or spinal claudication, were found to have an intraspinal cyst associated with the facet joint. In 14 patients, additional CT-arthrography was performed to determine whether a communication exists between the cyst and the facet joint and to try to rupture the cyst. Results: In T2-weighted images, juxtafacet cysts show a typical pattern consisting of a hyperintense center and hypointense rim. The center is likely to be inhomogeneous because of recurrent hemorrhage in the cyst. In T1-weighted images, the cysts are hypo/isointense. Irregular hyperintensity may indicate subacute hemorrhage, which may aggravate the clinical symptoms. MR allows superior visualization of the cyst in all anatomical planes. It also enables assessment of typical accompanying changes, such as degenerative spondylolisthesis and facet hypertrophy. All patients, who had CT-arthrography, were found to have a direct communication between joint space and cyst. Transarticular rupture of the cyst was possible in five patients. Two of these five patients had good to excellent improvement, and the remaining three patients underwent surgery. (orig.)

  17. A clinical and radiological observation of shoulder arthrography

    International Nuclear Information System (INIS)

    The authors analyzed 23 cases of shoulder arthrography performed at Busan National University Hospital and Inje Medical College Paik Hospital for about 2.5 years from March 1981 to September 1983, both clinically and radiologically. The results obtained were as follows: 1. Of the 23 cases, 20 cases (87.0%) were male and 3 cases (13.0%) were female, and the most prevalent age group was second decade. 2. Right shoulder arthrography was performed in 16 cases (69.6%), and left in 7 cases (30.4%). 3. The number of cases which had had certain history of trauma was 13 (56.5%), and remainder of 10 cases (43.5%) had no history of trauma. 4. Frequent symptoms and signs were pain in shoulder region in 16 cases (69.6%) and limitation of motion in 14 cases (60.9%). 5. On plain film findings, 18 cases (78.3%) were normal, and 5 cases (21.7%) were abnormal. 6. On shoulder arthrographic findings, 16 cases (69.6%) were normal, and 7 cases (30.4%) were abnormal. Those abnormal cases were consisted of 2 cases (8.7%) of adhesive capsulitis, 2 cases (8.7%) of chronic shoulder dislocation, 1 case (4.3%) of rotator cuff tear, 1 case (4.3%) of loose bodies in joint cavity, and 1 case (4.3%) of rupture of biceps tendon sheath. 7. Among routine views of shoulder arthrography of normal cases, the external rotation view revealed axillary recess and biceps tendon more distincity, and the internal rotation view revealed subscapular bursa more clearly. In case of double contrast shoulder arthrography, the contour and thickness of the medial segment of the contrast coated humeral articular cartilage were well demonstrated in erect views, with air-fluid levels in axillary recess, biceps tendon sheath and subscapular bursa. 8. The 2 cases of adhesive capsulitis revealed small joint space, obliteration of the axillary recess and subscapular bursa, and failure to fill the bicipital sheath. 9. The 2 cases of capsular deformities by chronic shoulder dislocation demonstrated loss of normal concavity of

  18. Comparison of MRI and arthrography in patients with functional disturbances of the temporomandibular joint

    International Nuclear Information System (INIS)

    31 patients with clinically diagnosed dysfunction of the temporomandibular joint (TMJ) were examined by magnetic resonance imaging (MRI; 1.5 Tesla, TR/TE 600/30) in closed and open mouth position and functional arthrography with digital image recording. Both methods agreed in the evaluation of the disc position. In 23 joints with displaced disc reposition was found in 11 cases and in 14 cases using MRI or arthrography, respectively. MRI proved to be superior in the diagnosis of sideways disc rotations. Joint hypermobility, eccentric disc displacement (n=4) and perforation (n=3) were shown by functional arthrography. Due to the good demonstration of osseous, muscular and discoligamentous structures, MRI as a noninvasive imaging modality is the method of choice for TMJ evaluation. Arthrography can be advantageous in complex functional disturbances or if MRI and clinical findings are inconclusive. The clinical diagnosis of disc displacement was found to be accurate in only 68% of the cases. (orig.)

  19. Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach

    Energy Technology Data Exchange (ETDEWEB)

    Gokalp, Gokhan; Dusak, Abdurrahim; Yazici, Zeynep [Uludag University Medical Faculty, Goeruekle Kampusu, Department of Radiology, Bursa (Turkey)

    2010-06-15

    Shoulder MR arthrography has an important role in the assessment of rotator cuff lesions, labral tears, glenohumeral ligaments, rotator interval lesions, and postoperative shoulder status. Injection in direct MR arthrography can be performed with palpation, fluoroscopy, ultrasonography (US), or MRI. Recently, the posterior approach is the preferred method due to the presence of fewer stabilizers, absence of important articular structures and less extravasation, has been advocated. Our aim was to assess the efficacy of US-guided MR arthrography via a posterior approach on the glenohumeral joint. Thirty MR arthrographies were performed on 29 patients. Ultrasonography (Xario, Toshiba) examinations were conducted by a wide-band 5-12 Mhz linear array transducer set to muscle-skeleton. Diluted contrast medium (1 ml gadolinium chelate and 100 ml saline, approximately 15 ml) was delivered into the glenohumeral joint space from between the humeral head and posterior labrum with a 20-gauge spinal needle. MRI examination was conducted by a 1.5 T scanner. Fat-saturated T1-weighted spin echo was applied on coronal, axial, and sagittal planes within the first 30 min after contrast material injection. One (3.3%) arthrography was not successful due to technical reasons associated with obesity. Contrast extravasation around the infraspinatus and teres minoer muscles was depicted in twelve examinations. One (3.3%) patient developed vasovagal collapse. Ultrasonography-guided posterior approach is an easy, reliable, fast, and comfortable method in experienced hands. It may be an alternative for fluoroscopy-guided shoulder MR arthrography. (orig.)

  20. Feasibility of ultrasonography and MR arthrography during evaluation of rotator cuff injury

    International Nuclear Information System (INIS)

    To evaluate the feasibility of MR arthrography and ultrasonography in evaluating shoulder pain. The subject group consisted of all patients who visited our institute complaining of shoulder pain or instability form June 2002 to December 2004. There were a total of 92 patients with an mean age of 48. On the basis of arthroscopic results, the sensitivity, specificity, and accuracy of ultrasonography and MR arthrography were evaluated by comparing them with each other. In the diagnosis of separateness tendon tears, ultrasonography had sensitivity and specificity of 100% and 64%, respectively, whereas MR arthrography had sensitivity and specificity of 80% and 94%, respectively. Ultrasonography also had high sensitivity and specificity in the diagnosis of subscapularis tendon tears (100% and 90%). MR arthrography was appropriate for identifying glenoid labral abnormalities (sensitivity, 95% and specificity, 61%). Similar results from ultrasonography and MR arthrography were obtained in the diagnosis of subscapular tendon tears or full-thickness tears of the rotator cuff tendons (kappa value, 0.644 and 0.911). While evaluating rotator cuff abnormalities, ultrasonography was appropriate for screening, whereas MR arthrography was useful to confirm the results of the ultrasonography

  1. Comparison of MRI and arthrography in patients with functional disturbances of the temporomandibular joint; Vergleich von Kernspintomographie und Arthrographie bei Funktionsstoerungen des Kiefergelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Fischbach, R. [Inst. und Poliklinik fuer Radiologische Diagnostik, Koeln Univ. (Germany); Heindel, W. [Inst. und Poliklinik fuer Radiologische Diagnostik, Koeln Univ. (Germany); Lin, Y. [Klinik und Poliklinik fuer Mund-, Kiefer- und Gesichtschirurgie, Koeln Univ. (Germany); Friedrich, R. [Klinik und Poliklinik fuer Zahn-, Mund- und Kieferheilkunde, Abt. fuer Vorklinische Zahnheilkunde, Koeln Univ. (Germany); Brochhagen, H.G. [Inst. und Poliklinik fuer Radiologische Diagnostik, Koeln Univ. (Germany)

    1995-03-01

    31 patients with clinically diagnosed dysfunction of the temporomandibular joint (TMJ) were examined by magnetic resonance imaging (MRI; 1.5 Tesla, T{sub R}/T{sub E} 600/30) in closed and open mouth position and functional arthrography with digital image recording. Both methods agreed in the evaluation of the disc position. In 23 joints with displaced disc reposition was found in 11 cases and in 14 cases using MRI or arthrography, respectively. MRI proved to be superior in the diagnosis of sideways disc rotations. Joint hypermobility, eccentric disc displacement (n=4) and perforation (n=3) were shown by functional arthrography. Due to the good demonstration of osseous, muscular and discoligamentous structures, MRI as a noninvasive imaging modality is the method of choice for TMJ evaluation. Arthrography can be advantageous in complex functional disturbances or if MRI and clinical findings are inconclusive. The clinical diagnosis of disc displacement was found to be accurate in only 68% of the cases. (orig.) [Deutsch] 31 Patienten mit klinisch diagnostizierter Funktionsstoerung des Kiefergelenkes wurden mittels Kernspintomographie (MRT; 1,5 Tesla, T{sub R}/T{sub E} 600/30) bei geschlossenem und geoeffnetem Mund und mittels Funktionsarthrographie mit digitaler Bildaufzeichnung untersucht. Die Diskusoperation wurde mit beiden Verfahren in allen Faellen uebereinstimmend bewertet. Bei 23 verlagerten Disci zeigte die MRT in 11 Faellen, die Arthrographie in 14 Faellen eine Reposition. Die MRT erwies sich im Nachweis seitlicher Verlagerungen als ueberlegen. Gelenkhypermobilitaet, exzentrische Diskusverlagerungen (n=4) und Diskusperforationen (n=3) waren in der Funktionsarthrographie nachzuweisen. Sie ist zur Gesamtbeurteilung aufgrund guter Darstellung ossaerer, muskulaerer und diskoligamentaerer Strukturen Methode der Wahl. Die Arthrographie kann bei komplexen Funktionsstoerungen oder uneindeutigen klinischen und kernspintomographischen Befunden von Vorteil sein. Die

  2. Examination of the sprained ankle: Anterior drawer test or arthrography?

    International Nuclear Information System (INIS)

    The accuracy of the anterior drawer test for the diagnosis of recent lateral ligament tears in the ankle was evaluated in a series of 192 patients using surgical or arthrographic findings for reference. Considerable overlapping of results was obtained in ankles with and without ligament tear. Twenty-eight per cent of the anterior talofibular ligament tears, and 38% of the combined anterior talofibular and calcaneofibular tears were not detected, and single and combined tears could not be differentiated. It is concluded that the anterior drawer test is too unreliable as a basis for any decision regarding surgical treatment of a recent sprain. Therefore, arthrography is recommended as the method of choice in such cases of recent ankle sprain, where the need of surgery has to be supported by X-ray analysis. (orig.)

  3. Epinephrine-enhanced computed tomographic arthrography of the canine shoulder.

    Science.gov (United States)

    De Rycke, Lieve; van Bree, Henri; Van Caelenberg, Annemie; Polis, Ingeborgh; Duchateau, Luc; Gielen, Ingrid

    2015-10-01

    The aim of this study was to investigate the effect of epinephrine-enhanced computed tomographic arthrography (CTA) on the image sharpness of the lateral and medial glenohumeral ligaments (LGHL and MGHL, respectively), biceps tendon (BT) and joint cartilage (JC) in the canine shoulder. The shoulders of eight normal dogs were examined using a 4-slice helical CT scanner. The right shoulders were injected with Iohexol and the left shoulders with a mixture of Iohexol and epinephrine. CTA images were obtained after 1, 3, 5, 9, 13, 20 and 30 min and the image sharpness of the intra-articular structures in both shoulders was graded for visibility. The attenuation values were measured to examine the persistence of contrast appearance. Admixture of epinephrine and Iohexol significantly improved the image sharpness of the LGHL and the BT, especially on delayed CTA images. The use of epinephrine did not negatively affect post-CTA recovery.

  4. Examination of the sprained ankle: Anterior drawer test or arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Laehde, S.; Putkonen, M.; Puranen, J.; Raatikainen, T.

    1988-11-01

    The accuracy of the anterior drawer test for the diagnosis of recent lateral ligament tears in the ankle was evaluated in a series of 192 patients using surgical or arthrographic findings for reference. Considerable overlapping of results was obtained in ankles with and without ligament tear. Twenty-eight per cent of the anterior talofibular ligament tears, and 38% of the combined anterior talofibular and calcaneofibular tears were not detected, and single and combined tears could not be differentiated. It is concluded that the anterior drawer test is too unreliable as a basis for any decision regarding surgical treatment of a recent sprain. Therefore, arthrography is recommended as the method of choice in such cases of recent ankle sprain, where the need of surgery has to be supported by X-ray analysis.

  5. Multi-detector CT knee arthrography - initial experience

    International Nuclear Information System (INIS)

    Full text: Traditional plain film arthrography can achieve reasonable accuracy and is an accepted method of investigation of patients with knee pain and possible meniscal tear. Multi-detector CT can potentially provide a more detailed and accurate examination due to its high-resolution crosssectional and multi-planar capabilities. The aim of this study was to assess the accuracy of our technique. All patients who underwent a multi-detector CT knee arthrogram in an initial 8 month period were identified. Initially the referring clinician was contacted. If the patient was referred to an orthopaedic surgeon the outcome of orthopaedic review was recorded using clinical, arthroscopic and / or MRI follow-up of the patient population. One hundred and twelve patients had a Multi-detector CT knee arthrogram performed within and 8 month period. Follow-up information was received in 69.7% of patients. Of these 68.9% had orthopaedic assessment - of which 69.2% underwent a knee arthroscopy.There was total agreement of findings in 67%, agreement of meniscal findings in 67% and chondral findings in 100%. Overall, orthopaedic opinion agreed with CT findings in 76.9%. At this stage, all meniscal tears not described in the initial CT arthrogram report have in retrospect been visible. Multi-detector CT knee arthrography is an accurate and elegant technique for investigation of knee pain, providing information in a format familiar to those reporting knee MRI. There is an initial learning curve. The technique is particularly useful in chondral assessment. It is accurate for meniscal pathology, although caution and recognition of potential pitfalls is required. Copyright (2002) Blackwell Science Pty Ltd

  6. Intrinsic ligament and triangular fibrocartilage complex tears of the wrist: comparison of MDCT arthrography, conventional 3-T MRI, and MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ryan K.L.; Ng, Alex W.H.; Tong, Cina S.L.; Griffith, James F. [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince Of Wales Hospital, Shatin (China); Tse, W.L.; Wong, C.; Ho, P.C. [The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince Of Wales Hospital, Shatin (China); The Chinese University of Hong Kong, Department of Orthopedics, Prince Of Wales Hospital, Shatin (China)

    2013-09-15

    This study compares the diagnostic performance of multidetector CT arthrography (CTA), conventional 3-T MR and MR arthrography (MRA) in detecting intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist. Ten cadaveric wrists of five male subjects with an average age 49.6 years (range 26-59 years) were evaluated using CTA, conventional 3-T MR and MRA. We assessed the presence of scapholunate ligament (SLL), lunotriquetral ligament (LTL), and TFCC tears using a combination of conventional arthrography and arthroscopy as a gold standard. All images were evaluated in consensus by two musculoskeletal radiologists with sensitivity, specificity, and accuracy being calculated. Sensitivities/specificity/accuracy of CTA, conventional MRI, and MRA were 100 %/100 %/100 %, 66 %/86 %/80 %, 100 %/86 %/90 % for the detection of SLL tear, 100 %/80 %/90 %, 60 %/80 %/70 %, 100 %/80 %/90 % for the detection of LTL tear, and 100 %/100 %/100 %, 100 %/86 %/90 %, 100 %/100 %/100 % for the detection of TFCC tear. Overall CTA had the highest sensitivity, specificity, and accuracy among the three investigations while MRA performed better than conventional MR. CTA also had the highest sensitivity, specificity, and accuracy for identifying which component of the SLL and LTL was torn. Membranous tears of both SLL and LTL were better visualized than dorsal or volar tears on all three imaging modalities. Both CT and MR arthrography have a very high degree of accuracy for diagnosing tears of the SLL, LTL, and TFCC with both being more accurate than conventional MR imaging. (orig.)

  7. Imaging diagnostics of the wrist: MRI and Arthrography/Arthro-CT; Bildgebende Diagnostik des Handgelenkes: MRT und Arthrographie/Arthro-CT

    Energy Technology Data Exchange (ETDEWEB)

    Klein, H.M.; Balas, R.; Neugebauer, F. [Radiologische Gemeinschaftspraxis, Betzdorf (Germany); Vrsalovic, V. [Handchirugie, Marienhospital Siegen, Siegen (Germany)

    2002-02-01

    Purpose: To evaluate the use of magnetic resonance imaging (MRI) compared with arthrography and arthro-CT (AG/ACT) in patients with wrist pain. Methods: MRI and arthrography/arthro-CT (AG/ACT) of the wrist joint were retrospectively evaluated in 346 patients over a three-year period. Imaging findings were correlated to surgical results (n=78) or clinical course in an at least 6-month follow-up. Results: For tears of the triangular fibrocartilage, arthrography, arthro-CT, and MRI demonstrated a sensitivity and specificity of more than 0.96. Only the positive predictive value was superior for arthrography/arthro-CT (0.99 and 0.98, respectively) compared with MRI (0.94). Arthrography was superior for functional diagnosis of scapho-lunate ligament tears (n=25). Ulno-lunate and ulno-triquetral ligament defects were demonstrated more exactly by arthrography. Traumatic osseous defects, particularly scaphoid fractures (n=33) and avascular necrosis (n=17), were better diagnosed using MRI. Conclusion: For suspected lesions of the triangular fibrocartilage complex, AG/ACT is slightly more reliable than MRI. However, MRI was found to be highly accurate in diagnosing TFC tears, and is superior to AG/ACT in detecting traumatic and vascular lesions of the wrist. (orig.) [German] Ziel: Die Untersuchung der diagnostischen Aussagekraft von Magnetresonanz-Tomographie (MRT), Arthrographie (AG) und Arthro-CT (ACT) bei Erkrankungen des Handgelenkes. Methodik: Insgesamt 346 Untersuchungen des Handgelenkes wurden fuer einen dreijaehrigen Beobachtungszeitraum retrospektiv ausgewertet. Es wurden 211 MRT, 151 Arthrographien (AG) und 126 Arthro-CT (ACT) durchgefuehrt. Alle Diagnosen wurden operativ (n=78) oder durch den klinischen Verlauf in einer 6-monatigen Nachbeobachtung gesichert. Ergebnisse: Fuer die Diagnostik von Laesionen des diskoulnaren Komplexes lag die Sensitivitaet und Spezifitaet von AG, ACT und MRT ueber 0,96. Lediglich der positive Vorhersagewert differierte, allerdings nicht

  8. Sacro-iliac joint arthrography in low back pain: feasibility of MRI guidance

    International Nuclear Information System (INIS)

    Objective: Evaluation of the feasibility of MR-guidance in sacro-iliac joint arthrography in patients whose low back pain is suspected to arise from the sacro-iliac joint (SIJ). Methods and patients: Twenty patients with low back pain underwent MR-guided sacro-iliac joint arthrography. Needles made from titanium (size 20 G, MDTech, USA) were used. For image guidance a 0.23T open-configuration C arm magnet (Proview, Marconi Medical Systems, USA) with special interventional hardware and software package (I-Path 200, Marconi Medical Systems) containing an MR compatible in-room console, large-screen (36'') display, optical navigator and accompanying software with dedicated sequences was used. No other image guidance modalities were used. Results: MR-guided SIJ arthrography was successfully performed in all twenty patients without complications. The optimal imaging sequence both for preoperative and intraoperative images was 3D-Gradient Echo sequence. The dispersal of the injected saline and anaesthetic could be determined inside the joint in all cases with heavily T2-weighted fast spin echo sequence. In the present study, 60% of the patients had significant reduction of pain after sacro-iliac joint arthrography and sacro-iliac joint was considered to be the source of patients low back pain in these patients. Conclusion: The present study shows that MR guidance with open configuration low field scanner is an accurate guiding method for sacro-iliac joint arthrography

  9. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips

    Energy Technology Data Exchange (ETDEWEB)

    Sahin, Guelden [Department of Radiology, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara (Turkey)]. E-mail: gsahin@medicine.ankara.edu.tr; Demirtas, Mehmet [Department of Hand Surgery, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara (Turkey)

    2006-06-15

    Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however, direct MR arthrography using diluted gadolinium as the contrast agent is the most commonly used technique and is the most reliable of all. MR arthrography is useful for demonstrating labrocapsular-ligamentous abnormalities and distinguishing partial thickness rotator cuff tears from focal full thickness tears in the shoulder, identifying or excluding recurrent tears following meniscal operations in the knee, demonstrating perforations of the triangular fibrocartilage complex (TFCC) and ligaments in the wrist, showing labral tears in the hip, diagnosing ligament tears in the ankle and identifying osteochondral lesions or loose bodies in any of the aforementioned joints. In this article, an overview of techniques of MR arthrography is provided with emphasis on direct MR arthrography using diluted gadolinium as the contrast agent. The current applications of the technique in major peripheral joints are reviewed, with emphasis given to the shoulder joint where the role of this technique has become well established.

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

    Energy Technology Data Exchange (ETDEWEB)

    Nakanishi, Katsunuki [Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita-city, Osaka 565 (Japan); Masatomi, Takashi [Department of Orthopedic Surgery, Osaka University Medical School, Osaka (Japan); Ochi, Takahiro [Department of Orthopedic Surgery, Osaka University Medical School, Osaka (Japan); Ishida, Takeshi [Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita-city, Osaka 565 (Japan); Hori, Shinichi [Department of Radiology, Izumisano Municipal Hospital, Osaka (Japan); Ikezoe, Junpei [Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita-city, Osaka 565 (Japan); Nakamura, Hironobu [Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita-city, Osaka 565 (Japan)

    1996-10-01

    Objective. The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI and MR arthrography. Design. Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. Results. The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. Conclusion. MR arthrography provided additional information for evaluating the degree of UCL injury. (orig.). With 5 figs., 1 tab.

  11. MR-plastination-arthrography: a new technique used to study the distal tibiofibular syndesmosis

    International Nuclear Information System (INIS)

    The purpose of this study was to describe a new technique called MR plastination arthrography to study both intra- and extra-articular anatomy. In six human cadaveric lower legs MR arthrography was performed in either a one-step or two-step procedure. In the former a mixture of diluted Gadolinium and dyed polymer was injected. In the latter the dyed polymer was injected after arthrography wih diluted Gadolinium. Three-millimeter slices of these legs, obtained in a plane identical to that of the MR images, were plastinated according to the E12 technique of von Hagens. The plastination slices were subsequently compared with the MR images. The one-step procedure resulted in an inhomogeneous arthrogram. The two-step procedure resulted in a good correlation between the high-resolution MR images and plastination slices, as expressed by a good comparison of anatomic detail of the small syndesmotic recess. Images of the distal tibiofibular syndesmosis obtained with plastination arthrography correlated well with images acquired by MR arthrography when performed in a two-step procedure. (orig.)

  12. MR-plastination-arthrography: a new technique used to study the distal tibiofibular syndesmosis

    Energy Technology Data Exchange (ETDEWEB)

    Hermans, John J.; Wentink, Noortje [Erasmus University Medical Center, Department of Radiology, Rotterdam (Netherlands); Kleinrensink, Gert-Jan [Erasmus University Medical Center, Department of Neurosciences, Rotterdam (Netherlands); Beumer, Annechien [Erasmus University Medical Center, Department of Orthopedics, Rotterdam (Netherlands)

    2009-07-15

    The purpose of this study was to describe a new technique called MR plastination arthrography to study both intra- and extra-articular anatomy. In six human cadaveric lower legs MR arthrography was performed in either a one-step or two-step procedure. In the former a mixture of diluted Gadolinium and dyed polymer was injected. In the latter the dyed polymer was injected after arthrography wih diluted Gadolinium. Three-millimeter slices of these legs, obtained in a plane identical to that of the MR images, were plastinated according to the E12 technique of von Hagens. The plastination slices were subsequently compared with the MR images. The one-step procedure resulted in an inhomogeneous arthrogram. The two-step procedure resulted in a good correlation between the high-resolution MR images and plastination slices, as expressed by a good comparison of anatomic detail of the small syndesmotic recess. Images of the distal tibiofibular syndesmosis obtained with plastination arthrography correlated well with images acquired by MR arthrography when performed in a two-step procedure. (orig.)

  13. Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries

    Energy Technology Data Exchange (ETDEWEB)

    Ramdhian-Wihlm, Reeta [University Hospital of Strasbourg, Department of Orthopedic Surgery, Strasbourg (France); Le Minor, Jean-Marie [University of Strasbourg, Institute of Anatomy, Strasbourg (France); University of Strasbourg, Faculty of Dentistry, Strasbourg (France); Schmittbuhl, Matthieu [University of Strasbourg, Faculty of Dentistry, Strasbourg (France); Jeantroux, Jeremy; Veillon, Francis; Dosch, Jean-Claude; Dietemann, Jean-Louis; Bierry, Guillaume [University Hospital of Strasbourg, Department of Radiology, Strasbourg (France); Mahon, Peter Mac [Massachusetts General Hospital, Department of Musculoskeletal Radiology, Boston, MA (United States)

    2012-08-15

    Cone-beam computed tomography (CBCT) has become an important modality in dento-facial imaging but remains poorly used in the exploration of the musculoskeletal system. The purpose of this study was to prospectively evaluate the performance and radiation exposure of CBCT arthrography in the evaluation of ligament and cartilage injuries in cadaveric wrists, with gross pathology findings as the standard of reference. Conventional arthrography was performed under fluoroscopic guidance on 10 cadaveric wrists, followed by MDCT acquisition and CBCT acquisition. CBCT arthrography and MDCT arthrography images were independently analyzed by two musculoskeletal radiologists working independently and then in consensus. The following items were observed: scapholunate and lunotriquetral ligaments, triangular fibrocartilage complex (TFCC) (tear, integrity), and proximal carpal row cartilage (chondral tears). Wrists were dissected and served as the standard of reference for comparisons. Interobserver agreement, sensitivity, specificity, and accuracy were determined. Radiation dose (CTDI) of both modalities was recorded. CBCT arthrography provides equivalent results to MDCT arthrography in the evaluation of ligaments and cartilage with sensitivity and specificity between 82 and 100%, and interobserver agreement between 0.83 and 0.97. However, radiation dose was significantly lower (p < 0.05) for CBCT arthrography than for MDCT arthrography with a mean CTDI of 2.1 mGy (range 1.7-2.2) versus a mean of 15.1 mGy (range 14.7-16.1). CBCT arthrography appears to be an innovative alternative to MDCT arthrography of the wrist as it allows an accurate and low radiation dose evaluation of ligaments and cartilage. (orig.)

  14. Direct coronal computed tomography arthrography of osteochondritis dissecans of the talus

    Energy Technology Data Exchange (ETDEWEB)

    Heare, M.M.; Gillespy, T. III; Bittar, E.S.

    1988-04-01

    Although radiographs, arthrography, tomography, and computed tomography can all be used to diagnose osteochondritis dissecans of the talus, these imaging methods may not demonstrate whether an undisplaced osteochondral fragment has any attachment to the articular cartilage or bony bed of the talus. As lack of such attachment is a relative indication for surgery, we studied the feasibility of using coronal computed tomography (CT) after double contrast arthrography to demonstrate attachment in four patients with osteochondritis dissecans seen on radiographs. Direct coronal CT arthrographic images showed intact articular cartilage in three patients. In the fourth patient, overlying cartilage was virtually absent and contrast tracked beneath the fragment, an appearance that correlated with arthroscopic findings of partial articular cartilage attachment and no union at the osteochondral fracture line. Our initial experience suggests that direct coronal CT arthrography clearly shows the state of attachment of the osteochondritic fragment to the talus.

  15. MR arthrography of the shoulder: Do we need local anesthesia?

    Energy Technology Data Exchange (ETDEWEB)

    Spick, Claudio, E-mail: claudio.spick@meduniwien.ac.at [Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna (AKH), Waehringer-Guertel 18-20, 1090 Vienna (Austria); Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred [Diagnostikum Graz-Südwest, Weblinger Guertel 25, 8054 Graz (Austria)

    2014-06-15

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  16. MR arthrography of the shoulder: Do we need local anesthesia?

    International Nuclear Information System (INIS)

    Purpose: To assess pain intensity with and without subcutaneous local anesthesia prior to intraarticular administration of contrast medium for magnetic resonance arthrography (MRa) of the shoulder. Materials and methods: This single-center study was conducted after an IRB waiver of authorization, between January 2010 and December 2012. All patients provided written, informed consent for the procedure. Our prospectively populated institutional database was searched, based on our inclusion criteria. There were 249 outpatients (178 men and 71 women; mean age, 44.4 years ± 14.6; range, 15–79) who underwent MRa and were enrolled in this study. Patients were excluded if they had received surgery of the shoulder before MRa, had undergone repeated MRa of the same shoulder, and/or had undergone MRa of both shoulders on the same day. Patients were randomly assigned into one of three groups. Patients in group A (n = 61) received skin infiltration with local anesthesia. Patients in control group B (n = 92) and group C (n = 96) did not receive local anesthesia. Pain levels were immediately assessed after the injection for MRa using a horizontal visual analog scale (VAS) that ranged from 0 to 10. To compare the pain scores of the three groups for male and female patients, a two-way analysis of variance was used. A p-value equal to or less than 0.05 was considered to indicate a significant result. Results: Patients who received local anesthesia (group A) showed a mean pain level on the VAS of 2.6 ± 2.3. In patients who did not receive local anesthetics (groups B and C), a mean pain level on the VAS of 2.6 ± 2.2 and 2.7 ± 2.4 were detected, respectively. Between the three groups, no statistically significant difference in pain intensity was detected (p = .960). There were significant differences in subjective pain perception between men and women (p = .009). Moreover, the sex difference in all three groups was equal (p = .934). Conclusion: Local anesthesia is not required to

  17. Shoulder magnetic resonance arthrography in the sagittal oblique plane: pictorial essay

    International Nuclear Information System (INIS)

    Shoulder magnetic resonance (MR) arthrography is the imaging study of choice for investigating glenohumeral instability. The axial and coronal oblique planes have traditionally been used because it is on these planes that the glenoid labrum, as well as the biceps anchor and rotator cuff, are thought to be best evaluated. The purpose of this illustrative review is to demonstrate the diagnostic utility of the sagittal oblique plane in shoulder MR arthrography. Images identifying the normal and abnormal appearance of the labral, ligamentous, myotendinous and osteocartilaginous structures are presented, and comparisons to the axial and coronal oblique planes are made. (author)

  18. MDCT arthrography of the wrist: Diagnostic accuracy and indications

    International Nuclear Information System (INIS)

    Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.

  19. MDCT arthrography of the wrist: Diagnostic accuracy and indications

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    De Filippo, Massimo [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy)], E-mail: massimo.defilippo@unipr.it; Pogliacomi, Francesco [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Bertellini, Annalisa [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Araoz, Philip A. [Department of Radiology, Division of Biostatistics, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (United States); Averna, Raffaele; Sverzellati, Nicola; Ingegnoli, Anna [Department of Clinical Sciences, Section of Radiological Sciences, University of Parma, Parma Hospital, Via Gramsci, 14, 43100 Parma (Italy); Corradi, Maurizio; Costantino, Cosimo [Orthopaedics, Traumatology and Functional Rehabilitation Unit, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma (Italy); Zompatori, Maurizio [Department of Radiological and Histopathological Sciences, Policlinic S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna (Italy)

    2010-04-15

    Purpose: To evaluate the diagnostic accuracy and indications of arthrography with Multidetector Computed Tomography (arthro-MDCT) of the wrist in patients with absolute or relative contraindications to magnetic resonance imaging (MRI) studies and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Materials and methods: After intra-articular injection of iodixanol and volumetric acquisition, 43 wrists in patients of both genders (18 females, 25 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. Fifteen patients had prior wrist surgery. The patients had arthralgia, degenerative and traumatic arthropathies as well as limited range of motion, but no radiologically detected fractures. All examinations were interpreted by two experienced musculoskeletal radiologists. The findings were compared with arthroscopic findings carried out within 28 days of the CT study. Results: In non-operated and operated wrists the comparison between arthro-MDCT and arthroscopy showed sensitivity, specificity and accuracy ranging between 92% and 94% for triangular fibrocartilage complex (TFCC), between 80% and 100% for intrinsic ligaments located within the proximal carpal compartment, and between 94% and 100% for articular cartilage. Inter-observer agreement between two radiologists, in the evaluation of all types of lesions, was almost perfect (k = 0.96) and statistically significant (p < 0.05). Conclusions: Arthro-MDCT of the wrist provides an accurate diagnosis to identify chondral, fibrocartilaginous and intra-articular ligament lesions in patients who cannot be evaluated by MRI, and in post-surgical patients.

  20. Comparison of conventional MRI and MR arthrography in the evaluation of wrist ligament tears: A preliminary experience

    Directory of Open Access Journals (Sweden)

    Shivani Pahwa

    2014-01-01

    Full Text Available Aims: To compare conventional magnetic resonance imaging (MRI and direct magnetic resonance (MR arthrography in the evaluation of triangular fibrocartilage complex (TFCC and intrinsic wrist ligament tears. Materials and Methods: T1-weighted, fat suppressed (FS proton density plus T2-weighted (FS PD/T2, 3D multiple-echo data image combination (MEDIC sequences and direct MR arthrography were performed in 53 patients with wrist pain. Images were evaluated for the presence and location of TFCC, scapholunate ligament (SLL and lunatotriquetral ligament (LTL tears, and imaging findings were compared with operative findings in 16 patients who underwent arthroscopy or open surgery (gold standard. Results: Sixteen patients underwent arthroscopy/open surgery: 12 TFCC tears were detected arthroscopically out of which 9 were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in the detection of TFCC tears were 75%, 83.3%, and 100%, respectively. Out of the eight arthroscopically confirmed SLL tears, three tears were detected on FS PD/T2 sequence, five on MEDIC sequence, and all eight were visualized on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in detecting SLL tears were 37.5%, 62.5%, and 100%, respectively. One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography. The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively. Conclusions: MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears.

  1. MR imaging of plica synovialis mediopatellaris. Efficacy of intraarticular MR arthrography with saline administration

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    Kobayashi, Yuko; Yamamoto, Kanae [Nippon Medical School, Tokyo (Japan). Tama-Nagayama Hospital; Tajima, Natsuki; Kumazaki, Tatsuo

    1997-10-01

    In order to determine the efficacy of MR imaging with intraarticular administration of saline (saline-MR arthrography) for detecting and diagnosing plica synovialis mediopatellaris (PSM), saline-MR arthrography was performed on 12 knees of 10 patients with arthroscopically proven PSM. Conventional MRI was also performed on 8 knees of 6 patients. On T{sub 2}-weighted images, evidence of PSM was detected in 10 knees using saline-MR arthrography as a low signal intensity band between the patella and the medial femoral condyle, whereas evidence of PSM was detected in only 2 knees using conventional MRI. Comparing arthroscopic findings with MRI findings, saline-MR arthrographic findings concurred with arthroscopic findings in 9 of 12 knees with PSM, whereas conventional MRI findings concurred with arthroscopic findings in only 2 of the 12 knees with PSM. In conclusion, our findings suggest that saline-MR arthrography is more useful than conventional MRI for detection of PSM, and shows better correlation with arthroscopic findings. (author)

  2. Arthrography, ultrasound and MR imaging in the evaluation of the rotator cuff: a prospective study

    International Nuclear Information System (INIS)

    Purpose: To evaluate the accuracy of arthrography, ultrasound and MR imaging in rotator cuff disease. Methods: 40 patients suffering from subacromial impingement syndrome for at least three months and who were selected for surgery, underwent ultrasound, bouble-contrast arthrography and MR imaging. Patient preselection focused on partial and small complete tears. Results: 13/26 surgically confirmed tears were partial tears (articular surface: 10, bursal surface: 2, intrasubstance tearing: 1). Arthrography, ultrasound and MR imaging yield a sensitivity for complete tears of 91%, 69% and 92% with a specificity of 100%, 93% and 93%. For partial tears sensitivity was 50%, 69% and 69% with a specificity of 100%, 79% and 86%. Concerning evaluation of localisation, extent and correct classification ultrasound was correct in 17/26 cases, MR in 21/26 cases. Conclusion: Arthrography is not helpful in detecting partial tears. Ultrasound and MR imaging yield comparable accuracy. MR imaging has advantages concerning better evaluation of extent, location and classification as well as for the detection of associated pathologies. (orig.)

  3. Prospective, double-blind comparison of shoulder MR imaging, US, arthrography, and arthroscopy

    International Nuclear Information System (INIS)

    To determine the efficacy of diagnostic imaging modalities in the evaluation of shoulder pain, magnetic resonance (MR) imaging, ultrasonography (US) and arthrography were prospectively compared in a double-blind experimental protocol. Thirty consecutive patients were studied by these modalities, which received separate, blinded interpretations. The images and interpretations were sealed in an envelope and blinded from the arthroscopist for initial arthroscopy, but second-look arthroscopy, and in some cases open surgery, was performed after the envelopes were unsealed. To avoid selection bias, negative MR and/or US examinations never affected confirmation by arthrography and/or arthroscopy, so negatives and positives were equivalently tested. To date, MR imaging and US are equally sensitive in the detection of rotator cuff tears, but the combination is more sensitive. Both MR imaging and US demonstrated tears not diagnosed by means of arthrography, and MR imaging distinguished hemorrhagic muscle tears from rotator cuff tears, which arthrography and arthroscopy did not. Both MR imaging and US showed characteristic appearances of biceps tendonitis, but neither demonstrated adhesive capsulitis. The authors conclude that all three imaging modalities have a role in shoulder diagnosis

  4. Comparison of MRI and arthrography in the preoperative work up of Legg-Calve-Perthes disease; Bilan preoperatoire des osteochondrites de hanches: comparaison de l'arthrographie et de l'IRM avec des cliches en abduction

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    Boyer, C.; Leclet, H.; Sutter, B.; Delforge, P.M. [Institut Calot, Service de l' Unite d' Imagerie de l' Appareil Locomoteur, 62 - Berck sur Mer (France)

    2001-05-01

    Purpose. Comparison between conventional arthrography and MRI in the preoperative work up of Legg-Calve-Perthes disease. Material and methods. We studied 17 children (18 hips) who had arthrography and MRI (open-magnet configuration) the same day. Coronal and sagittal T1 weighted were realised with the hip in neutral position. Additional coronal T1 weighted with abduction of the hip were obtained. Two readers analysed individually MRI and arthrographic findings: shape of femoral head, index of Heyman (antero-external covering), came effect, re-centering of femoral head and quality of examination. Results. No statistical difference between MRI and arthrography could be noted-exception made for the index of Heyman. Conclusion. MRI can replace arthrography in Legg-Calve-Perthes disease. (authors)

  5. Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA

    Directory of Open Access Journals (Sweden)

    Heba Ahmed Kamal

    2014-09-01

    Conclusion: MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.

  6. Ultrasound versus Magnetic Resonance Arthrography in Acetabular Labral Tear Diagnostics: A Prospective Comparison in 20 Dysplastic Hips

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    Troelsen, A.; Jacobsen, S.; Bolvig, L.; Gelineck, J.; Roemer, L.; Soeballe, K. [Orthopedic Research Unit and Dept. of Radiology, Univ. Hospital of Aarhus, A arhus (Denmark)

    2007-11-15

    Background: Acetabular labral tears are highly associated with hip dysplasia. Magnetic resonance arthrography (MR arthrography) is the expensive and time-consuming contemporary gold-standard method in the radiological assessment of acetabular labral tears. Purpose: To assess the diagnostic ability of noninvasive ultrasound (US) examination compared to MR arthrography in diagnosing acetabular labral tears in dysplastic hip joints. Material and Methods: The study compared US examination and MR arthrography diagnosis of labral tears in 20 consecutively referred dysplastic hip joints. Results: The ability to diagnose acetabular labral tears upon US examination was calculated: sensitivity 44%, specificity 75%, positive predictive value 88%, and negative predictive value 25%. Conclusion: The ability of US examination in diagnosing acetabular labral tears is not yet good enough. The technique is still to be developed, and more experience, especially with the interpretation of US examinations, is needed.

  7. Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears

    International Nuclear Information System (INIS)

    Investigation of shoulder pain is important before surgical treatment. The presence or absence of a full-thickness rotator cuff tear (FTRCT) may determine the type of surgical treatment. Both MRI and conventional arthrography can be used, but little is known about their relative diagnostic and therapeutic impact. We performed a prospective trial assessing: (a) the influence of MRI and arthrography results on the clinician's diagnostic thinking (diagnostic impact); (b) the influence of the results on the clinician's therapeutic thinking (therapeutic impact); and (c) the diagnostic performance of the two techniques in patients with surgical confirmation. A total of 104 consecutive patients with shoulder problems referred to a specialist orthopaedic shoulder clinic underwent pre-operative investigation with MRI and arthrography. The surgeon's diagnosis, diagnostic confidence and planned treatment were measured before the investigation, and then again after the results of each investigation. Before the presentation of the investigation results, the patients were randomised into two groups. In one group MRI was presented first; in the other group, arthrography. The MRI results led to fewer changes in diagnostic category (14 of 46, 30 %) than arthrography (20 of 54, 37 %), but the difference was not significant (P > 0.5). Magnetic resonance imaging led to slightly more changes in planned management (17 of 47, 36 %) than arthrography (14 of 55, 25 %), but again the difference was not statistically significant (P > 0.3). The results of the second investigation always had less diagnostic and therapeutic impact than the first. The accuracy of MRI for FTRCT in 38 patients with surgical confirmation was 79 %, sensitivity 81 % and specificity 78 %; the accuracy of arthrography was 82 %, sensitivity 50 % and specificity 96 %. The clinical diagnosis and management plan can be adequately defined by a single radiological investigation. Magnetic resonance imaging and arthrography

  8. The value of contrast and subtraction arthrography in the assessment of aseptic loosening of total hip prostheses: A meta-analysis

    International Nuclear Information System (INIS)

    Objective: To summarize and compare the diagnostic accuracy of contrast and subtraction arthrography in the assessment of aseptic loosening of total hip arthroplasties. Design: This meta-analysis was performed using methods described by the Cochrane Methods Group on Systematic Reviews of Screening and Diagnostic Tests. We included original, English-language papers published between January 1975 to October 2004 that examined contrast-enhanced arthrography with or without subtraction for diagnosis of loosening of total hip prostheses. A qualitative and quantitative analysis was performed by two investigators. Results: With regard to the acetabular component, pooled sensitivity and specificity for contrast arthrography was 70% (95% confidence interval, 52-84) and 74% (95% CI, 53-87), respectively. Subtraction arthrography had a significantly higher sensitivity of 89% (95% CI, 84-93) (p = 0.01), with a similar specificity of 76% (95% CI, 68-82). For the femoral component, pooled sensitivity and specificity for contrast arthrography were 63% (95% CI, 53-72) and 78% (95% CI, 68-86). Pooled estimates for subtraction arthrography revealed a significantly higher sensitivity of 86% (95% CI, 74-93) (p = 0.003). Specificity was 85% (95% CI, 77-91) and was similar to the data of contrast arthrography (p = 0.23). Conclusion: Using the present data we found that the subtraction arthrography is a sensitive technique for detection of loosening of total hip prostheses, offering added value over contrast arthrography, especially for evaluation of the femoral component

  9. Anterior labral tear: diagnostic value of MR arthrography of the shoulder

    International Nuclear Information System (INIS)

    To assess the accuracy of magnetic resonance(MR) arthrography in the diagnosis of anterior labral tear of the shoulder Between september 1996 and February 2000, MR arthrography of the shoulder was performed in 281 patients with a history of shoulder pain or instability. Among this total, only 157 shoulders in 154 patients who underwent arthroscopy or open surgery 0 to 230 (average, 20.9) days after MR arthrography were included in this study; the subjects comprised of 150 males and 4 females with an average age of 23.3 years. MR arthrographs of these 154 patients were analyzed for the presence of anterior labral tears, and the findings were correlated with the arthroscopic and surgical findings. Anterior labral tear was classified as A to D according to its location, as determined by arthroscopy and surgery. (A=4 to 6 o'clock direction, anteroinferior; B=2 to 4 o'clock direction, central; C=12 to 2 o'clock direction, anterosuperior; D= SLAP lesion). The retrospective analysis of MR arthrographs showing false-positive and negative findings was also underthken.. In the diagnosis of anterior labral tear, MR arthrography showed a sensitivity of 94%, a specificity of 90% and an accuracy of 91%. Anterior labral tears were confirmed by arthroscopy or surgery in 62 of the 157 shoulders (39%). Among 62 lesion, two (3%) were observed in area A, 32(52%) in area A+B, nine (15%) in area A+B+C, one(2%) in area A+B+D,13(21%) in area A+B+C+D, two (3%) in area B+C, one(2%) in area B+D, and two(3%) in area C. Among ten false-positive cases, seven were focal lessions (two, three and two lesions in area A, B and C, respectively), and in the remaining three cases, lacated in area A+B, MR arthrography revealed thickening and deformation. All four false negatives were focal lesions (two in area A and two in area C). Other than in focal lesions, in which accuracy was relatively low, MR arthrography showed high sensitivity, specificity and accuracy in the diagnosis of anterior labral tear

  10. MR arthrography: pharmacology, efficacy and safety in clinical trials

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    Schulte-Altedorneburg, G.; Gebhard, M.; Wohlgemuth, W.A.; Fischer, W.; Zentner, J.; Bohndorf, K. [Department of Radiology, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg (Germany); Wegener, R.; Balzer, T. [Clinical Development Diagnostics and Radiopharmaceuticals II, Schering AG, Berlin (Germany)

    2003-01-01

    A meta-analysis was carried out of clinical trials published between 1987 and 2001 in respect of the clinical pharmacology and safety as well as the diagnostic efficacy of gadolinium-DTPA (Gd-DTPA) for direct intra-articular injection before MRI examination.Design. Scientific papers (clinical, postmortem and experimental studies) and information from the manufacturer regarding intra-articular injection of Gd-DTPA that addressed questions of mode of action, optimal concentration and dose, elimination and safety were reviewed. Clinical studies were classified according to their study design. The sensitivity, specificity and accuracy of MR arthrography (MRA) were compared with a ''gold standard'' (arthroscopy, arthrotomy) and other radiological evidence for different joints.Results. Fifty-two clinical studies of the overall 112 studies addressed aspects of diagnostic efficacy of MRA in patients or in healthy volunteers. The shoulder was the most assessed joint (29 of 52 studies). Good (>80%) or even excellent (90-100%) sensitivity, specificity and accuracy were found for MRA in most indications, especially for the shoulder and knee joints and induced extension of rotator cuff lesions, labrum abnormalities and postoperative meniscal tears. Two millimoles per liter has proven to be the best concentration for intra-articular administration of Gd-DTPA. After passive complete diffusion from the joint within 6-24 h, complete and rapid renal elimination takes place after intra-articular injection. Local safety proved to be excellent after intra-articular administration of Gd-DTPA. Regarding systemic tolerance almost no side effects have been reported, but the same safety considerations apply for intra-articular administration of Gd-DTPA as for intravenous injection.Conclusions. The diagnostic efficacy of intra-articular MRA in most clinical conditions affecting major joints is greater than that of plain MRI. In some diagnostic problems MRA achieves almost

  11. Depiction of the triangular fibro-cartilage in patients with ulnar-sided wrist pain: comparison of direct multi-slice CT arthrography and direct MR arthrography

    International Nuclear Information System (INIS)

    To compare direct multi-slice CT arthrography (MSCT-AG) and direct MR arthrography (MR-AG) of the wrist with regard to the depiction of the triangular fibro-cartilage (TFC). Fifteen consecutive patients with ulnar-sided wrist pain suspicious for TFC tear underwent both MSCT-AG and MR-AG of the wrist. Images obtained were evaluated by two radiologists in a blinded fashion for the depiction of six anatomical areas (radial, central and ulnar portion on the proximal and distal side) of the TFC by means of a five-point scoring system (1excellent visibility to 5= not visible). Scores for MSCT-AG and MR-AG were compared using the Student's t-test. Mean scores for MSCT-AG and MR-AG, respectively, were 2.5/2.0, 3.2/2.5 and 2.8/2.4 for the radial, central and ulnar portion of the TFC on its proximal side, and 2.7/2.0, 3.1/2.3 and 2.9/2.4 for the radial, central and ulnar portion on its distal side (n=15). Paired Student's t-test showed no significant difference between MSCT-AG and MR-AG (P>0.05). In a first, small series, depiction of the TFC with MSCT-AG is comparable to that of MR-AG. Further evaluation of direct multi-slice CT arthrography of the wrist in a larger patient population would be promising. (orig.)

  12. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

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    Tian, Chun-Yan [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Wang, Jian-Quan [Department of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191,PR China (China); Zheng, Zhuo-Zhao, E-mail: zzhuozhao@aliyun.com [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Ren, A.-Hong [Department of Radiology, Beijing Daxing Hospital, 26 West Huangcun Road, Daxing District, Beijing 102600 (China)

    2014-10-15

    Highlights: • MR is the preferred imaging modality for diagnosing acetabular labral tears. • The diagnostic performance of MR arthrography are superior than conventional hip MR. • The hip MR arthrography is recommended for diagnosing acetabular labral lesions. - Abstract: Objective: To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears. Methods: 90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy. Results: 59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K = 0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K = 0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P < 0.05). Conclusion: Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.

  13. Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography

    International Nuclear Information System (INIS)

    We retrospectively evaluated the anterior talo-fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, i particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous). (authors)

  14. Shoulder arthrography: comparison of morbidity after use of various contrast media

    International Nuclear Information System (INIS)

    This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints associated with a high incidence of postprocedural pain

  15. Legg-Calve-Perthes disease. Comparison of conventional radiography, MR imaging, bone scintigraphy and arthrography

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    Kaniklides, C. [Dept. of Diagnostic Radiology, Univ. Hospital, Uppsala (Sweden); Loennerholm, T. [Dept. of Diagnostic Radiology, Univ. Hospital, Uppsala (Sweden); Moberg, A. [Dept. of Orthopaedics, Univ. Hospital, Uppsala (Sweden); Sahlstedt, B. [Dept. of Diagnostic Radiology, Univ. Hospital, Uppsala (Sweden)

    1995-07-01

    In a prospective study of 22 patients (24 hips) with Legg-Calve-Perthes disease (LCPD) the findings at conventional radiography, arthrography, bone scintigraphy and MR imaging, obtained at the time of diagnosis, were compared. MR was superior to conventional radiography and bone scintigraphy in the detection of the extent of involvement in the femoral head. Arthrography was as good as or better than MR imaging in determining the shape of the articular surfaces and the occurrence of lateral subluxation. Conventional radiography was less sensitive in identifying the degree of lateral subluxation and the extent of the necrosis in the femoral head. MR imaging provided anatomical and pathophysiological information about the extent and location of head involvement as well as the degree of lateral subluxation. Revascularisation was more clearly demonstrated with MR than with bone scintigraphy, irrespective of symptom duration. (orig.).

  16. Fast MR arthrography using VIBE sequences to evaluate the rotator cuff

    Energy Technology Data Exchange (ETDEWEB)

    Vandevenne, Jan E. [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium); Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Vanhoenacker, Filip; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Mahachie John, Jestinah M. [University of Hasselt, Centre for Statistics, Diepenbeek (Belgium); Gelin, Geert [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium)

    2009-07-15

    The purpose of this paper was to evaluate if short volumetric interpolated breath-hold examination (VIBE) sequences can be used as a substitute for T1-weighted with fat saturation (T1-FS) sequences when performing magnetic resonance (MR) arthrography to diagnose rotator cuff tears. Eighty-two patients underwent direct MR arthrography of the shoulder joint using VIBE (acquisition time of 13 s) and T1-FS (acquisition time of 5 min) sequences in the axial and paracoronal plane on a 1.0-T MR unit. Two radiologists scored rotator cuff tendons on VIBE and T1-FS images separately as normal, small/large partial thickness and full thickness tears with or without geyser sign. T1-FS sequences were considered the gold standard. Surgical correlation was available in a small sample. Sensitivity, specificity, and positive and negative predictive values of VIBE were greater than 92% for large articular-sided partial thickness and full thickness tears. For detecting fraying and articular-sided small partial thickness tears, these parameters were 55%, 94%, 94%, and 57%, respectively. The simple kappa value was 0.76, and the weighted kappa value was 0.86 for agreement between T1-FS and VIBE scores. All large partial and full thickness tears at surgery were correctly diagnosed using VIBE or T1-FS MR images. Fast MR arthrography of the shoulder joint using VIBE sequences showed good concordance with the classically used T1-FS sequences for the appearance of the rotator cuff, in particular for large articular-sided partial thickness tears and for full thickness tears. Due to its very short acquisition time, VIBE may be especially useful when performing MR arthrography in claustrophobic patients or patients with a painful shoulder. (orig.)

  17. Normal anatomy and common labral lesions at MR arthrography of the shoulder

    International Nuclear Information System (INIS)

    MR arthrography of the shoulder is the most accurate imaging modality in demonstrating abnormalities of the glenoid labrum and associated structures. Tears of the labrum, the capsule or the gleno-humeral ligaments can lead to pain, catching, popping or instability. The anatomy of this region is complex. We present the normal anatomy of the glenoid labrum, biceps anchor and gleno-humeral ligaments together with their normal variants and then describe common labral-ligamentous pathologies

  18. Abduction and external rotation (ABER) MR arthrography of the shoulder. Benefits and limitations

    International Nuclear Information System (INIS)

    The purpose of this study was to show the benefits and limitations of using abduction and external rotation (ABER) positions of the arm during MR arthrography of the shoulder in the evaluation of the rotator-cuff tendon, the capsulolabral complex and the shoulder joint after surgery. Forty-seven patients complaining of either shoulder instability, chronic shoulder pain, pain of unknown cause or pain following shoulder surgery were studied using the direct MR arthrography technique in both the standard neutral position with the arm adducted as well as with the arm in the ABER position. A correlation was obtained between the MR arthrography findings and the surgical findings in 10 reports and clinical presentations of the examined patients. Three patients [6%] were unable to perform ABER positioning. ABER oblique axial images were better than standard oblique coronal images in revealing undersurface tears of the rotator cuff particularly of the grade I type. Four tears were missed in standard images. Oblique axial images were better than standard axial images in demonstrating non-displaced anterior labral tears. One tear was missed and two tears were suspected in the standard images. Oblique axial images were less sensitive than oblique coronal images in the diagnosis of superior labral tears. Two tears were missed in ABER images. The ABER oblique axial MR arthrogram is a useful adjunct to the standard axial and oblique coronal MR arthrograms for assessment of capsulolabral abnormalities and rotator-cuff tendon tears despite some limitations. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Whal; Chung, Jin-Wook; Kang, Heung-Sik; Hong, Sung-Hwan; Choi, Ja-Young [Seoul National University, Seoul (Korea, Republic of); Kim, Ho-Sung; Kim, Seok-Jung; Kim, Hyung-Ho [Aeromedical Center, Seoul (Korea, Republic of)

    2004-03-15

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

  20. Comparison of MDCTA (16-slice multi-detector row computed tomography arthrography) and MRA (magnetic resonance arthrography) for detecting labral lesions of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung A; Cha, Jang Gyu; Hong, Hyun Sook; Choi, Deuk Lin; Park, Jai Soung; Lee, Hae Kyung; Kim, Dae Ho [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2007-11-15

    To compare the accuracy of 16-slice multi-detector row computed tomographic arthrography (MDCTA) and magnetic resonance arthrography (MRA) for making the diagnosis and classification of labroligamentous injuries. This study is a prospective series that used MRA and MDCTA to examine 23 patients who complained of shoulder instability. Two radiologists independently analyzed the MRA and MDCTA. The sensitivity, specificity, accuracy, positive and negative predictive values were calculated from the arthrograms and the arthroscopic findings. The images of MDCTA and MRA corresponded with the findings on arthroscopy. Both imaging modalities had the same sensitivity for detecting Bankart lesions (n = 10, 90%) and posterior labral tears (n = 2, 50%) on McNemar test ({rho} = 1.00). For superior labrum anterior-to-posterior (SLAP) lesions, 6 MRA cases and 4 MDCTA cases corresponded with the arthroscopic findings. The difference between the sensitivities of MDCTA (66.7%) and MRA (100%) was not significant ({rho} 0.09). We suggest that the sensitivity of diagnosing labral lesions that induce shoulder instability is similar for MDCTA and MRA. MDCTA is effective for diagnosing and evaluating shoulder instability.

  1. Femoral head shape in Legg-Calve-Perthes disease. Correlation between conventional radiography, arthrography and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Hochbergs, P. [Dept. of Diagnostic Radiology and Orthopedics, Univ. Hospital, Lund (Sweden)]|[Dept. of Diagnostic Radiology, Univ. Hospital, Odense (Denmark); Eckerwall, G. [Dept. of Diagnostic Radiology and Orthopedics, Univ. Hospital, Lund (Sweden)]|[Dept. of Diagnostic Radiology, Univ. Hospital, Odense (Denmark); Egund, N. [Dept. of Diagnostic Radiology and Orthopedics, Univ. Hospital, Lund (Sweden)]|[Dept. of Diagnostic Radiology, Univ. Hospital, Odense (Denmark); Jonsson, K. [Dept. of Diagnostic Radiology and Orthopedics, Univ. Hospital, Lund (Sweden)]|[Dept. of Diagnostic Radiology, Univ. Hospital, Odense (Denmark); Wingstrand, H. [Dept. of Diagnostic Radiology and Orthopedics, Univ. Hospital, Lund (Sweden)]|[Dept. of Diagnostic Radiology, Univ. Hospital, Odense (Denmark)

    1994-11-01

    Twenthy-three children with Legg-Calve-Perthes disease were examined to determine the femoral head shape. We evaluated and correlated conventional radiography, arthrography and MR imaging. In the a.p. view, measurements were obtained from the center of the femoral head along the bony or cartilaginous outline at 30 intervals. Maximum flattening of the cartilaginous outline appeared laterally, 60 from the center of the baseline of the epiphyseal index and the caput index. Maximum flattening of the bony outline was found at 75 . Arthrography and MR imaging gave the same information about the shape of the femoral head cartilage. The bony femoral head shape on conventional radiographs in the a.p. view did not reflect the cartilage shape obtained by MR and arthrography. (orig.).

  2. A study of the anatomy and injection techniques of the ovine stifle by positive contrast arthrography, computed tomography arthrography and gross anatomical dissection.

    Science.gov (United States)

    Vandeweerd, Jean-Michel; Kirschvink, Nathalie; Muylkens, Benoit; Depiereux, Eric; Clegg, Peter; Herteman, Nicolas; Lamberts, Matthieu; Bonnet, Pierre; Nisolle, Jean-Francois

    2012-08-01

    Although ovine stifle models are commonly used to study osteoarthritis, meniscal pathology and cruciate ligament injuries and repair, there is little information about the anatomy of the joint or techniques for synovial injections. The objectives of this study were to improve anatomical knowledge of the synovial cavities of the ovine knee and to compare intra-articular injection techniques. Synovial cavities of 24 cadaver hind limbs from 12 adult sheep were investigated by intra-articular resin, positive-contrast arthrography, computed tomography (CT) arthrography and gross anatomical dissection. Communication between femoro-patellar, medial femoro-tibial and lateral femoro-tibial compartments occurred in all cases. The knee joint should be considered as one synovial structure with three communicating compartments. Several unreported features were observed, including a communication between the medial femoro-tibial and lateral femoro-tibial compartments and a latero-caudal recess of the lateral femoro-tibial compartment. No intermeniscal ligament was identified. CT was able to define many anatomical features of the stifle, including the anatomy of the tendinous synovial recess on the lateral aspect of the proximal tibia under the combined tendon of the peroneus tertius, extensor longus digitorum and extensor digiti III proprius. An approach for intra-articular injection into this recess (the subtendinous technique) was assessed and compared with the retropatellar and paraligamentous techniques. All three injection procedures were equally successful, but the subtendinous technique appeared to be most appropriate for synoviocentesis and for injections in therapeutic research protocols with less risk of damaging the articular cartilage.

  3. Importance of transthoracic X-ray in arthrography of the shoulder

    International Nuclear Information System (INIS)

    Even in this era of sonography, arthrography of the shoulder is an important diagnostic investigation, making it possible to exclude unrecognized connective tissue lesions in patients with chronic shoulder pain resisant to therapy. Sometimes standard X-ray techniques do not yield all the information the surgeon needs about ventral or dorsal localization of a rotator-cuff rupture. An Additional approach to the joint is needed: A transthoracic lateral-view X-ray provides the surgeon with adequate information to help in selection of the most appropriate operative approach to the shoulder. (orig.)

  4. Use of anesthetic arthrography in the identification of the source of chronic posttraumatic hindfoot disability

    International Nuclear Information System (INIS)

    Selective anesthetic arthrography was performed in 18 patients to define precisely the source of chronic posttraumatic hindfoot pain. A solution composed of local anesthetic and iodinated contrast material was injected into the hindfoot articulations, and the clinical response was determined. Although there was close correlation between pain relief and abnormalities depicted with both routine radiography and CT, both imaging methods tended to underestimate the severity of articular involvement, and plain film findings in five patients were misleading as to the site of pain origin. Long-term follow-up evaluation in nine patients who underwent arthrodesis on the basis of arthrographic findings indicated satisfactory results in eight

  5. Accuracy of 3-Tesla MR and MR arthrography in diagnosis of meniscal retear in the post-operative knee

    International Nuclear Information System (INIS)

    This study assesses the accuracy of 3-Tesla (3-T) conventional MR imaging, 3-T MR arthrography, and the combined use of conventional MR and MR arthrography in the diagnosis of meniscal retears as compared with arthroscopy. The study also assess whether there are false-negative cases in which injected contrast does not extend into the meniscus despite a meniscal retear being seen on arthroscopy. One hundred consecutive knee MR arthrograms performed on patients with previous knee surgery were reviewed retrospectively. 3-T conventional MR imaging, 3-T MR arthrography, and the combined use of conventional MR and MR arthrography were assessed for meniscal retears as compared with arthroscopy. The criterion used to diagnose a meniscal retear on MR arthrogram was injected contrast tracking into the meniscus. All patients underwent second-look arthroscopy. Seventy-four patients had conventional MR findings consistent with a meniscal retear. In 83 of the 100 patients, intraarticular contrast helped in demonstrating a retear. In ten patients, there were MR findings consistent with a meniscal retear despite intra-articular contrast not tracking into the meniscus. Ninety-four of the 100 patients had meniscal retears on second-look arthroscopy. Three-Tesla conventional MR examination was 78 % sensitive and 75 % specific, MR arthrogram examination was 88 % sensitive and 100 % specific, and the combined use of MR and MR arthrogram imaging was 98 % sensitive and 75 % specific in the diagnosis of a meniscal retear. The combined use of 3-T MR and MR arthrography allows for high sensitivity and specificity in meniscal retear detection. In some patients, intraarticular contrast will not track into a meniscal retear. When MR findings are consistent with a meniscal retear but contrast does not extend into the meniscus, a meniscal retear is likely. (orig.)

  6. Comparison of three dimensional isotropic and two dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Yoon, Young Cheol; Kwon, Jong Won; Yoo, Jae Chul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Cha, Jang Kyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jee, Suk Kyoung [Joeun Madi Hospital, Seoul (Korea, Republic of)

    2014-12-15

    To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

  7. MR arthrography of the shoulder: tolerance evaluation of four different injection techniques

    Energy Technology Data Exchange (ETDEWEB)

    Perdikakis, Evangelos; Drakonaki, Eleni; Karantanas, Apostolos [University Hospital, Department of Medical Imaging, Heraklion, Crete (Greece); Maris, Thomas [University Hospital, Department of Medical Physics, Heraklion, Crete (Greece)

    2013-01-15

    We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography. A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n{sub 1} = 37), with CT guidance using an anterior (n{sub 2} = 29) or a posterior approach (n{sub 3} = 32) and with ultrasound guidance (n{sub 4} = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = ''no pain'', 10 = ''intolerable pain''), technical success of the method used, and reason for referral were recorded. The technical success rate was 100 % for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 {+-} 1.24, CT anterior guidance demonstrated a mean pain of 3.87 {+-} 0.95, CT posterior guidance showed a mean pain of 1.59 {+-} 0.81, and ultrasound guidance a mean pain of 3.63 {+-} 1.12. A significant difference (p <.05) was observed for the posterior route under CT guidance. The mean pain level was significantly higher for older (> 51 year) female patients. No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient. (orig.)

  8. MR arthrography of the shoulder: tolerance evaluation of four different injection techniques

    International Nuclear Information System (INIS)

    We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography. A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n1 = 37), with CT guidance using an anterior (n2 = 29) or a posterior approach (n3 = 32) and with ultrasound guidance (n4 = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = ''no pain'', 10 = ''intolerable pain''), technical success of the method used, and reason for referral were recorded. The technical success rate was 100 % for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 ± 1.24, CT anterior guidance demonstrated a mean pain of 3.87 ± 0.95, CT posterior guidance showed a mean pain of 1.59 ± 0.81, and ultrasound guidance a mean pain of 3.63 ± 1.12. A significant difference (p 51 year) female patients. No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient. (orig.)

  9. Displaceability of SLAP lesion on shoulder MR arthrography with external rotation position

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jin Young; Ha, Doo Hoe; Lee, Sang Min [CHA University, Department of Radiology, CHA Bundang Medical Center, Gyeonggi-do (Korea, Republic of); Blacksin, Marcia F. [University of Medicine and Dentistry of New Jersey, Department of Radiology, New Jersey Medical School, Newark, NJ (United States); Kim, Kyung Ah [Inje University Ilsan-Paik Hospital, Department of Radiology, Gyeonggi-do (Korea, Republic of); Kim, Jae Wha [CHA University, Department of Orthopedics, CHA Bundang Medical Center, Gyeonggi-do (Korea, Republic of)

    2011-08-15

    To investigate the usefulness of the external rotation (ER) position on magnetic resonance (MR) arthrography for the diagnosis of superior labral anterior to posterior (SLAP) lesion. Approval of institutional review board was obtained, and informed consent was waived. The MR arthrograms of 210 shoulders that were arthroscopically confirmed as SLAP lesion in 163 shoulders and intact superior labrum in 47 shoulders were retrospectively reviewed in each neutral and ER position for the diagnosis of SLAP lesion, the extent of distraction of the torn labrum, and the external rotation angle. The sensitivity, specificity, and diagnostic accuracy of MR arthrograms for determining SLAP lesion were assessed in each position. For the arthroscopically confirmed group, the diagnosis of SLAP lesion and the extent of distraction about the tear were compared between neutral and ER positions by Fisher's exact test and the paired t-test. The correlation between the external rotation angle and the diagnosis of SLAP lesion, and between the external rotation angle and the differences in the extent of distraction were evaluated in the ER position using the ANOVA test. Sensitivity and diagnostic accuracy of MR arthrography for SLAP lesion increased from 64.4% and 71.0% in the neutral position to 78.5% and 81.9% in the ER position, respectively, without change of specificity, which was 93.6% in both positions. The diagnosis of SLAP lesion was changed from negative to SLAP lesion in 16.0% of the arthroscopically confirmed group. Mean difference in the extent of distraction about the tear was 0.69 mm (range -1.40 {proportional_to} 6.67 mm), which was statistically significant. There was no relationship between the external rotation angle and the diagnosis of SLAP lesion, and between the external rotation angle and the differences in the extent of distraction. Shoulder MR arthrography with additional ER positioning helps in the diagnosis of SLAP lesion and provides information about the

  10. Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries

    Energy Technology Data Exchange (ETDEWEB)

    Cerezal, Luis; Fernandez-Hernando, Moises [Department of Radiology, Diagnostico Medico Cantabria, Santander, Cantabria (Spain); Perez Carro, Luis [Learnig Trauma Med. Centro de Consultas Medicas CCM, Orthopedic Surgery department, Santander (Spain); Llorca, Javier [University of Cantabria - IDIVAL, Santander (Spain); CIBER Epidemiology and Public Health, Santander (Spain); Llopis, Eva [Alzira Hospital, Department of Radiology, Valencia (Spain); Montero, Juan Antonio [Cantabria University, Anatomy and Cell Biology, Santander (Spain); Canga, Ana [Cantabria University, Anatomy and Cell Biology, Santander (Spain); Department of Radiology Marques de Valdecilla University Hospital, Santander, Cantabria (Spain)

    2015-11-15

    To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries. Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19-53 years) and 76 women (mean age, 38.5 years; range, 18-56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated. At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6 %) patients and had suffered low-grade partial tears in 15 (8.1 %) patients, high-grade partial tears in 10 (5.4 %) patients, and complete ruptures in 7 (3.8 %) patients. MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93 %) and high-grade (66/96 %) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87 % and a specificity of 95 %. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92 %) and specificity (98 %). Articular distraction was significantly increased in patients with complete ruptures of the

  11. CT arthrography of the wrist using a novel, mobile, dedicated extremity cone-beam CT (CBCT)

    Energy Technology Data Exchange (ETDEWEB)

    Koskinen, Seppo K. [Helsinki University Central Hospital, Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki (Finland); Helsinki University Hospital, Toeoeloe Trauma Center, Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki (Finland); Haapamaeki, Ville V.; Kortesniemi, Mika [Helsinki University Central Hospital, Department of Radiology, HUS Helsinki Medical Imaging Center, Helsinki (Finland); Salo, Jari [Helsinki University Central Hospital, Department of Orthopedic and Trauma Surgery, Helsinki (Finland); Kuopio University Hospital, UEF, Department of Orthopedics, Traumatology and Hand Surgery, Kuopio (Finland); Lindfors, Nina C. [Helsinki University Central Hospital, Department of Orthopedic and Hand Surgery, Helsinki (Finland); Seppaelae, Lauri [Planmed Oy, Helsinki (Finland); Mattila, Kimmo T. [Turku University Central Hospital, Department of Diagnostic Radiology, Turku (Finland)

    2013-05-15

    To evaluate the feasibility and intra- and interobserver agreement of CBCT arthrography of wrist ligaments, triangular fibrocartilaginous complex (TFCC), and to assess the sensitivity (SE), specificity (SP), accuracy (ACC), and positive and negative predictive value (PPV, NPV) of CBCT arthrography in the diagnosis of scapholunate (SLL) and lunotriquetral (LTL) ligament tears, TFCC, and cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) using a novel, mobile, dedicated extremity CBCT scanner. Fifty-two consecutively enrolled subjects (26 M, 26 F, mean age 38 years, range 18-66 years) with suspected wrist ligament tears underwent CBCT-arthrography before normally scheduled MR arthrography.An extremity CBCT was used for imaging with isotropic voxel size of 0.4 x 0.4 x 0.4 mm{sup 3}. Subsequent routine 1.5 T MRI was performed using a dedicated wrist coil.Two observers reviewed the anonymized CBCT images twice for contrast enhancement (CE) and technical details (TD), for tears of the SLL, LTL, and TFCC. Also, cartilage abnormalities of the scaphoid and lunate with their corresponding radial surfaces (scaphoid and lunate fossa) were evaluated. Inter- and intraobserver agreement was determined using weighted kappa statistics. Since no surgery was performed, MRI served as a reference standard, and SE and SP, ACC, PPV, and NPV were calculated. Intra- and interobserver kappa values for both readers (reader 1/reader 2; first reading/second reading) with 95 % confidence limits were: CE 0.54 (0.08-1.00)/ 0.75 (0.46-1.00); 0.73 (0.29-1.00)/ 0.45 (0.07-0.83), TD 0.53 (0.30-0.88)/ 0.86 (0.60-1.00); 0.56 (0.22-0.91)/ 0.67 (0.37-0.98), SLL 0.59 (0.25-0.93)/ 0.66 (0.42-0.91); 0.31 (0.06-0.56)/ 0.49 (0.26-0.73), LTL 0.83 (0.66-1.00)/ 0.68 (0.46-0.91); 0.90 (0.79-1.00)/ 0.48 (0.22-0.74); TFCC (0.72-1.00)/ (0.79-1.00); 0.65 (0.43-0.87)/ 0.59 (0.35-0.83), radius (scaphoid fossa) 0.45 (0.12-0.77)/ 0.64 (0.31-0.96); 0

  12. Preoperative conventional magnetic resonance images versus magnetic resonance arthrography of subacromial impingement syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong [Pusan National Univ. Yangsan Hospital, Yangsan (Korea, Republic of); Lee, In Sook; Lee, Seung Jun [Pusan National Univ. Hospital, Busan (Korea, Republic of)

    2012-09-15

    To evaluate the usefulness of conventional magnetic resonance images (MRI) for arthroscopic surgery in subacromial impingement syndrome of the shoulder, as an alternative to MR arthrography with additional T2 fat saturation images (MRA). The preoperative MRI of 77 patients (45 females, 32 males) (52 right, 25 left) and MRA of 34 patients (14 females, 20 males) (24 right, 10 left) with subsequent arthroscopic confirmation of subacromial impingement syndrome were reviewed retrospectively. The lesions requiring arthroscopic surgery were 95 subacromial spurs, 101 subacromial bursitis, and 51 full-thickness and 44 partial thickness tears of the supraspinatus among 111 cases for both studies. A two by two table was constructed in order to calculate the sensitivity and specificity of both studies against arthroscopic outcomes. Also we analyzed the false positive and false negative cases of the full-thickness tears individually. The detection rates of subacromial spur and bursitis and full and partial thickness tears of the supraspinatus were 91%, 94%, 77%, and 65% in MRI and 93%, 100%, 83%, and 77% in MRA respectively. Their specificities were 33%, 33%, 90%, and 76% in MRI and 50%, 75%, 100%, and 71% in MRA respectively. Eleven false negative cases in regards to MRI resulted in Ellman's grade 3 partial thickness tear (72.7%), mild bursitis (63.6%), greater tuberosity erosion (45.5%), and negative fluid signal of the glenohumeral joint (81.8%). Three false positive cases on the MRI were induced from errors with lower window depth and width on the imagings. Two false negative cases on MRA were induced from the adhesion between Ellman's grade 3 rim rent tear and the glenohumeral joint cavity. Conventional MR images could be used to decide the arthroscopic surgery in subacromial impingement syndrome, as an alternative to MR arthrography with additional T2 fat saturation images.

  13. [Double-contrast arthrography in chondropathia patellae--clinical and experimental study on pathogenesis and diagnosis (author's transl)].

    Science.gov (United States)

    Reichelt, A; Hehne, H J; Rau, W S; Schlageter, M

    1979-10-01

    This study is based on the evaluation of 250 arthrographies of the patellofemoral joint ("défilé" arthrographs in Ficat's terminology) which were performed because of clinical suspicion of chondropathia patellae and which could be controlled intraoperatively in 30 cases, as well as on examinations employing an etching paste as used in metallurgy and performed on 20 knee-joints of corpses. 46% of the arthrographies showed a ridge-shaped cartilaginous thickening which was not pre-modelled in the osseous structure and which separated the medial facette into a paramedian and a marginal segment and correlated with chondromalacia to a greater degree than patellar dysplasias or secondary osseous changes. This variant, which could not be detected by plain roentgenography, must be considered as a pre-arthrotic deformity on account of the high point-shaped pressure load on the ridge. The findings were fully confirmed by macroscopic examination of the postmortem material.

  14. Spiral CT arthrography of the knee: technique and value in the assessment of internal derangement of the knee

    International Nuclear Information System (INIS)

    Computed tomography imaging has achieved excellent multiplanar capability and submillimeter spatial resolution due to the development of the spiral acquisition mode and multidetector row technology. Multidetector spiral CT arthrography (CTA) yields valuable information for the assessment of internal derangement of the joints. This article focuses on the value of spiral CTA of the knee in the assessment of the meniscus, anterior cruciate ligament, and hyaline cartilage lesions. Advantages and disadvantages of spiral CTA with respect to MR imaging are presented. (orig.)

  15. Shoulder Magnetic Resonance Arthrography: A Prospective Randomized Study of Anterior and Posterior Ultrasonography-Guided Contrast Injections

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    Koivikko, M.P.; Mustonen, A.O.T. (Dept. of Radiology, Helsinki Univ. Central Hospital, Helsinki (Finland))

    2008-10-15

    Background: Magnetic resonance (MR) arthrography is an accurate imaging method for internal shoulder derangements and rotator cuff pathologies. Both anterior and posterior contrast injection techniques, under palpatory, fluoroscopic, or ultrasonographic guidance have been described in the literature. However, clinical comparisons of the injection techniques remain few. Purpose: To compare the performance of anterior and posterior ultrasonography (US)-guided arthrography injections of the shoulder regarding patient discomfort and influence on diagnostic MR reading, and to illustrate the typical artifacts resulting from contrast leakage in the respective techniques. Material and Methods: 43 MR arthrographies were prospectively randomized into anterior and posterior US-guided contrast injections and performed by two radiologists, with the study of artifacts from contrast leakage. Pain from the injections was assessed by a survey utilizing a 100-mm visual analogue scale (VAS). Results: Of the 23 anterior injections, nine caused contrast artifacts in the subscapular tendon, and in three the leakage extended further anteriorly. Of the 20 posterior injections, 12 showed injection artifacts of the rotator cuff, extending outside the cuff in seven. Two of the anterior and none of the posterior artifacts compromised diagnostic quality. In posterior injections, the leakage regularly occurred at the caudal edge of the infraspinatus muscle and was easily distinguishable from rotator cuff tears. All patients completed the pain survey. Mean VAS scores were 25.0 (median 18, SD 22) for anterior, and 25.4 (median 16, SD 25) for posterior injections. The two radiologists achieved different mean VAS scores but closely agreed as to anterior and posterior VAS scores. Conclusion: Arthrography injections were fairly simple to perform under US guidance. Patient discomfort for anterior and posterior injections was equally minor. A tailored approach utilizing anterior or posterior injections

  16. Shoulder Magnetic Resonance Arthrography: A Prospective Randomized Study of Anterior and Posterior Ultrasonography-Guided Contrast Injections

    International Nuclear Information System (INIS)

    Background: Magnetic resonance (MR) arthrography is an accurate imaging method for internal shoulder derangements and rotator cuff pathologies. Both anterior and posterior contrast injection techniques, under palpatory, fluoroscopic, or ultrasonographic guidance have been described in the literature. However, clinical comparisons of the injection techniques remain few. Purpose: To compare the performance of anterior and posterior ultrasonography (US)-guided arthrography injections of the shoulder regarding patient discomfort and influence on diagnostic MR reading, and to illustrate the typical artifacts resulting from contrast leakage in the respective techniques. Material and Methods: 43 MR arthrographies were prospectively randomized into anterior and posterior US-guided contrast injections and performed by two radiologists, with the study of artifacts from contrast leakage. Pain from the injections was assessed by a survey utilizing a 100-mm visual analogue scale (VAS). Results: Of the 23 anterior injections, nine caused contrast artifacts in the subscapular tendon, and in three the leakage extended further anteriorly. Of the 20 posterior injections, 12 showed injection artifacts of the rotator cuff, extending outside the cuff in seven. Two of the anterior and none of the posterior artifacts compromised diagnostic quality. In posterior injections, the leakage regularly occurred at the caudal edge of the infraspinatus muscle and was easily distinguishable from rotator cuff tears. All patients completed the pain survey. Mean VAS scores were 25.0 (median 18, SD 22) for anterior, and 25.4 (median 16, SD 25) for posterior injections. The two radiologists achieved different mean VAS scores but closely agreed as to anterior and posterior VAS scores. Conclusion: Arthrography injections were fairly simple to perform under US guidance. Patient discomfort for anterior and posterior injections was equally minor. A tailored approach utilizing anterior or posterior injections

  17. Spiral CT arthrography of the knee: technique and value in the assessment of internal derangement of the knee

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    Berg, Vande B.C.; Lecouvet, F.E.; Maldague, B.; Malghem, J. [Department of Radiology, Cliniques Universitaires St. Luc, Universite Catholique de Louvain, Brussels (Belgium); Poilvache, P. [Department of Orthopedic Surgery, Cliniques Universitaires St. Luc, Universite Catholique de Louvain, Brussels (Belgium)

    2002-07-01

    Computed tomography imaging has achieved excellent multiplanar capability and submillimeter spatial resolution due to the development of the spiral acquisition mode and multidetector row technology. Multidetector spiral CT arthrography (CTA) yields valuable information for the assessment of internal derangement of the joints. This article focuses on the value of spiral CTA of the knee in the assessment of the meniscus, anterior cruciate ligament, and hyaline cartilage lesions. Advantages and disadvantages of spiral CTA with respect to MR imaging are presented. (orig.)

  18. C-arm flat-panel CT arthrography of the wrist and elbow: first experiences in human cadavers

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    Guggenberger, Roman; Morsbach, Fabian; Alkadhi, Hatem; Pfammatter, Thomas; Hodler, Juerg; Andreisek, Gustav [University Hospital Zurich, Department of Radiology, Zurich (Switzerland); Vich, Magdalena [University Zurich, Institute of Anatomy, Zurich (Switzerland)

    2013-03-15

    To determine the optimal intra-articular iodine concentration for C-arm flat-panel computed tomography (FPCT) arthrography using advanced joint phantoms and to evaluate its application in human cadaveric wrists and elbows. Multi-detector (MD) CT served as the standard of reference. Joint phantoms and 10 human cadaveric wrist and elbow joints were scanned with C-arm FPCT (5-s, 8-s, and 20-s runs) and standard MDCT using different and optimal concentrations of iodinated contrast material. CT numbers of contrast material, tissue, and noise were measured and contrast-to-noise ratios (CNR) calculated for quantitative analysis. Image and depiction of cartilage, bone, and soft tissues were rated. Radiation doses were compared. In FPCT, iodine concentrations positively correlated with CT numbers and noise of contrast material and with radiation dose (r = 0.713-0.996, p < 0.05 each). At an iodine concentration of 45 mg/ml, CNR of cartilage and soft tissues were highest for all FPCT acquisitions and higher than in MDCT. The 20-s FPCT run performed best for image quality and depiction of anatomical structures and was rated overall equal to MDCT (p = 0.857). The optimal iodine concentration for C-arm FPCT arthrography in this study is 45 mg/ml, leading to superior CNR and image quality for an optimal FPCT protocol compared with standard MDCT arthrography in human cadaveric joints. (orig.)

  19. Indirect MR arthrography of the wrist in the diagnosis of TFCC-lesions; Indirekte MR-Arthrographie des Handgelenks bei TFCC-Laesionen

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    Herold, T.; Lenhart, M.; Held, P.; Feuerbach, S.; Link, J. [Regensburg Univ. (Germany). Inst. fuer Roentgendiagnostik; Babel, M.; Ruf, S. [Regensburg Univ. (Germany). Chirurgische Klinik und Poliklinik

    2001-11-01

    Purpose: The objective of this prospective study was to assess the value of the indirect MR arthrography (MR-AR) of the wrist in the detection of lesions of the TFCC. Material and methods: Indirect MR-AR was performed in 45 patients (23 f/22 m) with unclear ulnar wrist pain. After i.v. injection of 0.1 mmol/kg Gd-DTPA and after a motion-phase of the wrist (15 minutes) MRI was performed in a coronal plane. We used a STIR-, a fatsaturated (fs) T1-SE and a 3D-DESS sequence. The images were evaluated by two radiologists using a consensus score. The lesions were assigned to the system of Palmer and correlated with arthroscopy. Results: Indirect MR-AR showed in 35 of 45 patients a lesion of the TFCC, but arthroscopy only revealed a defect in 32 cases. This means three false positive but no false negative assessments by MRI. Using this MRI protocol sensitivity and specificity in the detection of TFCC lesions were calculated as 100% and 77%. The accuracy was 93%. Small degenerative changes of the fibres were most common (Palmer type IIA). In trauma patients the ligaments usually showed tears near the insertion at the ulna (Palmer type IB). The sensitivity and specificity was 88% and 95% for evaluation of the scapho-lunate (SL) ligament, the accuracy was 93%. Arthroscopy and MRI did not diagnose any rupture of the lunate-triquetral (LT) ligament. Conclusion: Indirect MR-AR is a non-invasive method with a high sensitivity in the evaluation of the TFCC and associated injuries. Therefore, it is an excellent screening procedure to assess the indication for therapeutic arthroscopy. (orig.) [German] Ziel dieser Studie ist die Evaluierung der Leistungsfaehigkeit der indirekten MR-Arthrographie (MR-AR) bei der Erfassung von TFCC-Laesionen. Material und Methode: Es wurden 45 Patienten (23 w/22 m) mit unklarem ulnaren Handgelenksschmerz mittels einer indirekten MR-AR untersucht. Nach i.v. Injektion von 0,1 mmol/kg Gd-DTPA und einer anschliessenden Bewegungsphase von 15 Minuten wurde

  20. MORPHOLOGICAL AND SIGNAL CHARACTERISTICS OF ROTATOR CUFF TEARS ON CONVENTIONAL MRI AND MR ARTHROGRAPHY:COMPARING WITH GROSS ANATOMY AND HISTOPATHOLOGY

    Institute of Scientific and Technical Information of China (English)

    XU Jian-rong; DENG Xia; HUA Jia; CAI Wei-min; LI Lei; ZHU Jian-shan

    2005-01-01

    Objective To study the MR characterizations of supraspinatus and infraspinatus tendon lesions by comparing with gross anatomy and histopathology. Methods The study group consisted of 20 cadaver shoulders which were underwent the same imaging protocols of conventional MRI and MR arthrography. Results SE-T2WI images or MR arthrography respectively possessed of high specificity (95.6%, 100%), but low sensitivity (70.6%, 58.8%) for diagnosing rotator cuff tears. By uniting two images techniques, could remedy its limitations and would markedly increase the sensitivity (88.2%). There were many factors influencing the visualizations of partial thickness tears of rotator cuff on MR images, from which uppermost factors are tear extent, ruptured synovial capsule, scar and synovial proliferation. Conclusion MRI diagnoses of rotator cuff lesions (especially partial thickness tears) must carefully be estimated by combining T2WI images and MR arthrography.

  1. MR arthrography of the shoulder: Optimizing pulse sequence protocols for the evaluation of cartilage and labrum

    International Nuclear Information System (INIS)

    Objectives: To compare axial T1weighted fat-saturated (T1w fs) and T1w non-fs sequences, and coronal T1w-fs and T2w-fs sequences, for evaluation of cartilage and labrum using CT arthrography (CTA) as the reference. Methods: Patients had MR arthrography (MRA) and CTA of the shoulder on the same day. Cartilage was assessed for superficial and full thickness focal and diffuse damage. Labral lesions were graded for Bankart variants and SLAP lesions. CTA images were read for the same features. The diagnostic performance of MRA including area under the curve (AUC) was evaluated against CTA. Results: When comparing axial sequences, the diagnostic performance for cartilage lesion detection on T1w non-fs was 61.9% (sensitivity) 93.6% (specificity) and 89.5% (accuracy) with AUC 0.782, while that for T1w fs was 61.9%, 94.0%, 89.8% and 0.783. For labral assessment, it was 89.1%, 93.0%, 91.4% and 0.919 for T1w non-fs, and 89.9%, 94.0%, 92.6% and 0.922 for T1w fs. Comparing coronal sequences, diagnostic performance for cartilage was 42.5%, 97.5%, 89.8% and 0.702 for T1w fs, and 38.4%, 98.7%, 90.2%, and 0.686 for T2w fs. For the labrum it was 85.1%, 87.5%, 86.2%, and 0.868 for T1w fs, and 75.7%, 97.5%, 80.8% and 0.816 for T2w fs. Conclusions: Axial T1w fs and T1w non-fs sequences are comparable in their ability to diagnose cartilage and labral lesions. Coronal T1w fs sequence offers slightly higher sensitivity but slightly lower specificity than T2w fs sequence for diagnosis of cartilage and labral lesions

  2. MR arthrography of the shoulder: Optimizing pulse sequence protocols for the evaluation of cartilage and labrum

    Energy Technology Data Exchange (ETDEWEB)

    Guermazi, Ali, E-mail: Ali.Guermazi@aspetar.com [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Jomaah, Nabil [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Hayashi, Daichi [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, 267 Grant Street, Bridgeport, CT 06610 (United States); Jarraya, Mohamed [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Silva, Jose Roberto [Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Niu, Jingbo [Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118 (United States); Almusa, Emad; Landreau, Philippe [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); and others

    2014-08-15

    Objectives: To compare axial T1weighted fat-saturated (T1w fs) and T1w non-fs sequences, and coronal T1w-fs and T2w-fs sequences, for evaluation of cartilage and labrum using CT arthrography (CTA) as the reference. Methods: Patients had MR arthrography (MRA) and CTA of the shoulder on the same day. Cartilage was assessed for superficial and full thickness focal and diffuse damage. Labral lesions were graded for Bankart variants and SLAP lesions. CTA images were read for the same features. The diagnostic performance of MRA including area under the curve (AUC) was evaluated against CTA. Results: When comparing axial sequences, the diagnostic performance for cartilage lesion detection on T1w non-fs was 61.9% (sensitivity) 93.6% (specificity) and 89.5% (accuracy) with AUC 0.782, while that for T1w fs was 61.9%, 94.0%, 89.8% and 0.783. For labral assessment, it was 89.1%, 93.0%, 91.4% and 0.919 for T1w non-fs, and 89.9%, 94.0%, 92.6% and 0.922 for T1w fs. Comparing coronal sequences, diagnostic performance for cartilage was 42.5%, 97.5%, 89.8% and 0.702 for T1w fs, and 38.4%, 98.7%, 90.2%, and 0.686 for T2w fs. For the labrum it was 85.1%, 87.5%, 86.2%, and 0.868 for T1w fs, and 75.7%, 97.5%, 80.8% and 0.816 for T2w fs. Conclusions: Axial T1w fs and T1w non-fs sequences are comparable in their ability to diagnose cartilage and labral lesions. Coronal T1w fs sequence offers slightly higher sensitivity but slightly lower specificity than T2w fs sequence for diagnosis of cartilage and labral lesions.

  3. Use of MR arthrography in detecting tears of the ligamentum teres with arthroscopic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Gill, Corey M.; Huang, Ambrose J.; Simeone, Frank J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); McCarthy, Joseph C. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

    2014-12-20

    To demonstrate the normal appearance of the ligamentum teres on MR arthrography (MRA) and evaluate the accuracy of MRA in detecting ligamentum teres tears with arthroscopic correlation. Institutional Review Board approval was obtained with a waiver for informed consent because of the retrospective study design. A total of 165 cases in 159 patients (111 females, 48 males; mean age 41 ± 12 years) who underwent both MRA and hip arthroscopy were evaluated for appearance of the ligamentum teres, including the size, number of bundles, and ligamentum teres tears. Marrow edema of the fovea capitis adjacent to the ligamentum teres insertion and the presence of hip plicae were also recorded. The mean thickness and length of the ligamentum teres were 3.5 ± 1.5 mm and 25.2 ± 3.8 mm, respectively. Sensitivity, specificity, positive and negative predictive value, and accuracy of MRA for the detection of ligamentum teres tears were 78, 97, 74, 97, and 95 %, respectively. MRA is an accurate method to evaluate the normal morphology and to detect tears of the ligamentum teres. (orig.)

  4. The diagnostic value of direct CT arthrography using MDCT in the evaluation of acetabular labral tear: with arthroscopic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Yong-Chan; Kim, Jae Yoon [Chung-Ang University College of Medicine, Department of Orthopaedic Surgery, Seoul (Korea, Republic of); Choi, Jung-Ah; Lee, Guen Young; Kang, Heung Sik [Seoul National University Bundang Hospital, Departments of Radiology, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam (Korea, Republic of); Lee, Young-Kyun; Koo, Kyung-Hoi [Seoul National University Bundang Hospital, Orthopaedic Surgery, Seoul National University College of Medicine, Seongnam (Korea, Republic of)

    2013-05-15

    The purpose of this study was first, to determine the sensitivity, specificity, and accuracy of MDCT arthrography (CTA) for the diagnosis of acetabular labral tear and sulcus; second, to correlate tear types using the Lage classification system on CTA compared with the arthroscopic classification; and third, to correlate CTA localization with arthroscopic localization. Direct CTA was performed using 16- or 64-slice MDCT in 126 hips (124 patients) who had chronic groin pain and positive impingement test. Images were reviewed and evaluated by two experienced musculoskeletal radiologists preoperatively. CTA findings were compared with arthroscopic findings in 58 hips (56 patients) under consensus by two orthopedic surgeons. Forty-one of the 58 hips were diagnosed as labral tears on CT arthrography. Forty-three of the 58 hips were shown to have a labral tear on arthroscopy. Sensitivity, specificity, and accuracy for detecting labral tear and sulcus by CTA were 90.7%, 86.7%, and 89.7%, and 93.8%, 97.6% and 96.6% respectively for observer 1, and 90.7% and 80.0%, 87.9% and 87.5%, 95.2%, and 93.1 % respectively for observer 2. Thirty-five out of 41 hips (85%) that were diagnosed with labral tear on CTA correlated substantially with arthroscopic Lage classification (kappa coefficient = 0.65). CTA and arthroscopic findings showed similar distribution patterns of the tears with most lesions located in antero- and postero-superior areas (p = 0.013). Direct CT arthrography using MDCT may be a useful diagnostic technique in the detection of acetabular labral tear. (orig.)

  5. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

    Directory of Open Access Journals (Sweden)

    Asem A. Al-Hiari

    2013-05-01

    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  6. Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation

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    Holzapfel, Konstantin; Waldt, Simone; Bruegel, Melanie; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Paul, Jochen; Imhoff, Andreas B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Klinikum rechts der Isar, Munich (Germany); Heinrich, Petra [Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Munich (Germany)

    2010-03-15

    The purpose of this study was to determine inter- and intraobserver variability of MR arthrography of the shoulder in the detection and classification of superior labral anterior posterior (SLAP) lesions. MR arthrograms of 78 patients who underwent MR arthrography before arthroscopy were retrospectively analysed by three blinded readers for the presence and type of SLAP lesions. MR arthrograms were reviewed twice by each reader with a time interval of 4 months between the two readings. Inter- and intraobserver agreement for detection and classification of SLAP lesions were calculated using {kappa} coefficients. Arthroscopy confirmed 48 SLAP lesions: type I (n = 4), type II (n = 37), type III (n = 3), type IV (n = 4). Sensitivity and specificity for detecting SLAP lesions with MR arthrography for each reader were 88.6%/93.3%, 90.9%/80.0% and 86.4%/76.7%. MR arthrographic and arthroscopic grading were concurrent for 72.7%, 68.2% and 70.5% of SLAP lesions for readers 1-3, respectively. Interobserver agreement was excellent ({kappa} = 0.82) for detection and substantial ({kappa} = 0.63) for classification of SLAP lesions. For each reader intraobserver agreement was excellent for detection ({kappa} = 0.93, {kappa} = 0.97, {kappa} = 0.97) and classification ({kappa} = 0.94, {kappa} = 0.84, {kappa} = 0.93) of SLAP lesions. MR arthrography allows reliable and accurate detection of SLAP lesions. In addition, SLAP lesions can be diagnosed and classified with substantial to excellent inter- and intraobserver agreement. (orig.)

  7. Direct MR Arthrography of the wrist in comparison with Arthroscopy: A prospective study on 125 patients; Direkte MR-Arthrographie des Handgelenks im Vergleich zur Arthroskopie: Eine prospektive Studie an 125 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R.; Christopoulos, G.; Coblenz, G.; Froehner, S. [Institut fuer Diagnostische und Interventionelle Radiologie der Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany); Meier, R.; Lanz, U.; Krimmer, H. [Klinik fuer Handchirurgie GmbH, Bad Neustadt an der Saale (Germany)

    2003-07-01

    Objective: In literature the diagnostic value of MRI for detecting lesions of the carpal ligaments and the TFCC is judged controversially. The aim of the following study is to determine the diagnostic accuracy of direct MR arthrography for depicting and staging of intraarticular lesions of the wrist. Material and methods: One day before undergoing arthroscopy, 125 patients suffering from wrist pain were examined with direct MR arthrography in a prospective and blinded study. A mixture of contrast medium (iodine-containing contrast medium and gadopentetate in relation 200:1) was injected into both radiocarpal and midcarpal joints. The following sequences were acquired on a 1.5T scanner: coronal T1-weighted SE, coronal fat-saturated T1-weighted SE, coronal T1-/T2*-DESS-3D, and sagittal T2*-weighted MEDIC. MRI results were compared with arthroscopic findings using statistical analysis (SEN=sensitivity, SPE=specificity, PPV=positive predictive value, NPV=negative predictive value, ACC=accuracy). Results: In comparison to arthroscopy as the accepted diagnostic gold standard, the following results were found for MR arthrography. Detection of TFCC lesions: SEN 97.1%, SPE 96.4%, PPV 97.1%, NPV 96.4%, ACC 96.8%. Detection of complete tears of the scapholunate ligament: SEN 91.7%, SPE 100%, PPV 100%, NPV 99.1%, ACC 99.2%. Detection of partial tears: SEN 62.5%, SPE 100%, PPV 100%, NPV 94.8%, ACC 95.2%. Detection of cartilage defects: SEN 84.2%, SPE 96.2%, PPV 80%, NPV 97.1%, ACC 94.4%. In total, only three lesions of the lunotriquetral ligament were present. Conclusion: Direct MR arthrographic imaging is well suited for detecting intraarticular lesions of the wrist. The presented diagnostic results of MR arthrography are superior to the results of unenhanced MRI reported in the literature. Direct MR arthrography as a reliable diagnostic tool is strongly recommended if lesions of the scapholunate ligament and the triangular fibrocartilage complex are suspected. In contrast, an

  8. Indirect MR-arthography in the fellow up of autologous osteochondral transplantation; Indirekte MR-Arthrographie zur Verlaufskontrolle nach autologer osteochondraler Transplantation

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    Herber, S.; Pitton, M.B.; Kalden, P.; Thelen, M.; Kreitner, K.F. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Runkel, M. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Unfallchirurgie

    2003-02-01

    Purpose: To evaluate the spectrum of findings in indirect MR-arthrography following autologous osteochondral transplantation. Patients and Methods: 10 patients with autogenous osteochondral homografts underwent indirect MR-arthrography at three, 6 and 12 months postoperatively. The MR protocol at 1.5T comprised unenhanced imagings with PD- and T{sub 2}-weighted TSE-sequences with and without fat-suppression as well as T{sub 1}-weighted fat-suppressed SE-sequences before and after iv. contrast administration and after active joint exercise. Image analysis was done by two radiologists in conference and comprised the evaluation of signal intensity (SI) and integrity of the osseous plug and the cartilage surface, as well as the presence of joint effusion or bone marrow edema. Results: At three months, all cases demonstrated a significant bone marrow edema at the recipient and donor site that corresponded to a significant enhancement after iv. contrast administration. The interface between the transplant and the normal bone showed an increased SI at three and 6 months in T{sub 2}-weighted images as well as in indirect MR-arthrography. The marrow signal normalized in most cases after 6 to 12 months, indicating vitality and healing of the transplanted osteochondral graft. The SI of the interface decreased in the same period, demonstrating the stability of the homograft at the recipient site. The osteochondral plugs were well-seated in 9/10 cases. Indirect MR-arthrography was superior to unenhanced imaging in the assessment of the cartilage surface. Cartilage coverage was complete in every case. The transplanted hyaline cartilage as well as the original cartilage showed a significant increase of the SI in indirect MR-arthrography, that did not change in follow up studies. There were no pathological alterations of signal and thickness alterations of the transplanted cartilage in follow up investigations. Conclusion: Indirect MR-arthrography is a useful diagnostic tool

  9. Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography

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    Tadros, Anthony S.; Huang, Brady K. [University of California, Department of Radiology, San Diego, CA (United States); Wymore, Lucas; Hoenecke, Heinz; Fronek, Jan [Scripps Clinic, Department of Orthopedic Surgery, La Jolla, CA (United States); Chang, Eric Y. [VA San Diego Healthcare System, Radiology Service, San Diego, CA (United States); University of California, Department of Radiology, San Diego, CA (United States)

    2015-09-15

    We sought to determine the diagnostic accuracy of unenhanced MRI and direct MR arthrography (MRA) for evaluation of the intra-articular long head of the biceps brachii tendon (LHBT) using arthroscopy as the gold standard. A retrospective review of patients who underwent shoulder MRI (n = 132) and MRA (n = 67) within 12 months prior to arthroscopy was performed. MR images were independently reviewed by two blinded musculoskeletal radiologists. Routinely recorded arthroscopic photos/videos were reviewed by an orthopedic surgeon. The LHBT was graded as normal, tendinosis, partial thickness tear less or greater than 50 %, and complete tear. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for tendinosis and tear detection were calculated. MRI correctly diagnosed fewer normal LHBTs compared to MRA (39-54 % versus 74-84 %, respectively; p < 0.005). MRI and MRA did not differ significantly in the diagnosis of tendinosis (18-36 % and 15-38 %, respectively; p > 0.05) and tears (75-83 % and 64-73 %, respectively; p > 0.05). For tendinosis, MRI versus MRA showed 18-36 % and 15-38 % sensitivity, 69-79 % and 83-91 % specificity, 22-28 % and 18-50 % PPV, 74-76 % and 80-86 % NPV, and 61-64 % and 70-81 % accuracy; respectively. For tears, MRI versus MRA showed 75-83 % and 64-73 % sensitivity, 73-75 % and 82-91 % specificity, 66-69 % and 41-62 % PPV, 82-87 % and 92-94 % NPV, and 74-78 % and 79-88 % accuracy; respectively. No significant difference was found between unenhanced MRI and direct MRA for the detection of tendinosis and tears of LHBTs. (orig.)

  10. Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain

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    Bencardino, Jenny T.; La Rocca Vieira, Renata [NYU Hospital for Joint Diseases, Department of Radiology, New York, NY (United States); Kassarjian, Ara [Corades, S.L., Majadahonda-Madrid (Spain); Schwartz, Richard [Longwood MRI Specialists, Brookline, MA (United States); Mellado, Jose M. [Hospital Reina Sofia, Department of Radiology, Tudela (Spain); Kocher, Mininder [Children' s Hospital of Boston, Department of Orthopedic Surgery, Boston, MA (United States)

    2011-04-15

    The appearance and distribution of the intra-articular plicae of the hip have been addressed in few reports in the anatomic and radiological literature. This study aims to determine the prevalence of visible synovial hip plicae using MR arthrography and to measure the association of visible synovial hip plicae with MR arthrographic diagnosis of labral tears, femoroacetabular impingement, and osteoarthritis. Following institutional review board approval, 63 direct MR arthrographic examinations of the hip in 61 patients with a clinical history of hip pain were retrospectively reviewed by two experienced musculoskeletal radiologists in consensus. The following variables were measured using a binary system (0 = absent; 1 = present): labral plica, neck plica, ligamental plica, labral tear, femoroacetabular impingement, and osteoarthritis. The surgical reports and arthroscopic images of 10 patients were reviewed. Statistical analysis was performed using the Fisher's exact test. In all 63 cases at least one plica was visualized on MR-arthrographic images. Labral, neck, and ligamental plicae were found with a prevalence of 76, 97, and 78%, respectively. There was no statistically significant association between the presence of labral tears, femoroacetabular impingement, and osteoarthritis among patients with visible labral, neck, and ligamental plicae. The prevalence of labral tears, femoroacetabular impingement, and osteoarthritis in our patient population was 79, 28, and 28%, respectively. The presence of intra-articular plicae was the only MR-arthrographic finding in 5 of our 63 symptomatic cases. Visible labral, neck, and/or ligamental plicae are highly prevalent on MR-arthrographic images of the hip performed in the setting of hip pain. There was no statistically significant association between the presence of labral tears, femoroacetabular impingement, and osteoarthritis and visible labral, neck, and ligamental plicae. (orig.)

  11. Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures

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    Kraniotis, Pantelis; Petsas, Theodore [University Hospital of Patras, Department of Radiology, Rion, Patras (Greece); Maragkos, Spyridon; Tyllianakis, Minos [University Hospital of Patras, Department of Orthopedics, Rion, Patras (Greece); Karantanas, Apostolos H. [University Hospital, Heraklion, Department of Medical Imaging, Stavrakia, Crete (Greece)

    2012-07-15

    To detect radiographically occult cartilage lesions using CT arthrography (CTa) in patients with malleolar fractures treated with open reduction internal fixation and to correlate the lesions with the functional outcome score. Twenty-one patients (13 men and 8 women, mean age 35 years, range 16-55) underwent ankle CTa after a mean postoperative period of 565 days (range 271-756). CTa images were analyzed by two radiologists. Articular surface post-traumatic collapse and subsequent cartilage defects or erosions were recorded in millimeters and in a binary mode (i.e., present if >50% of cartilage thickness) respectively. The functional outcome was assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score by two orthopaedic surgeons. The statistical analysis correlated the AOFAS score with both imaging parameters and was performed with ANOVA using the MedCalc statistical package, version 11.3. Of the total of 12 articular surface steps recorded, 2/12 (16.67%) were anterolateral, 4/12 (33.33%) posterolateral, 5/12 (41.67%) anteromedial, and 1/12(8.33%) posteromedial. Of the total of 42 cartilage lesions, 7/42 (16.67%) were anterolateral, 14/42 (33.33%) posterolateral, 12/42 (28.57%) anteromedial, and 9/42 (21.43%) posteromedial. The mean AOFAS score was 8.67 (range 5.95-9.70). There was no statistically significant correlation between the AOFAS score and the post-traumatic internal derangement of the ankle joint (p = 0.524). CTa detects radiographically silent cartilage lesions in patients with fractures of the ankle joint. There is no correlation of the extent of lesions and the patient's AOFAS score. (orig.)

  12. A comparison of magnetic resonance arthrography and arthroscopic findings in the assessment of anterior shoulder dislocations

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    Jordan, R.W.; Naeem, R.; Srinivas, K.; Shyamalan, G. [Birmingham Heartlands Hospital, Birmingham (United Kingdom)

    2015-05-01

    The aim of this study is to establish the sensitivity and specificity of MRA in the investigation of patients with traumatic anterior shoulder dislocations. A retrospective analysis of consecutive patients undergoing both magnetic resonance arthrography and arthroscopic assessment after a traumatic anterior shoulder dislocation between January 2011 and 2014 was performed. Demographic data were collected from electronic records. Images were interpreted by 8 musculoskeletal radiologists and patients were treated by 8 consultant orthopaedic surgeons. Arthroscopic findings were obtained from surgical notes and these findings were used as a reference for MRA. The sensitivity, specificity, and positive predictive value were calculated for the different injuries. Sixty-nine patients underwent both an MRA and shoulder arthroscopy during the study period; however, clinical notes were unavailable in 9 patients. Fifty-three patients (88 %) were male, the mean age was 28 years (range 18 to 50) and 16 subjects (27 %) had suffered a primary dislocation. The overall sensitivity and specificity of MRA to all associated injuries was 0.9 (CI 0.83-0.95) and 0.94 (CI 0.9-0.96) retrospectively. The lowest sensitivity was seen in osseous Bankart 0.8 (CI 0.44-0.96) and superior labral tear (SLAP) lesions 0.5 (CI 0.14-0.86). The overall positive predictive value was 0.88 (CI 0.76-0.91) with the lowest values found in rotator cuff 0.4 (CI 0.07-0.83) and glenohumeral ligament (GHL) lesions 0.29 (CI 0.05-0.7). Magnetic resonance angiography has a high sensitivity when used to identify associated injuries in shoulder dislocation, although in 8 patients (13 %) arthroscopy identified an additional injury. The overall agreement between MRA and arthroscopic findings was good, but the identification of GHL and rotator cuff injuries was poor. (orig.)

  13. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison

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    Schmaranzer, Florian; Klauser, Andrea; Henninger, Benjamin [Medical University Innsbruck, Department of Radiology, Innsbruck (Austria); Kogler, Michael; Schmaranzer, Ehrenfried [District Hospital St. Johann in Tyrol, Department of Radiology, St. Johann in Tyrol (Austria); Forstner, Thomas [Johannes Keppler University, Department for Applied Systems Research and Statistics, Linz (Austria); Reichkendler, Markus [District Hospital St. Johann in Tyrol, Department of Orthopedic Surgery, St. Johann in Tyrol (Austria)

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. (orig.)

  14. Effects of iodinated contrast agent, xylocaine and gadolinium concentration on the signal emitted in magnetic resonance arthrography: a samples study

    Directory of Open Access Journals (Sweden)

    Yvana Lopes Pinheiro da Silva

    2015-04-01

    Full Text Available Objective: To investigate the effects of dilution of paramagnetic contrast agent with iodinated contrast and xylocaine on the signal intensity during magnetic resonance arthrography, and to improve the paramagnetic contrast agent concentration utilized in this imaging modality. Materials and Methods: Samples specially prepared for the study with three different concentrations of paramagnetic contrast agent diluted in saline, iodinated contrast agent and xylocaine were imaged with fast spin echo T1-weighted sequences with fat saturation. The samples were placed into flasks and graphical analysis of the signal intensity was performed as a function of the paramagnetic contrast concentration. Results: As compared with samples of equal concentrations diluted only with saline, the authors have observed an average signal intensity decrease of 20.67% for iodinated contrast agent, and of 28.34% for xylocaine. However, the increased gadolinium concentration in the samples caused decrease in signal intensity with all the dilutions. Conclusion: Minimizing the use of iodinated contrast media and xylocaine and/or the use of a gadolinium concentration of 2.5 mmol/L diluted in saline will improve the sensitivity of magnetic resonance arthrography.

  15. Magnetic resonance arthrography in chronic wrist pain. Artografia con Risonanza Magnetica (arto-RM) nelle malattie dolorose croniche del polso

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    Valeri, G.; Ferrara, C. (Ancona Univ. (Italy). Cattedra di Radiologia); Carloni, S. (Ancona Univ. (Italy). Cattedra di Ortopedia) (and others)

    The purpose of this paper is to investigate the clinical role of Magnetic Resonance Arthrography (MRA) of the wrist in subjects with chronic pain. Thirty-five patients complaining of wrist pain for more than 6 months were submitted to MRI an MRA. All patients received and intra-articular injection of 2-10 mL of a 10 mmol saline solution of Gd-DPTA. The overall diagnostic accuracy rates of MRI and MRA were 40% and 81% respectively, with sensitivity and specificity of 63% and 39% (MRI) and of 82% and 79% (MRA). The conclusion is that compared with MRI, MRA can be considered a useful tool for the visualization of interosseus carpal ligaments and of the triangular fibrocartilage complex. MRA also helps detect injuries in these structures.

  16. Spiral CT arthrography of multiplanar reconstruction and virtual arthroscopy technique in diagnosis of knee with internal derangements

    Institute of Scientific and Technical Information of China (English)

    熊传芝; 郝敬明

    2004-01-01

    5Objective:To evaluate the values of spiral CT arthrography with multiplanar reconstruction and virtual arthroscopy technique in diagnosis of internal derangements of the knee. Methods:Ten bovine knees were used for experiment. The menisci, anterior and posterior cruciate ligaments and cartilage of these 10 bovine knees were injured with a hook. Each of the joints was injected with 100 mi air, then soon scanned with a PQ6000 spiral computed tomography scanner. The data obtained was input into the work station, and multiplanar reconstruction technique was used to illustrate lesions in the knees. The results of CT diagnosis were compared to those found by gross inspection of the specimens. Clinically, 10 knees of 9 patients diagnosed as internal derangement were evaluated with the same method after 50-70 ml air was injected into each of the joints. Nine months later, the data of 2 patients were used for CT endoscopy reconstruction. The results were compared with intraoperative findings. Results:Experimentally,the sensitivity and specificity were 88.9% and 93.9% by detection of meniscal abnormalities, 85.7% and 100% by detection of cruciate ligament lesions, and 72.7% and 100% by detection of cartilage damage, respectively. Clinically, the sensitivity and specificity were 90. 0% and 95.0% by detection of meulscal lesion. As to ligament, the figures were 85.7% and 100% respectively. Images of virtual arthroscopy simulated the images of real arthroscopy. Conclnsious:Spiral CT arthrography of multiplanar reconstruction technique offers fime images of internal structures of the knee, with clear border and internal structure. It is an accurate method for detecting meulscal, cruciate and collateral ligament and cartilaginous lesions that cause internal derangement of the knee.Virtual arthroscopy technique is a hopeful method for detecting reasons of derangement of the knee.

  17. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: Comparison with arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Amin, Mohammed Farghally, E-mail: Mohammed_amin37@yahoo.com [Department of Radiodiagnosis ElMinya University, ElMinya High Road, ElMinya (Egypt); Youssef, Ahmed Omar [Department of Orthropedic Surgery El Minya University, ElMinya (Egypt)

    2012-09-15

    Purpose: The purpose of the study is to determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery Material and methods: This was a prospective study including fifty nine clinically diagnosed SLAP patients. The study was done during the period from January 2008 to June 2010. All patients were submitted to history taking, clinical examination and conventional MRI examination of the shoulder, MRA was done in patients with negative conventional MRI, all of these patients underwent arthroscopy for diagnosis wither open or arthroscopy for diagnosis and treatment and results were compared with MRA findings. Main outcome measures: Sensitivity, specificity, positive and negative predictive values, and overall accuracy of MR arthrography in detection and grading of SLAP lesions of the gelnoid labrum. Results: Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results. The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients. Conclusion: MR arthrography is a sensitive minimally invasive technique for detection and grading of SLAP lesions, it can help in avoiding patients unnecessary diagnostic arthroscopy.

  18. A New Promising Technique of 3D Isovoxel Imaging Using 3T MRI in the Wrist: Comparison with 3T MR Arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Guen Young; Kim, Baek Hyun; Park, Jong Woong [Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of)

    2011-02-15

    We wanted to evaluate the usefulness of 3D isovoxel MR imaging using 3T MRI in the wrist joint, as compared with 3T MR arthrography. A total of 33 patients underwent both MR arthrography and 3D isovoxel imaging of the wrist joints using 3T MR, including 11 patients with arthroscopic confirmation. 3D isovoxel MR imaging was performed using an intermediateweighted fast spin echo coronal scan with a 0.4-mm slice thickness and the axial images were reconstructed with a 1-mm slice thickness. One radiologist evaluated for the presence of scapholunate or lunotriquetral ligament tear and she determined the grade of the triangular fibrocartilage complex tear and chondromalacia with its location. We compared the two examinations using kappa values. The rates of detecting wrist injury were similar for both exams with substantial to almost perfect inter-examination agreement (kappa value = 0.864 for scapholunate ligament tear, 0.835 for lunotriquetral ligament tear, 0.799 for TFCC tear and 0.940 for chondromalacia). For the eleven cases that underwent arthroscopy, their results of 3D isovoxel MRI were also similar to that of MR arthrography. 3D isovoxel MR imaging is useful for the evaluation of the wrist joint

  19. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

    International Nuclear Information System (INIS)

    To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF). Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification). In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions. In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography. (orig.)

  20. Injuries of the scapholunate and lunotriquetral ligaments as well as the TFCC in intra-articular distal radius fractures. Prevalence assessed with MDCT arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Klempka, A.; Wagner, M.; Fodor, S.; Schmitt, R. [Cardiovascular Center Bad Neustadt an der Saale, Department of Diagnostic and Interventional Radiology, Bad Neustadt an der Saale (Germany); Prommersberger, K.J. [Clinic for Hand Surgery, Bad Neustadt an der Saale (Germany); Uder, M. [Friedrich-Alexander-University Erlangen-Nuernberg (FAU), Department of Diagnostic Radiology, Erlangen (Germany)

    2016-03-15

    To evaluate the prevalence of injuries of the scapholunate and lunotriquetral interosseous ligaments (SLIL, LTIL) as well as the triangular fibrocartilage complex (TFCC) in intra-articular distal radius fractures (iaDRF). Two hundred and thirty-three patients with acute iaDRF underwent MDCT arthrography. The SLIL and LTIL were described as normal, partially or completely ruptured. Major injuries of the SLIL were defined as completely ruptured dorsal segments, those of the LTIL as completely ruptured palmar segments. The TFCC was judged as normal or injured. Interobserver variability was calculated. Injury findings were correlated with the types of iaDRF (AO classification). In 159 patients (68.2 %), no SLIL injuries were seen. Minor SLIL injuries were detected in 54 patients (23.2 %), major injuries in 20 patients (8.6 %). No correlation was found between the presence of SLIL lesions and the types of iaDRF. Minor LTIL injuries were seen in 23 patients (9.9 %), major injuries in only 5 patients (2.2 %). The TFCC was altered in 141 patients (60.5 %). Interobserver variability was high for MDCT arthrography in assessing SLIL and TFC lesions, and fair for LTIL lesions. In iaDRF, prevalence of major injuries of the most relevant SLIL is about 9 % as evaluated with CT arthrography. (orig.)

  1. Labral and cartilage abnormalities in young patients with hip pain: accuracy of 3-Tesla indirect MR arthrography

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    Petchprapa, Catherine N.; Rybak, Leon D. [NYU Langone Medical Center-Hospital for Joint Diseases, Department of Radiology, New York, NY (United States); Dunham, Kevin S.; Recht, Michael P. [NYU Langone Medical Center, Department of Radiology, New York, NY (United States); Lattanzi, Riccardo [NYU Langone Medical Center, The Bernard and Irene Schwartz Center for Biomedical Imaging, New York, NY (United States)

    2015-01-15

    Assess the diagnostic accuracy of 3-T indirect magnetic resonance arthrography (iMRA) for hip cartilage and labral pathology detection using arthroscopy as the reference standard and compare it to the published performance of direct magnetic resonance arthrography (dMRA). Between 2009 and 2011, 290 patients suspected of having femoroacetabular impingement underwent iMRA. Our study group consisted of 41 of these patients (17 males, mean age 35 years; 24 females, mean age 33 years) who did not have a prior history of hip surgery and who subsequently underwent arthroscopy. Two experienced musculoskeletal radiologists separately evaluated the randomized and anonymized studies for the presence and quadrant location of labral and cartilage pathology. These recorded data were compared to arthroscopic reports. Forty-one patients had labral pathology, 34 patients had acetabular and 5 patients had femoral cartilage pathology at arthroscopy. Sensitivity, specificity, accuracy, negative- and positive-predictive values for labral lesion detection were respectively 98, 99, 99, 99 and 98 %; for acetabular cartilage lesion detection they were 69, 98, 89, 87 and 95 %; for femoral cartilage lesion detection they were 69, 95, 93 and 39 %. Sensitivities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum were 100.0, 95.0, NA and 85.7 %, for acetabular cartilage were NA, 58.8, NA and 39.5 % and for femoral cartilage were 50.0, 33.3, 75.0 and 75.0 %. NA indicates results not available because of the absence of findings in those quadrants. Specificities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum (95.0, 100.0, 95.1, 67.5 %), acetabular (100.0, 85.7, 92.6, 79.5 %) and femoral cartilage (100.0, 94.7, 96.2, 85.9 %). iMRA at 3 T is accurate in detecting labral pathology suggesting that it is a viable alternative to dMRA. (orig.)

  2. Prevalence of the acetabular sublabral sulcus at MR arthrography in patients under 17 years of age: does it exist?

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    Magerkurth, Olaf [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Hospital Baden, Department of Radiology, Baden (Switzerland); Jacobson, Jon A.; Morag, Yoav; Fessell, David [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Bedi, Asheesh; Sekiya, Jon K. [University of Michigan, Department of Orthopedic Surgery, Ann Arbor, MI (United States)

    2015-04-18

    To retrospectively determine characteristics of contrast-filled acetabular labral clefts in patients under the age of 17 years at MR arthrography (Mra) correlated with arthroscopy, which may impact the thinking regarding the existence of a sublabral sulcus. After IRB approval, 41 patients under the age of 17 who had MRa were identified. The following observations of contrast-filled clefts were assessed: (1) presence/absence, (2) location, (3) depth, (4) abnormal signal within the labrum and (5) shape (linear, gaping, complex). Fisher's exact and the Wilcoxon matched-pairs signed-rank test were performed. Interreader agreement was calculated with Cohen's k. Reader 1 found clefts in 41 %. Depth was less than half in 6 %, more than half in 65 % and full thickness in 29 %. Shape was linear in 53 %, gaping in 18 % and complex in 29 %. Signal changes occurred in 88 %. Reader 2 found clefts in 29 %. Depth was less than half in 17 %, more than half in 58 % and full thickness in 25 %. Shape was linear in 50 %, gaping in 42 % and complex in 17 %. Signal changes occurred in 50 %. None of the clefts fulfilled the criteria for a sublabral sulcus at MRa and arthroscopy. None of the clefts found in our subjects under the age of 17 years met the MRa and arthroscopy criteria for a sublabral sulcus, which supports the theory that such clefts represent labral tears. (orig.)

  3. MR arthrography including abduction and external rotation images in the assessment of atraumatic multidirectional instability of the shoulder

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    Schaeffeler, Christoph [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kantonsspital Graubuenden, Musculoskeletal Imaging, Chur (Switzerland); Waldt, Simone; Bauer, Jan S.; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Traumatology, Munich (Germany); Haller, Bernhard [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Munich (Germany); Schroeder, Michael [Center for Sports Orthopedics and Medicine, Orthosportiv, Munich (Germany); Imhoff, Andreas B. [Technische Universitaet Muenchen, Department of Orthopedic Sports Medicine, Munich (Germany)

    2014-06-15

    To evaluate diagnostic signs and measurements in the assessment of capsular redundancy in atraumatic multidirectional instability (MDI) of the shoulder on MR arthrography (MR-A) including abduction/external rotation (ABER) images. Twenty-one MR-A including ABER position of 20 patients with clinically diagnosed MDI and 17 patients without instability were assessed by three radiologists. On ABER images, presence of a layer of contrast between the humeral head (HH) and the anteroinferior glenohumeral ligament (AIGHL) (crescent sign) and a triangular-shaped space between the HH, AIGHL and glenoid (triangle sign) were evaluated; centring of the HH was measured. Anterosuperior herniation of the rotator interval (RI) capsule and glenoid version were determined on standard imaging planes. The crescent sign had a sensitivity of 57 %/62 %/48 % (observers 1/2/3) and specificity of 100 %/100 %/94 % in the diagnosis of MDI. The triangle sign had a sensitivity of 48 %/57 %/48 % and specificity of 94 %/94 %/100 %. The combination of both signs had a sensitivity of 86 %/90 %/81 % and specificity of 94 %/94 %/94 %. A positive triangle sign was significantly associated with decentring of the HH. Measurements of RI herniation, RI width and glenoid were not significantly different between both groups. Combined assessment of redundancy signs on ABER position MR-A allows for accurate differentiation between patients with atraumatic MDI and patients with clinically stable shoulders; measurements on standard imaging planes appear inappropriate. (orig.)

  4. Infrapatellar plica of the knee: Revisited with MR arthrographies undertaken in the knee flexion position mimicking operative arthroscopic posture

    International Nuclear Information System (INIS)

    Purpose: To describe the appearance of the infrapatellar plica (IPP) on magnetic resonance arthrography (MRA) taken in 70° knee flexion, corresponding to the arthroscopic posture. Materials and methods: Twenty-two patients (23 knee joints) who underwent MRA with 70° knee flexion were enrolled. All patients underwent MRA with 70° knee flexion to simulate operative arthroscopy. The images included fat-suppressed T1-weighted spin echo axial, sagittal, and coronal images. The visualization and morphology of the IPP were retrospectively assessed by two musculoskeletal radiologists. Results: The IPP was demonstrated in 78.3% (n = 18/23) and was best visualized on the sagittal section through the intercondylar notch. The IPP manifested as a linear hypointense structure with variable thicknesses. The intercondylar component was delineated clearly, arising from the anterior intercondylar notch in parallel with the ACL and curving gently downward to attach to the infrapatellar fat pad. On the other hand, the Hoffa's fat pad component was not depicted clearly. The morphology of the IPP was either a separate type (60.9%) or a split type (17.4%). Conclusion: The IPPs can be visualized with a high rate of detection and various morphologic appearances must be appreciated under the review of a flexed knee MRA

  5. MR-imaging of anterior tibiotalar impingement syndrome: Agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography

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    Haller, Joerg [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Ludwig Boltzmann Institute for Osteology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Bernt, Reinhard [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria)]. E-mail: reinhard.bernt@wgkk.sozvers.at; Seeger, Thomas [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Weissenbaeck, Alexander [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Tuechler, Heinrich [Ludwig Boltzmann Institute for Hematology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Resnick, Donald [Department of Radiology, VA Medical Center, UCSD, 3350 La Jolla Village Dr, San Diego, CA 92161 (United States)

    2006-06-15

    Objective: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. Materials and methods: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. Results: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). Conclusion: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.

  6. 3-T direct MR arthrography of the wrist: Value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears

    Energy Technology Data Exchange (ETDEWEB)

    Cerny, Milena; Marlois, Romain [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland); Theumann, Nicolas [Institute of Radiology, Clinique Hirslanden Bois-Cerf, Avenue d’Ouchy 31, 1006 Lausanne (Switzerland); Bollmann, Christof; Wehrli, Laurent [Department of Plastic and Hand Surgery, Clinique Longeraie and Centre Hospitalier Universitaire Vaudois, University of Lausanne, Avenue de la Gare 9, 1003 Lausanne (Switzerland); Richarme, Delphine [Institute of Radiology, Clinique Hirslanden Bois-Cerf, Avenue d’Ouchy 31, 1006 Lausanne (Switzerland); Meuli, Reto [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland); Becce, Fabio, E-mail: fabio.becce@chuv.ch [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland)

    2013-10-01

    Purpose: To determine the value of applying finger trap distraction during direct MR arthrography of the wrist to assess intrinsic ligament and triangular fibrocartilage complex (TFCC) tears. Materials and methods: Twenty consecutive patients were prospectively investigated by three-compartment wrist MR arthrography. Imaging was performed with 3-T scanners using a three-dimensional isotropic (0.4 mm) T1-weighted gradient-recalled echo sequence, with and without finger trap distraction (4 kg). In a blind and independent fashion, two musculoskeletal radiologists measured the width of the scapholunate (SL), lunotriquetral (LT) and ulna-TFC (UTFC) joint spaces. They evaluated the amount of contrast medium within these spaces using a four-point scale, and assessed SL, LT and TFCC tears, as well as the disruption of Gilula's carpal arcs. Results: With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1 mm, p ≤ 0.040), and noticed more contrast medium therein (p ≤ 0.035). In contrast, the differences in width of the LT (mean Δ = +0.1 mm, p ≥ 0.057) and UTFC (mean Δ = 0 mm, p ≥ 0.728) spaces, as well as the amount of contrast material within these spaces were not statistically significant (p = 0.607 and ≥0.157, respectively). Both readers detected more SL (Δ = +1, p = 0.157) and LT (Δ = +2, p = 0.223) tears, although statistical significance was not reached, and Gilula's carpal arcs were more frequently disrupted during finger trap distraction (Δ = +5, p = 0.025). Conclusion: The application of finger trap distraction during direct wrist MR arthrography may enhance both detection and characterisation of SL and LT ligament tears by widening the SL space and increasing the amount of contrast within the SL and LT joint spaces.

  7. SLAP tears: diagnosis using 3-T shoulder MR arthrography with the 3D isotropic turbo spin-echo space sequence versus conventional 2D sequences

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    Jung, Joon-Yong; Jee, Won-Hee; Park, Michael Yong [The Catholic University of Korea, Department of Radiology, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of); Lee, So-Yeon [Sungkyunkwan University School of Medicine, Department of Radiology, Kangbuk Samsung Hospital, Seoul (Korea, Republic of); Kim, Yang-Soo [The Catholic University of Korea, Department of Orthopaedic Surgery, Seoul St. Mary' s Hospital, College of Medicine, Seoul (Korea, Republic of)

    2013-02-15

    The aim of this study was to determine the accuracy and reliability of shoulder magnetic resonance (MR) arthrography with three-dimensional (3D) isotropic intermediate-weighted turbo spin-echo (TSE) sampling perfection with application-optimised contrasts using different flip angle evolution (SPACE) in the diagnosis of superior labrum anterior-to-posterior (SLAP) lesions compared with two-dimensional (2D) TSE at 3.0 T. MR arthrograms, including 2D TSE and 3D TSE-SPACE, in 87 patients who underwent arthroscopy were retrospectively analysed by two reviewers for the presence and type of SLAP lesions. Sensitivity and specificity were compared using McNemar's test, and inter-observer agreement was calculated using Cohen's kappa. Receiver operating characteristic (ROC) curve analyses were performed. The mean sensitivity, specificity and accuracy were 90%, 85% and 86% for 2D TSE, and 81%, 86% and 85% for 3D TSE-SPACE respectively, with no statistically significant differences. Inter-observer agreements were substantial in 2D TSE ({kappa} = 0.76) and 3D TSE-SPACE ({kappa} = 0.68). The areas under the ROC curves were 0.92 for 2D TSE and 0.90 for 3D TSE-SPACE, which were not significantly different. MR arthrography with 3D TSE-SPACE showed comparable accuracy and substantial inter-observer agreement for the diagnosis of SLAP lesions circle MR arthrography is regarded as the definitive method of shoulder imaging circle Different MR sequences are evolving for SLAP lesions circle 3D TSE-SPACE demonstrated comparable overall accuracy to 2D TSE for SLAP lesions. (orig.)

  8. Arthrography and its value in comparison with fixation radiography in the diagnosis of lesions to the capsular ligament of the ankle joint

    International Nuclear Information System (INIS)

    From May 1981 till May 1982, we consistently performed arthography of the injured joint and fixation radiography according to Scheuba (pressure: 15 kp) of both ankle joints for reasons of comparison in all patients with a distorsion trauma of the ankle joint and with suspected lesions to the ligaments. 259 cases were used for the assessment. Fixation radiography should not be used any more. Mere clinical examination combined with the case history can be assumed to be superior to fixation radiography still. Arthrography clearly is the more sensitive method for the diagnosis of injuries to the external capsular ligament of the ankle joint. (orig./SHA)

  9. MR-arthrography of the acetabular labrum - radiologic-pathologic correlation in 20 cadaveric hip joints; MR-Arthrographie des Labrum acetabulare - Radiologisch-anatomische Korrelation an 20 Leichenhueften

    Energy Technology Data Exchange (ETDEWEB)

    Brossmann, J.; Steffens, J.C.; Heller, M. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie; Ploetz, G.M.J.; Hassenpflug, J. [Kiel Univ. (Germany). Klinik fuer Orthopadie

    1999-08-01

    Purpose: To investigate frequency of acetabular labral lesions in elderly hip joints, and to determine sensitivity and specificity of MR arthrography (MRa) for the detection of these abnormalities. Materials and Methods: Twenty cadaveric hip joints were examined by MRa. For MRa, 15 ml of a solution of iodinated contrast solution (Solutrast 300) and Gd-DTPA (100:1) were injected under fluoroscopic guidance. MR imaging was performed on a 1.5 TM scanner (Vision, Siemens; FOV 16 cm, matrix 256x256, fat-suppressed 3D-FLASH). Multiplanar image reconstructions were done perpendicular to the acetabulum in the oblique-coronal, oblique-axial, and radial planes. The labral specimens were examined macroscopically. Results: In 12/20 hips (60%), a labral lesion was found on pathologic examination. In 7 specimens, the labrum was partially or completely detached in the weight-bearing superior region. One flap-like variant of the labrum was seen; in 4 hip joints, the labrum was degenerated (one cystic degeneration). Pathologic findings were confirmed by MRa in 8/12 specimens (sensitivity 67%). All degenerated labra were correctly diagnosed on MRa. Three small labral detachments and the flap-like variant were misinterpreted as being normal. There were no false positive findings (specificity 100%). The accuracy was 80%. Labral lesions were seen in 6/8 and in 6/12 of hips with and without osteoarthritis, respectively. Conclusion: MRa is well suited to delineate the acetabular labrum and to diagnose labral abnormalities. Detection of small labral detachments and anatomic variants is difficult and requires some experience. Labral lesions are correlated to osteoarthritis of the hip, but may be frequently seen in the elderly without underlying osteoarthritis. (orig.) [German] Ziel: Feststellung der Haeufigkeit von Laesionen des Labrum acetabulare bei aelteren Hueftgelenkspraeparaten und Untersuchung der Sensitivitaet und Spezifitaet der MR-Arthrographie (MRa) fuer die Darstellung dieser

  10. Magnetic resonance arthrography of the shoulder: accuracy of gadolinium versus saline for rotator cuff and labral pathology

    Energy Technology Data Exchange (ETDEWEB)

    Helms, Clyde A.; McGonegle, Shane J.; Vinson, Emily N.; Whiteside, Michael B. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2011-02-15

    The purpose of this study was to evaluate the necessity of intra-articular gadolinium versus saline alone in magnetic resonance arthrography (MRA) of the shoulder. Our database was reviewed for 100 consecutive shoulder MRA examinations performed between January 2007 and December 2007. Patient information was blinded and images were retrospectively reviewed by at least two radiologists with dedicated musculoskeletal training. T2-weighted (T2W) images were initially analyzed in isolation to simulate MRA with saline alone. After a delay, the full study was analyzed including T1-weighted (T1W) and T2W images. If there was a significant discordance between the two analyses with regard to rotator cuff or labral pathology, the study was again reviewed by all evaluators in consensus to determine if the T1W images offered additional diagnostic information and increased diagnostic confidence. Of the 100 MRA examinations, there were 15 discordant cases. Two cases were discordant with regard to rotator cuff pathology and 13 were discordant on the basis of labral pathology. When the discordant cases were reviewed in consensus, the T2W images appeared to display rotator cuff and labral pathology as definitively as the T1W images. Interobserver and intraobserver variability was favored to have played a role in causing the discordances. MRA of the shoulder performed with joint distention provided by saline alone appears to offer equivalent diagnostic information to MRA performed with gadolinium enhancement. This protocol modification improves efficiency by eliminating several image series and provides a small cost savings by eliminating gadolinium. (orig.)

  11. High origin of the anterior band of the inferior glenohumeral ligament: MR arthrography with anatomic and histologic correlation in cadavers

    Energy Technology Data Exchange (ETDEWEB)

    Ramirez Ruiz, Francisco Alejandro [University of California and VA healthcare system, Department of Radiology, Musculoskeletal Division, San Diego, CA (United States); University of California and VA healthcare system, San Diego, CA (United States); Hospital Pablo Tobon Uribe, Departamento de Radiologia, Medellin (Colombia); Baranski Kaniak, Beatriz Cristina; Trudell, Debra; Resnick, Donald L. [University of California and VA healthcare system, Department of Radiology, Musculoskeletal Division, San Diego, CA (United States); Haghighi, Parviz [University of California and VA healthcare system, Department of Radiology, Musculoskeletal Division, San Diego, CA (United States); University of California San Diego, VA Healthcare System Dan Diego, Department of Pathology, San Diego, CA (United States)

    2012-05-15

    The anterior band of the inferior glenohumeral ligament has been described to arise from the anteroinferior labrum, but we have observed that in some persons its origin is from the anterior or anterosuperior labrum, creating diagnostic difficulties. Ten fresh unembalmed cadaveric shoulders underwent magnetic resonance arthrography (MRA) using a posterior approach with a 1.5 T GE magnet, with the following sequences: T1-weighted fast spin-echo in axial, coronal and sagittal planes, and T1 fat-suppressed spin-echo in the axial plane (TR/TE 600/20, section thickness 2.5 mm, 0.5 mm interslice space, number of signals acquired, two, field of view 12 x 12 cm, and matrix 512 x 256 pixels). Following imaging, the shoulders were frozen and later sectioned using a band saw into 3-mm sections corresponding to the axial imaging plane. Histological analysis was also performed to determine the origin of the anterior band. Four of the ten shoulders had an origin of the anterior band above or at the 3 o'clock position: one at the 1 o'clock position, two at the 2 o'clock position, and one at the 3 o'clock position. In another shoulder, the anterior band of the inferior glenohumeral ligament originated from the middle glenohumeral ligament, and in five other shoulders, the anterior band originated from the anteroinferior labrum as has been described in the literature. This finding is of clinical significance as a high origin of the anterior band of the inferior glenohumeral ligament leads to MR arthrographic finding that can simulate those of labral tears or detachments. (orig.)

  12. Optimization of computed tomography (CT) arthrography of hip for the visualization of cartilage: an in vitro study

    Energy Technology Data Exchange (ETDEWEB)

    Simoni, Paolo; Leyder, Pierre-Philippe; Malchair, Francoise; Marechal, Carole; Alvarez Miezentseva, Victoria [CHU de Liege, Diagnostic Imaging Department, MSK Imaging, Liege (Belgium); Albert, Adelin [CHU de Liege, Biostatistics Department, Liege (Belgium); Scarciolla, Laura; Beomonte Zobel, Bruno [Campus Bio-Medico University, Diagnostic Imaging Department, Rome (Italy); Gillet, Philippe [CHU de Liege, Orthopaedic Surgery Department, Liege (Belgium)

    2014-02-15

    We sought to optimize the kilovoltage, tube current, and the radiation dose of computed tomographic arthrography of the hip joint using in vitro methods. A phantom was prepared using a left femoral head harvested from a patient undergoing total hip arthroplasty and packed in a condom filled with iodinated contrast. The right hip joint of a cadaver was also injected with iodinated contrast. The phantom and the cadaver were scanned using different values of peak kilovoltage (kVp) and tube current (milliamp seconds, mAs). Three different regions of interest (ROI) were drawn in the cartilage, subchondral bone plate, and intraarticular contrast. The attenuation values, contrast/noise ratio (CNR), and effective dose were calculated. Two independent observers classified the quality of the contrast-cartilage interface and the cartilage-subchondral bone plate interface as (1) diagnostic quality or (2) nondiagnostic quality. Contrast, cartilage, and subchondral bone plate attenuation values decreased at higher kVp. CNR increased with both kVp and mAs. The qualitative analysis showed that in both phantom and cadaver, at 120 kVp and 50 mAs, the contrast-cartilage and cartilage-subchondral bone plate interfaces were of diagnostic quality, with an effective dose decreased to 0.5 MSv. The absolute effective dose is not directly related to the quality of images but to the specific combination of kVp and mAs used for image acquisition. The combination of 120 kVp and 50 mAs can be suggested to decrease the dose without adversely affect the visibility of cartilage and subchondral bone plate. (orig.)

  13. Indirect magnetic resonance arthrography of the shoulder; a reliable diagnostic tool for investigation of suspected labral pathology

    Energy Technology Data Exchange (ETDEWEB)

    Fallahi, Farshid [North Cumbria University Hospitals NHS Trust, Carlisle (United Kingdom); North Cumbria University Hospitals, Department of Radiology, Carlisle (United Kingdom); Green, Nick; Gadde, Sarat; Jeavons, Lisa; Armstrong, Patrick; Jonker, Leon [North Cumbria University Hospitals NHS Trust, Carlisle (United Kingdom)

    2013-09-15

    Indirect magnetic resonance arthrography (I-MRA) confers significant logistical advantages over direct MRA and does not require articular injection. In this study, we determined the diagnostic performance of I-MRA in relation to conventional MRI and arthroscopy or surgery in detecting tears of the glenoid labrum, including Bankart lesions and superior labral antero-posterior (SLAP) tears in a standard clinical setting. Ninety-one symptomatic patients underwent conventional MRI and I-MRA of the affected shoulder, followed by either arthroscopy or open surgery. The scans were interpreted independently by two experienced radiology consultants with a special interest in musculoskeletal radiology. Using the surgical findings as the standard of reference, sensitivity, specificity, and diagnostic accuracy of conventional non-contrast MRI and I-MRA in the detection of labral tears were calculated. The sensitivity of I-MRA was 95 and 97 %, respectively, for two radiologists as opposed to 79 and 83 % for conventional MRI. For both radiologists, the specificity of I-MRA, as well as MRI, was 91 % for detection of labral tears of all types. Accuracy of diagnosis was 93 and 95 %, respectively, for two radiologists with indirect MRA, compared to 84 and 86 % with non-contrast MRI. This retrospective study shows that I-MRA is a highly accurate and sensitive method for the detection of labral tears. The data obtained supports the use of I-MRA as standard practice in patients with shoulder instability due to suspected labral pathology where further investigative imaging is indicated. (orig.)

  14. Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now

    International Nuclear Information System (INIS)

    Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation. (orig.)

  15. Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now

    Energy Technology Data Exchange (ETDEWEB)

    Messina, Carmelo [Universita degli Studi di Milano, Scuola di Specializzazione in Radiodiagnostica, Milano (Italy); Banfi, Giuseppe [IRCCS Istituto Ortopedico Galeazzi, Milano (Italy); Universita Vita-Salute San Raffaele, Milano (Italy); Aliprandi, Alberto [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); Mauri, Giovanni [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); Istituto Europeo di Oncologia, Unita di Radiologia Interventistica, Milano (Italy); Secchi, Francesco; Sardanelli, Francesco; Sconfienza, Luca Maria [Universita degli Studi di Milano, Dipartimento di Scienze Biomediche per la Salute, Milano (Italy); IRCCS Policlinico San Donato, Servizio di Radiologia, San Donato, Milanese (Italy)

    2016-05-15

    Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation. (orig.)

  16. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum

    International Nuclear Information System (INIS)

    Aim: To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. Materials and methods: Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. Results: Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (∼5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98–6.7 mm (2.46 ± 1.16 mm). Conclusions: When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required. - Highlights: • We present a hip CTA protocol to clearly delineate the intra-articular space. • A Hare traction splint provides a simple, cost-effective way to apply traction. • The required traction force depends on individual hip morphology. • The traction force

  17. Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer?

    Energy Technology Data Exchange (ETDEWEB)

    Lohan, Derek G.; Seeger, Leanne L.; Motamedi, Kambiz; Sayre, James [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Hame, Sharon [David Geffen School of Medicine at UCLA, Department of Orthopedic Surgery, Los Angeles, CA (United States)

    2009-09-15

    In our institutional experience, determination of the alpha ({alpha}) angle at MR arthrography as an indicator of the likelihood of cam-type femoroacetabular impingement (FAI) is fraught with inconsistency. The aims of this study were to quantify the degree of variability in and calculate the diagnostic accuracy of the {alpha} angle in suggesting a diagnosis of cam impingement, to determine the accuracy of a positive clinical impingement test, and to suggest alternative MR arthrographic measures of femoral head-neck overgrowth and determine their diagnostic utilities. We carried out a retrospective analysis of MR arthrographic studies performed during a 4-year period, combined with chart analysis, which allowed identification of 78 patients in whom surgical correlation was also available. The status of a preoperative clinical impingement test was also noted. Patients were designated as having cam-type FAI (Group A, n = 39) if intra-operative femoral head-neck junction bony osteochondroplasty/arthoscopic femoral debridement was performed. Group B (n = 39) acted as controls. Three radiologists independently and blindly performed a series of measurements ({alpha} angle and two newly proposed measurements) in each patient on two separate occasions. An {alpha} angle of greater than 55 was considered indicative of the presence of cam-type FAI. Performance values for {alpha} angle measurement were poor for each observer. There was considerable (up to 30% of the mean value) intra-observer variability between the first and second {alpha} angle measurements for each subject. Binary logistic regression analysis confirmed that the {alpha} angle is of no value in predicting the presence or absence of cam-FAI. A statistically significant difference existed between Groups A and B with regard to the newly proposed anterior femoral distance (AFD; p = 0.004). Using an AFD value of 3.60 mm or greater as being indicative of the presence of cam-FAI yields a 0.67 performance measure (95

  18. Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer?

    International Nuclear Information System (INIS)

    In our institutional experience, determination of the alpha (α) angle at MR arthrography as an indicator of the likelihood of cam-type femoroacetabular impingement (FAI) is fraught with inconsistency. The aims of this study were to quantify the degree of variability in and calculate the diagnostic accuracy of the α angle in suggesting a diagnosis of cam impingement, to determine the accuracy of a positive clinical impingement test, and to suggest alternative MR arthrographic measures of femoral head-neck overgrowth and determine their diagnostic utilities. We carried out a retrospective analysis of MR arthrographic studies performed during a 4-year period, combined with chart analysis, which allowed identification of 78 patients in whom surgical correlation was also available. The status of a preoperative clinical impingement test was also noted. Patients were designated as having cam-type FAI (Group A, n = 39) if intra-operative femoral head-neck junction bony osteochondroplasty/arthoscopic femoral debridement was performed. Group B (n = 39) acted as controls. Three radiologists independently and blindly performed a series of measurements (α angle and two newly proposed measurements) in each patient on two separate occasions. An α angle of greater than 55 was considered indicative of the presence of cam-type FAI. Performance values for α angle measurement were poor for each observer. There was considerable (up to 30% of the mean value) intra-observer variability between the first and second α angle measurements for each subject. Binary logistic regression analysis confirmed that the α angle is of no value in predicting the presence or absence of cam-FAI. A statistically significant difference existed between Groups A and B with regard to the newly proposed anterior femoral distance (AFD; p = 0.004). Using an AFD value of 3.60 mm or greater as being indicative of the presence of cam-FAI yields a 0.67 performance measure (95% confidence interval 0

  19. Magnetic resonance imaging arthrography following type II superior labrum from anterior to posterior repair: interobserver and intraobserver reliability

    Directory of Open Access Journals (Sweden)

    Kurji HM

    2015-11-01

    Full Text Available Hafeez M Kurji,1 Yohei Ono,2,3 Atiba A Nelson,2 Kristie D More,2 Ben Wong,4 Corinne Dyke,4 Richard S Boorman,2 Gail M Thornton,2,5 Ian KY Lo2 1College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada; 2Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada; 3Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan; 4Department of Radiology, University of Calgary, Calgary, AB, Canada; 5Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada Background: Arthroscopic repair of type II superior labrum from anterior to posterior (SLAP lesions is a common surgical procedure. However, anatomic healing following repair has rarely been investigated. The intraobserver and interobserver reliability of magnetic resonance imaging arthrography (MRA following type II SLAP repair has not previously been investigated. This is of particular interest due to recent reports of poor clinical results following type II SLAP lesion repair. Purpose: To evaluate the MRA findings following arthroscopic type II SLAP lesion repair and determine its intraobserver and interobserver reliability. Study design: Cohort study (diagnosis, Level of Evidence, 2. Methods: Twenty-five patients with an isolated type II SLAP lesion (confirmed via diagnostic arthroscopy underwent standard suture anchor-based repair. At a mean of 25.2 months postoperatively, patients underwent a standardized MRA protocol to investigate the integrity of the repair. MRAs were independently reviewed by two radiologists and a fellowship trained shoulder surgeon. The outcomes were classified as healed SLAP repair or re-torn SLAP repair. Results: On average, 54% of MRAs were interpreted as healed SLAP repairs while 46% of MRAs were interpreted as having a re-torn SLAP repair. Overall, only 43% of the studies had 100% agreement across all

  20. Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases

    Energy Technology Data Exchange (ETDEWEB)

    Omoumi, Patrick [Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Department of Medical Imaging, Avenue Hippocrate 10/2942, 1200, Brussels (Belgium); Centre Hospitalier Universitaire de Tours, Department of Medical Imaging, Tours (France); Gheldere, Antoine de; Leemrijse, Thibaut [Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Department of Orthopedics, Brussels (Belgium); Galant, Christine [Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Department of Pathology, Brussels (Belgium); Van den Bergh, Peter [Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Department of Neurology, Brussels (Belgium); Malghem, Jacques; Simoni, Paolo; Berg, Bruno C.V.; Lecouvet, Frederic E. [Cliniques Universitaires Saint-Luc, Universite Catholique de Louvain, Department of Medical Imaging, Avenue Hippocrate 10/2942, 1200, Brussels (Belgium)

    2010-04-15

    Ganglion cysts are a common cause of tarsal tunnel syndrome. As in other locations, these cysts are believed to communicate with neighboring joints. The positive diagnosis and preoperative work-up of these cysts require identification and location of the cyst pedicles so that they may be excised and the risk of recurrence decreased. This can be challenging with ultrasonography and magnetic resonance (MR) imaging. We present three cases of symptomatic ganglion cysts of the tarsal tunnel, diagnosed by MR imaging, where computed tomography (CT) arthrography with delayed acquisitions helped to confirm the diagnosis and identify precisely the topography of the communication with the subtalar joint. These cases provide new evidence of the articular origin of ganglion cysts developing in the tarsal tunnel. (orig.)

  1. Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases

    International Nuclear Information System (INIS)

    Ganglion cysts are a common cause of tarsal tunnel syndrome. As in other locations, these cysts are believed to communicate with neighboring joints. The positive diagnosis and preoperative work-up of these cysts require identification and location of the cyst pedicles so that they may be excised and the risk of recurrence decreased. This can be challenging with ultrasonography and magnetic resonance (MR) imaging. We present three cases of symptomatic ganglion cysts of the tarsal tunnel, diagnosed by MR imaging, where computed tomography (CT) arthrography with delayed acquisitions helped to confirm the diagnosis and identify precisely the topography of the communication with the subtalar joint. These cases provide new evidence of the articular origin of ganglion cysts developing in the tarsal tunnel. (orig.)

  2. Magnetic resonance imaging and magnetic resonance arthrography of the shoulder: dependence on the level of training of the performing radiologist for diagnostic accuracy

    Energy Technology Data Exchange (ETDEWEB)

    Theodoropoulos, John S. [University of Toronto, Division of Orthopaedics, Mount Sinai Hospital and the University Health Network, Toronto, ON (Canada); Andreisek, Gustav [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto, ON (Canada); University Hospital Zuerich, Institute for Diagnostic Radiology, Zuerich (Switzerland); Harvey, Edward J. [McGill University, Division of Orthopaedics, MUHC - Montreal General Hospital, Montreal, Quebec (Canada); Wolin, Preston [Center for Athletic Medicine, Chicago, IL (United States)

    2010-07-15

    Discrepancies were identified between magnetic resonance (MR) imaging and clinical findings in patients who had MR imaging examinations evaluated by community-based general radiologists. The purpose of this study was to evaluate the diagnostic performance of MR imaging examinations of the shoulder with regard to the training level of the performing radiologist. A review of patient charts identified 238 patients (male/female, 175/63; mean age, 40.4 years) in whom 250 arthroscopies were performed and who underwent MR imaging or direct MR arthrography in either a community-based or hospital-based institution prior to surgery. All MR imaging and surgical reports were reviewed and the diagnostic performance for the detection of labral, rotator cuff, biceps, and Hill-Sachs lesions was determined. Kappa and Student's t test analyses were performed in a subset of cases in which initial community-based MR images were re-evaluated by hospital-based musculoskeletal radiologists, to determine the interobserver agreement and any differences in image interpretation. The diagnostic performance of community-based general radiologists was lower than that of hospital-based sub-specialized musculoskeletal radiologists. A sub-analysis of re-evaluated cases showed that musculoskeletal radiologists performed better. {kappa} values were 0.208, 0.396, 0.376, and 0.788 for labral, rotator cuff, biceps, and Hill-Sachs lesions (t test statistics: p =<0.001, 0.004, 0.019, and 0.235). Our results indicate that the diagnostic performance of MR imaging and MR arthrography of the shoulder depends on the training level of the performing radiologist, with sub-specialized musculoskeletal radiologists having a better diagnostic performance than general radiologists. (orig.)

  3. Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography; Instabilite chronique externe de la cheville. Apport des radiographies dynamiques, de la tomodensitometrie et de l`arthro-tomodensitometrie

    Energy Technology Data Exchange (ETDEWEB)

    Faure, Ch.; Deplus, F.; Bochu, M. [Hopital Edouard-Herriot, 69 - Lyon (France); Besse, J.L.; Moyen, B. [Centre Hospitalier Lyon-Sud, 69 -Pierre-Benite (France)

    1997-09-01

    We retrospectively evaluated the anterior talo-fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, i particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous). (authors). 12 refs.

  4. Temporomandibular joint arthrography

    International Nuclear Information System (INIS)

    The stress and occlusion disturbance are very important etiologic factors in the temporomandibular joint (TMJ) pain dysfunction syndromes. Authors performed TMJ arthrograms in the patients with TMJ problem such as pain, click sound, limited motion and locking, etc. The following results noted: 1. The arthrographic findings of 22 TMJ were analyzed. a) Normal: 6 cases b) Anterior disc displacement with rediction: 6 cases · Early reduction: 2 cases · Intermediate reduction: 3 cases · Late reduction: 1 case c) Anterior disc displacement without reduction: 6 cases · Two cases had adhesion between the posterior portion of disc and the posterior surfaces of the articular eminence. 2. Among 22 cases, the clinical findings of 16 cases (73%) were compatible with arthrographic findings. 6 cases showed disparity between them.

  5. Arthrography of the ankle

    International Nuclear Information System (INIS)

    The contribution of artrography in the diagnosis of acute ligaments injuries of the ankle is discussed. The technique of examination is described. An anatomic review, diagnostic elements and the proceeding are presented emphasizing the lateral ligaments. (M.A.C.)

  6. What happens to the triangular fibrocartilage complex during pronation and supination of the forearm? Analysis of its morphology and diagnostic assessment with MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Pfirrmann, C.W.A. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Dept. of Radiology, Orthopedic University Hospital Balgrist, Zurich (Switzerland); Theumann, N.H. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Service de Radiologie, CHUV, Lausanne (Switzerland); Chung, C.B.; Trudell, D.J.; Resnick, D. [Dept. of Radiology, Veterans Administration Medical Center, San Diego, CA (United States); Botte, M.J. [Div. of Orthopedic Surgery, Scripps Clinic and Research Foundation, La Jolla, CA (United States)

    2001-12-01

    Objective: To evaluate the dynamic morphologic changes of the triangular fibrocartilage complex (TFCC) during pronation and supination of the forearm using high-resolution MR arthrography in cadavers and to evaluate the impact of these changes on the diagnostic assessment of the normal and abnormal TFCC. Design and specimens: High-resolution MR arthrography of 10 wrists of cadaveric specimens was obtained in maximum pronation, in the neutral position, and in maximum supination of the forearm. The structures of the TFCC were evaluated by two musculoskeletal radiologists and correlated with anatomic sections. The position of the forearm that allowed the best visualization of normal structures and lesions of the TFCC was determined. Results: The shape and extent of the articular disc as well as the radial portions of the radioulnar ligaments did not change with pronation and supination. The articular disc was horizontal in the neutral position and tilted more distally to align with the proximal carpal row in pronation and supination. The fibers of the ulnar part of the radioulnar ligaments (ulnar attachment of the articular disc) revealed the most significant changes: their orientation was coronal in the neutral position and sagittal in positions of pronation and supination. The ulnomeniscal homologue was largest in the neutral position and was reduced in size during pronation and supination. The extensor carpi ulnaris tendon was centered in its groove in the neutral position and pronation. In supination this tendon revealed subluxation from this groove. The dorsal capsule of the distal radioulnar joint was taut in pronation, and the palmar capsule was taut in supination. The preferred forearm position for analysis of most of the structures of the TFCC was the neutral position, followed by the pronated position. The neutral position was rated best for the detection of ulnar and radial detachments of the TFCC, followed by the pronated position, except for two central

  7. Ultrasonographic evaluation of degenerative changes in the distal radioulnar joint: Correlation of findings with gross anatomy and MR arthrography in cadavers

    Energy Technology Data Exchange (ETDEWEB)

    Buck, Florian M., E-mail: florian.buck@gmail.com [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States); Nico, Marcelo A.C., E-mail: nico.marcelo@gmail.com [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States); Gheno, Ramon, E-mail: ramon.gheno@yahoo.com [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States); Trudell, Debra J., E-mail: debtrudell@hotmail.com [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States); Resnick, Donald, E-mail: dresnick@ucsd.edu [Department of Radiology, Veterans Administration Medical Center, 3350 La Jolla Village Dr., San Diego, CA 92161 (United States)

    2011-02-15

    Objective: To determine the accuracy of ultrasonography (US) in the evaluation of degenerative changes in the distal radioulnar joint (DRUJ). Methods and materials: Ten cadaveric specimens were obtained. US evaluation of cartilage degeneration and thickness was performed by two independent and blinded readers (R1 and R2). Gross anatomy and MR arthrography evaluated by two readers in consensus served as the reference standard. The joint surface not accessible to US was measured. Results: US interreader agreement was non-existent for cartilage thickness measurements and moderate for cartilage degeneration grading (weighted kappa = 0.41). Comparing US and MR imaging evaluation, there was no correlation between US R1 and MR imaging (Pearson correlation coefficient [PCC] = 0.352) and a moderate correlation between US R2 and MR imaging (PCC = 0.570) concerning cartilage thickness measurements. Concerning cartilage degeneration grading, there was a moderate to strong (R1 Spearman correlation coefficient [SCC] = 0.729)/R2 SCC = 0.767) correlation concerning cartilage degeneration grading. Comparing US and gross anatomic evaluation, there was no correlation for US R1 (PCC = 0.220) and a strong correlation for US R2 (PCC = 0.922) concerning cartilage thickness measurements, and a strong to moderate correlation (R1 SCC = 0.808/R2 SCC = 0.597) concerning cartilage degeneration grading. The mean sector of the articular surface of the ulna head not accessible to US was 13{sup o}. Conclusion: In conclusion the DRUJ is accessible to US except in the central 13{sup o} sector of the joint surface. US was approved to be sufficient in demonstrating advanced stages of cartilage degeneration. Thus, US of the DRUJ is recommended in patients suffering from ulnar-sided wrist pain.

  8. Direct MR arthrography in the diagnosis of injury of the triangular fibrocartilage complex in the wrist%MR直接关节造影在腕三角纤维软骨复合体损伤中的应用

    Institute of Scientific and Technical Information of China (English)

    陈爽; 徐文东; 冯晓源

    2008-01-01

    Objective To compare direct magnetic resonance(MR)arthrography with arthroscopy of the wrist for evaluation of injury in the triangular fibrocartilage complex(TFCC).Methods Fourteen cases with suspicion of injury of triangular fibrocartilage complex were performed with conventional MR and direct MR arthrography,10 cases were done by arthroscopy.In the direct MR arthrography,needle placement was obtained using clinical landmark under sterile technique and fluoroscopy,intra-articular injection was performed at the radius-scaphoid space with 5-7 ml 0.3%mixture of Gadolinium (0.1 mmol/L)and saline(0.3 ml Gd-DTPA+100 ml saline).The findings of MRI and MR arthrography were analyzed with results of arthroscopy.Resuits (1)Among 14 cases with injury of TFCC,there were ulnar tear in 5cases,radius tear in 4 cases,complete tear in 5 cases(included 2 cases with long term rheumatoid).(2)High signal intensity and isointensity signal of injury of TFCC were revealed on STIR or T2 WI and T1 WIrespectively,normal hypointensity signal of the TFCC was partially or completely absent.Contrast media at the ulnar insertion(5 cases with ulnar tear)or radius attachment of the TFCC(4 cases with radius tear)were seen in the MR arthrography with difierent extent,5 cases with complete tear showed contrast media at the both ulnar insertion and radius attachment of the TFCC.The findings of MR arthrography were well corresponded with results of arthroscopy on the lesion site,including ulnar tear in 3 cases,radius tear in 4cases and complete tear in 3 cases.(3)Among 14 cases with TFCC,8 cases had dislocation of radius-ulnar joint,6 cases had bone contusion of radius or ulnar,synovial reaction was also clearly depicted on conventional MRI and direct MR arthrography in all cases.Conclusion Compared with results of arthroscopy,direct MR arthrography can adequately reveal the injury of the triangular fibrocartilage complex,synovial reaction and edema changes are depicted on conventional MRI.%目的 通

  9. Arthrography of the dog's shoulder

    International Nuclear Information System (INIS)

    Different volumes with varying concentrations of meglumine-sodium diatrizoate were injected to study positive contrast shoulder arthrograms in six experimental dogs weighing 23-37 kg. The best delineation of the articular cartilage was obtained following injection of 1.5 ml of a 25% solution (185 mg iodine/joint). To visualize the bicipital tendon sheet and the different pouches of the shoulder joint, 6 ml of a 25% solution (750 mg iodine/joint) should be used. If no definite lesions are previewed, 6 ml of a 19% solution (550 mg iodine/joint) offers an acceptable compromise since with this volume and concentration no pooling of contrast medium overlapping the caudal area of the humeral head was seen. Radiographs should be obtained within 5 minutes after injection of the contrast medium. After that period the delineation of the joint structures is vaguening by absorption of the contrast medium. Repeated contrast examination with meglumine-sodium diatrizoate should be avoided. After four procedures at weekly intervals, the necropsy performed on two dogs showed inflammatory changes of the synovial membrane

  10. 高分辨率CT关节造影在膝关节病变诊断中的应用%Application of high resolution CT arthrography in the diagnosis of knee joint lesions

    Institute of Scientific and Technical Information of China (English)

    吕永革; 陈智毅; 吴冬; 莫金潮; 专庆春; 侯瑜; 江振华; 贺德行

    2013-01-01

    Objective To explore the value of the high resolution CT arthrography to the diagnosis of knee joint lesions. Methods Fifty patients with suspected knee joint lesion underwent high resolution CT scanning, the raw data were reconstructed with multi-plane techniques, and the lesions were observed from various angles. Results In fifty cases, 32 cases were diagnosed as meniscal injury, demonstrating contrast agent filling in the injured part, 18 cases were diagnosed as articular cartilage injury, demonstrating articular cartilage thinning, rough surface and partial cartilage defect, 12 cases were diagnosed as cruciate ligament injury, demonstrating abnormal density and morphology, contrast infiltration from the injured part, 8 cases were diagnosed as discoid meniscus, demonstrating the meniscus broadening and thickening, 6 cases were diagnosed as meniscal cyst, demonstrating high density in its adjacent meniscus, and 10 cases were diagnosed as popliteal cyst, demonstrating high density saclike shadow in popliteal fossa communicating with knee joint cavity. Conclusion High resolution CT arthrography has a high clinical value to the diagnosis of knee joint lesions, and plays an important reference role in preoperative screening, treatment plan and postoperative assessment.%目的 探讨高分辨率CT关节造影(high resolution CT arthrography,HRCTA)在诊断膝关节病变的应用价值.方法 50例疑诊膝关节病变患者,行HRCTA扫描及多平面重建成像,多角度观察膝关节病变的影像表现.结果 HRCTA诊断半月板损伤32例,表现为损伤部位可见高密度造影剂充填;诊断关节软骨损伤18例,表现为关节面软骨变薄、表面毛糙、部分缺损;诊断交叉韧带损伤12例,表现为密度及形态异常、损伤处造影剂渗入;诊断盘状半月板8例,表现为半月板增宽、增厚;诊断半月板囊肿6例,表现为与半月板相邻的小囊袋状高密度影;诊断腘窝囊肿10例,表现为腘窝内与

  11. Frequency and topography of lesions of the femoro-tibial cartilage at spiral CT arthrography of the knee: a study in patients with normal knee radiographs and without history of trauma

    International Nuclear Information System (INIS)

    To determine the frequency and topography of cartilage lesions involving the femoro-tibial joints in patients with normal knee radiographs and without a remembered history of trauma.Design and patients. A radiologist retrospectively reviewed the dual-detector spiral CT knee arthrograms performed in 209 consecutive patients (mean age 37.6 years) with normal knee radiographs. Images were analyzed for the presence, grade (Noyes classification system) and location of cartilage lesions, the location being designated by dividing each articular surface into a grid of 16 parts.Results. Fifty-three percent of knees had cartilage lesions of grade 2A or higher that involved articular surfaces to a variable extent: lateral tibial plateau (31%), medial femoral condyle (27%), medial tibial plateau (14%) and lateral femoral condyle (5%). Areas of the posterior half of the lateral tibial plateau and of the inner half of the medial femoral condyle were statistically more frequently involved than their counterparts (P<0.0001). The bare area of the medial tibial plateau, but not that of the lateral tibial plateau, was more frequently involved than the corresponding meniscus-covered area (P<0.0001).Conclusion. Cartilage lesions of grade 2A or higher, detected at spiral CT arthrography in 53% of the knees, predominantly involved the posterior half of the lateral tibial plateau, the inner half of the medial femoral condyle and the bare area of the medial tibial plateau. (orig.)

  12. Comparison of three-dimensional isotropic and conventional MR arthrography with respect to the diagnosis of rotator cuff and labral lesions: Focus on isotropic fat-suppressed proton density and VIBE sequences

    International Nuclear Information System (INIS)

    Aim: To compare the diagnostic accuracies of three-dimensional (3D) isotropic magnetic resonance arthrography (MRA) using fat-suppressed proton density (PD) or volume interpolated breath-hold examination (VIBE) sequences with that of conventional MRA for the diagnosis of rotator cuff and labral lesions. Materials and methods: Eighty-six patients who underwent arthroscopic surgery were included. 3D isotropic sequences were performed in the axial plane using fat-suppressed PD (group A) in 53 patients and using VIBE (group B) in 33 patients. Reformatted images were obtained corresponding to conventional images, and evaluated for the presence of labral and rotator cuff lesions using conventional and 3D isotropic sequences. The diagnostic performances of each sequence were determined using arthroscopic findings as the standard. Results: Good to excellent interobserver agreements were obtained for both 3D isotropic sequences for the evaluation of rotator cuff and labral lesions. Excellent agreement was found between two-dimensional (2D) and 3D isotropic MRA, except for supraspinatus tendon (SST) tears by both readers and for subscapularis tendon (SCT) tears by reader 2 in group B. 2D MRA and 3D isotropic sequences had high diagnostic performances for rotator and labral tears, and the difference between the two imaging methods was insignificant. Conclusions: The diagnostic performances of 3D isotropic VIBE and PD sequences were similar to those of 2D MRA

  13. Diagnosis of chondropathia patellae using CT arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Reiser, M.; Rupp, N.; Zacher, H.; Paar, O.; Aigner, R.

    1985-11-01

    In suspected chondropathia patellae, CT after intraarticular contrast injection considerably facilitates the preoperative diagnosis. This technique is less costly and laborious than arthroscopy and has a high level of reliability. Before taking surgical measures, the clinical symptoms and the extent of cartilage degeneration must be known.

  14. 磁共振平扫与磁共振关节造影在肩袖撕裂诊断中的应用价值%Application value of conventional MRI and MR arthrography in the diagnosis of rotator cuff tear

    Institute of Scientific and Technical Information of China (English)

    刘树学; 李水连; 任明达; 肖铮; 吴宇峰; 洪云恒; 张雄彪; 唐玉德; 罗丽好; 陈志明

    2013-01-01

    Objective To study the imaging features of conventional MR] and MR arthrography(MRA) of rotator cuff tear, evaluate the value of these two techniques,and explore the indications of MRA . Methods 79 cases with rotator cuff tear confirmed by arthroscopic or surgery were divided into five types according to the intraopcrativc findings, Image features of conventional MRI and MRA of rotator cuff tear were retrospectively analysed, and the sensitivity and specificity of the two techniques for various rotator cuff tears were comparatcd. Results Type I rotator cuff tear was showed in 18 cases, the two methods all made the right diagnosis (accuracy rate of 100 % ) ; type Ⅱ rotator cuff tear in 18 cases, conventional MRI correctly diagnosed 1 6 cases(accuracy rate of 89 % ) , MRA correctly diagnosed 18 cascs( accuracy rate of 100%); type Ⅲrotator cuff tear in 7 cases, conventional MRI correctly diagnosed 7 cascs(accuracy rate of 100% ), MRA correctly diagnosed 0 case; type Ⅳ rotator cuff tear in 22 cases, conventional MRI correctly diagnosed 1 6 cascs( accuracy rate of 73 % ) , MRA correctly diagnosed 22 cascs(accuracy rate of 100% ); type Ⅴ rotator cuff tear in 14 cases, conventional MRI correctly diagnosed 14 cascs(accuracy rate of 100%), MRA correctly diagnosed 0 case. Conclusion Conventional MRI can make the right diagnosis for most cases of rotator cuff tear, but not accurate enough for the diagnosis of type Ⅱ and typeⅣ rotator cuff tear, there arc some false positive and false negative dianosis:thc MRA has an important value for the diagnosis of type Ⅱ and type Ⅳ rotator cuff tear, but it docs not help the diagnosis of type Ⅲ and type Ⅴ rotator cuff tear; magnetic resonance shoulder check should first select the conventional MRI. If a suspicious rotator cuff tear is not determined on conventional MRI, MRA should be performed to diagnose type Ⅱ and type Ⅳ rotator cuff tear.%目的 研究肩袖撕裂的磁共振平扫(MRI

  15. A clinical study of temporomandibular joint disorders by using arthrography

    International Nuclear Information System (INIS)

    The purpose of this study was to prove the relationship between arthrographic and clinical features in temporomandibular joint disorders. In order to carry out this study, ninety-eight arthrographic examinations of temporomandibular joints were performed in eighty-two patients who had the temporomandibular joint disorders. As the arthrographic examination, the cases were classified in three groups, disk displacement with reduction, disk displacement without reduction, within normal limit. After this, the cases were clinically examined, and the results were compared and analyzed in each other group. The obtained results were as follows ; 1. As the classification by arthrographic examination, three groups (disc displacement with reduction, disc displacement without reduction, within normal limit) were 41%, 54%, 5% of total cases in this study, respectively. 2. The third decade (65%) was most frequent in this study. The average age of each group (disc displacement with reduction, disc displacement without reduction, within normal limit) was 24, 28, 21, and disc displacement without reduction group was higher than any other group. 3. In the chief complaint, pain was the most frequent in all three groups. Joint sound was also frequent in disc displacement with reduction group, but in disc displacement without reduction group, limitation of mouth opening was more frequent. 4. Of the various pain, the movement pain was most frequent (61%) in this study. In joint sound, click (63%) was the most frequent in disc displacement with reduction group, but sound history (42%) and no sound (31%) were more frequent in disc displacement without reduction group. 5. The average maximum opening of each group (disc displacement with reduction, disc displacement without reduction, within normal limit) was 44 mm, 32.9 mm, 44 mm, and disc displacement without reduction group was less than any other group. 6. The masticatory disturbance of each group (disc displacement with reduction, disc displacement without reduction, within normal limit) was 53%, 79%, 40%, and the trauma history of each group was 50%, 40%, 60%.

  16. Bicipital tenosynovitis in the dog: evaluation with positive contrast arthrography

    International Nuclear Information System (INIS)

    This paper describes seven dogs with traumatic bicipital tenosynovitis in which complete clinical, radiographic, and surgical evaluations were performed. All were adult dogs of medium to large breed and were presented with a chronic front limb lameness of several months' duration and shoulder muscle atrophy. Survey radiographs of the scapulohumeral joint showed new bone production almost exclusively in the region of the biceps tendon, i.e., the intertubercular groove and the supraglenoid tuberosity. Arthrograms in six of seven dogs revealed difficulty in filling or irregular filling of the bicipital tendon sheath, best seen on the mediolateral view of the shoulder. On surgical exploration, macroscopic lesions of the tendon and/or the sheath were observed in all dogs and included adhesions, fibrosis, scar tissue, edema, and thickening. Partial tear of the tendon was observed in three dogs

  17. Treatment of Frozen Shoulder Using Distension Arthrography (Hydrodilatation)

    OpenAIRE

    Simpson, J. Keith; Budge, Richard

    2004-01-01

    Frozen shoulder (adhesive capsulitis) is a common, painful and disabling condition which is typically slow to resolve. Patients with this condition will be seen in every musculoskeletal practitioner’s clinic on a regular basis. There is a wide variety of treatment modalities available, some more effective than others. This article reviews the literature on the aetiology and natural history of the condition, and the common treatments provided. The literature on hydraulic arthrographic capsular...

  18. Arthrography and the medical compartment of the patello-femoral joint

    Energy Technology Data Exchange (ETDEWEB)

    Thijn, C.J.P.; Hillen, B.

    1984-03-01

    In four groups of patients with normal patellar cartilage, synovitis, patellar chondropathy, and degenerative changes of the patellar surface of the femur, the anatomical relationships within the medial compartment of the patello-femoral joint were examined. Clear differences were observed between these groups in the incidence of visualization of the medial alar plica and the mediopatellar synovial plica. As a consequence, an explanation has been sought for the occurrence of patellar chondropathy and degenerative changes of the patellar surface of the femur. It seems probable that a long-standing traumatic synovitis with effusion, attenuation of the synovial membrane, and the composition of the synovial fluid can lead to patellar chondropathy. The degenerative changes of the patellar surface of the femur are usually secondary to those of the load-bearing patellar facet. Insufficient covering of the cartilage by soft tissue may play a role in chondropathy of the nonload-bearing portion of the patella and the femoral condyle.

  19. Magnetic resonance arthrography assessment of the superior labrum using the BLC system: age-related changes mimicking SLAP-2 lesions

    Energy Technology Data Exchange (ETDEWEB)

    Koziak, Adrian [Queen' s School of Medicine, Kingston, Ontario (Canada); Chuang, Michael J.; Jancosko, Jason J.; Nottage, Wesley M. [The Sport Clinic Orthopedic Medical Associates, Inc., Laguna Hills, CA (United States); Burnett, Keith R. [Saddleback Valley Radiology, Laguna Hills, CA (United States)

    2014-08-15

    The purpose of the study was to describe the variation of the superior labrum with increasing age by assessing magnetic resonance (MR) arthrograms. Inclusion criteria were used to include only the MR arthrograms of patients devoid of clinical labral pathology. Two hundred thiry-six MR arthrograms were blindly assessed for biceps-labral complex (BLC) type 1-3 and sublabral recess size by a musculoskeletal radiologist. We have chosen the BLC system, which defines normal superior labral variants, since it is established in the literature and is used by reporting musculoskeletal (MSK) radiologists. The MR arthrograms demonstrated that the majority of patients <40 years old were BLC type 1 and showed a steady increase in BLC types 2 and 3 with increasing age. Assessments demonstrated significantly greater (p < 0.01) mean BLC types (1.62 vs 1.29) and recess size (1.35 vs 0.66 mm) in those over 40 compared with those less than 40 years of age. Furthermore, significant differences (p < 0.05) were noted between mean BLC assessments between different decades of age. There appears to be a physiologic deepening of the superior labrum sulcus with age, which becomes significant after the age of 40. These findings can contribute to whether the superior labrum is considered abnormal when assessed radiographically. The differentiation of normal age-related changes in the shoulder, from those of a type 2 SLAP tear can reduce the rates of unnecessary SLAP-2 repairs. This is the first reported series to use the BLC system; we believe it provides a common nomenclature to allow clear communication between specialists. (orig.)

  20. A new method for measurement of subcoracoid outlet and its relationship to rotator cuff pathology at MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Porter, N.A.; Singh, J.; Tins, B.J.; Lalam, R.K.; Tyrrell, P.N.M.; Cassar-Pullicino, V.N. [Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)

    2015-09-15

    Orthopaedic surgical studies have shown that variations in the vertical distance between the tip of the coracoid process and the supra-glenoid tubercle alter the shape of the subcoracoid outlet. Our objective was to measure the vertical distance between the coracoid tip and the supra-glenoid tubercle (CTGT) on MR and to assess whether this showed better correlation with rotator cuff pathology compared with the axial coraco-humeral distance. A retrospective review was performed of 100 consecutive shoulder MR arthrograms. Vertical distance between the coracoid tip and the supraglenoid tubercle was measured in the sagittal oblique plane. Separate assessment was then made of tendon pathology of the subscapularis, supraspinatus and long head of biceps tendons. Axial coraco-humeral distance was then measured. Correlation between tendon abnormalities and the two measurements was then made. Of the 100 cases, 42 had subscapularis tendon lesions, 21 had lesions of the long head of biceps and 53 had supraspinatus tendon lesions. Mean vertical distance from the coracoid tip to supraglenoid tubercle was greater in those with lesions of any of these tendons and was statistically significant for the supraspinatus group (P = 0.005). Reduced axial coraco-humeral distance was also seen in patients with tendinopathy, although with less statistically significant difference (p = 0.059). Our results support orthopaedic studies that have shown that the vertical distance between the coracoid tip and the supraglenoid tubercle increases the incidence and risk of rotator cuff disease by altering the shape of the subcoracoid outlet. (orig.)

  1. Fatty degeneration of the rotator cuff muscles on pre- and postoperative CT arthrography (CTA): is the Goutallier grading system reliable?

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    Lee, Eugene; Choi, Jung-Ah; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeongi-do (Korea, Republic of); Seoul National University College of Medicine, Department of Radiology, 28 Yeongon-dong, Chongno-gu, Seoul (Korea, Republic of); Oh, Joo Han [Seoul National University Bundang Hospital, Department of Orthopedic Surgery, Seongnam-si, Gyeongi-do (Korea, Republic of); Ahn, Soyeon [Seoul National University Bundang Hospital, Medical Research Collaborating Center, Seongnam-si, Gyeongi-do (Korea, Republic of); Hong, Sung Hwan [Seoul National University College of Medicine, Department of Radiology, 28 Yeongon-dong, Chongno-gu, Seoul (Korea, Republic of); Chai, Jee Won [SMG-SNU Boramae Medical Center, Department of Radiology, 425 Shindaebang-dong, Dongjak-gu, Seoul (Korea, Republic of)

    2013-09-15

    To retrospectively evaluate fatty degeneration (FD) of rotator cuff muscles on CTA using Goutallier's grading system and quantitative measurements with comparison between pre- and postoperative states. IRB approval was obtained for this study. Two radiologists independently reviewed pre- and postoperative CTAs of 43 patients (24 males and 19 females, mean age, 58.1 years) with 46 shoulders confirmed as full-thickness tears with random distribution. FD of supraspinatus, infraspinatus/teres minor, and subscapularis was assessed using Goutallier's system and by quantitative measurements of Hounsfield units (HUs) on sagittal images. Changes in FD grades and HUs were compared between pre- and postoperative CTAs and analyzed with respect to preoperative tear size and postoperative cuff integrity. The correlations between qualitative grades and quantitative measurements and their inter-observer reliabilities were also assessed. There was statistically significant correlation between FD grades and HU measurements of all muscles on pre- and postoperative CTA (p < 0.05). Inter-observer reliability of fatty degeneration grades were excellent to substantial on both pre- and postoperative CTA in supraspinatus (0.8685 and 0.8535) and subscapularis muscles (0.7777 and 0.7972), but fair in infraspinatus/teres minor muscles (0.5791 and 0.5740); however, quantitative Hounsfield units measurements showed excellent reliability for all muscles (ICC: 0.7950 and 0.9346 for SST, 0.7922 and 0.8492 for SSC, and 0.9254 and 0.9052 for IST/TM). No muscle showed improvement of fatty degeneration after surgical repair on qualitative and quantitative assessments; there was no difference in changes of fatty degeneration after surgical repair according to preoperative tear size and post-operative cuff integrity (p > 0.05). The average dose-length product (DLP, mGy . cm) was 365.2 mGy . cm (range, 323.8-417.2 mGy . cm) and estimated average effective dose was 5.1 mSv. Goutallier grades correlated well with HUs of rotator cuff muscles. Reliability was excellent for both systems, except for FD grade of IST/TM muscles, which may be more reliably assessed using quantitative measurements. (orig.)

  2. Shoulder MR arthrography of the posterior labrocapsular complex in overhead throwers with pathologic internal impingement and internal rotation deficit

    International Nuclear Information System (INIS)

    To determine if overhead-throwing athletes with internal impingement pain and internal rotation deficit have thickening of the posterior inferior labrocapsular complex on MR arthrogram images. This study was approved and a waiver of consent granted by our institutional review board. Twenty-six overhead-throwing athletes with internal impingement pain and internal rotation deficit, and 26 controls who had undergone MR arthrograms, were retrospectively examined. The MR studies were combined and read in a blind fashion. On an axial image through the posteroinferior glenoid rim, the readers measured the labral length, capsule-labrum length, and the posterior recess angle. A t-test was used to determine statistical significance. The mean labral length was 4.9 mm [standard deviation (SD) 1.4 mm] for the controls, and 6.4 mm (SD 1.6 mm) for the athletes (P = 0.001). The mean capsule-labrum length was 5.4 mm (SD 2.1 mm) for the controls, and 8.8 mm (SD 2.9 mm) for the athletes (P < 0.001). The mean posterior recess angle measured 65 (SD 27 ) for the controls and 94 (SD 38 ) for the athletes (P = 0.002). Overhead-throwing athletes with internal impingement pain and internal rotation deficit tend to have a thicker labrum and a shallower capsular recess in the posterior inferior shoulder joint than do non-overhead-throwing athletes. In many, the posteroinferior capsule is also thickened. These MR findings should alert the radiologist to closely inspect the posterior cuff and posterosuperior labrum for the tears associated with internal impingement. (orig.)

  3. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

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    Tudisco Cosimo

    2013-01-01

    Full Text Available Abstract Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA, showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS, the Simple Shoulder Test (SST scores, surgical time and implant expense. Results The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications. Level of evidence III. Treatment study: Case–control study.

  4. Magnetic resonance arthrography assessment of the superior labrum using the BLC system: age-related changes mimicking SLAP-2 lesions

    International Nuclear Information System (INIS)

    The purpose of the study was to describe the variation of the superior labrum with increasing age by assessing magnetic resonance (MR) arthrograms. Inclusion criteria were used to include only the MR arthrograms of patients devoid of clinical labral pathology. Two hundred thiry-six MR arthrograms were blindly assessed for biceps-labral complex (BLC) type 1-3 and sublabral recess size by a musculoskeletal radiologist. We have chosen the BLC system, which defines normal superior labral variants, since it is established in the literature and is used by reporting musculoskeletal (MSK) radiologists. The MR arthrograms demonstrated that the majority of patients <40 years old were BLC type 1 and showed a steady increase in BLC types 2 and 3 with increasing age. Assessments demonstrated significantly greater (p < 0.01) mean BLC types (1.62 vs 1.29) and recess size (1.35 vs 0.66 mm) in those over 40 compared with those less than 40 years of age. Furthermore, significant differences (p < 0.05) were noted between mean BLC assessments between different decades of age. There appears to be a physiologic deepening of the superior labrum sulcus with age, which becomes significant after the age of 40. These findings can contribute to whether the superior labrum is considered abnormal when assessed radiographically. The differentiation of normal age-related changes in the shoulder, from those of a type 2 SLAP tear can reduce the rates of unnecessary SLAP-2 repairs. This is the first reported series to use the BLC system; we believe it provides a common nomenclature to allow clear communication between specialists. (orig.)

  5. [Is it possible to diagnose idiopathic chondropathia patellae using radiologic methods?].

    Science.gov (United States)

    Kaufmann, J; Langlotz, M

    1984-10-01

    In a retrospective study of 47 cases of chondromalacia proved by operation, a correct diagnosis had been made by arthrography in three cases. In 44 patients a false negative finding had been obtained. A prospective study was carried out comparing single and double contrast arthrography as well as double contrast arthrotomography and scintigraphy in ten patients with typical chondropathia. It was confirmed by arthroscopy in nine cases. Only two patients with severe chondromalacia showed abnormal findings by arthrography or scintigraphy. Our investigation has led to the conclusion that arthrography is not a suitable method for demonstrating idiopathic chondropathia of the patella.

  6. Arthrography of upper caving of temporomandibular joint sydrome and comparative analysis of clinical symptom%颞颌关节紊乱综合征上腔造影影像与临床症状对比分析

    Institute of Scientific and Technical Information of China (English)

    高红旗; 赵凤祥; 李强; 王培源; 魏长亭

    2006-01-01

    自1944年Norgaard首先报告颞下颌关节造影术(TMJ Arthrography)并于1947年发表专著以来,颞下颌关节造影术得到了较广泛推广和应用.近年来虽然CT、MR等已应用于颞下颌关节紊乱综合征(Temporomandibular joint disturbance syndrome,TMJDS)的诊断,但CT检查不能清楚地显示关节盘,MR虽能显示关节盘的形态、大小、位置,却不能明确关节盘有无穿孔及穿孔的位置和程度,故TM造影检查仍是TMJDS诊断的重要方法.

  7. Shoulder MR arthrography and injury mechanism of partial articular surface tendon avulsion%肩关节MR造影诊断肩袖关节侧大结节止点处外伤性撕脱的价值

    Institute of Scientific and Technical Information of China (English)

    田春艳; 周宏宇; 郑卓肇; 崔国庆

    2014-01-01

    目的 评估肩关节MR造影诊断肩袖关节侧大结节止点处外伤性撕脱(PASTA损伤)的能力.方法 回顾性分析经关节镜证实的19例PASTA损伤的肩关节MR造影图像.19例PASTA损伤中,职业运动员15例,运动爱好者4例,年龄16 ~ 35岁.总结PASTA损伤的影像特点,并计算肩关节MR造影对PASTA损伤的诊断敏感度.结果 12例PASTA损伤累及冈上肌腱,4例累及冈上肌腱与冈下肌腱交界部,3例累及冈下肌腱.中立位肩关节MR造影可确定15例为肩袖下表面的部分撕裂,诊断敏感度为78.9% (15/19),但只能确定13例为PASTA损伤,诊断敏感度为68.4% (13/19).19例PASTA损伤中,18例合并有盂唇撕裂,肩关节MR造影诊断上方盂唇前后向撕裂的敏感度为100.0%(11/11),前下盂唇撕裂为92.3% (12/13),3例后方盂唇撕裂诊断2例.结论 肩关节MR造影可以较全面的评价PASTA损伤.

  8. The Value of Indirect MR Arthrography in Diagnosis of Anterior Cruciate Ligament Injury%间接法MR膝关节造影在前交叉韧带损伤中的诊断价值

    Institute of Scientific and Technical Information of China (English)

    王亮; 王颖; 王琦; 张雪峰

    2012-01-01

    目的:评价间接法MR膝关节造影对前交叉韧带(ACL)损伤的诊断价值.方法:分析78例经手术证实的膝关节MR平扫加间接法MR膝关节造影扫描的膝关节外伤患者的MR资料,与关节镜手术结果对比分析.结果:常规MR平扫诊断ACL损伤的敏感性、特异性、准确性、阳性似然比和阴性似然比分别为83.3%、80.5%、86.5%、4.3421和0.1645,间接法MR关节造影诊断ACL损伤的敏感性、特异性、准确性、阳性似然比和阴性似然比分别为93.5%、92.8%、94.4%、11.7317和0.0531,两者对诊断ACL的损伤在统计学分析上有显著性差异.结论:间接法MR膝关节造影相比于常规MR平扫明显提高了对ACL损伤的诊断符合率.

  9. Clinical Results and MRI Arthrography Evaluation of Meniscal Repair with FasT-Fix System%FasT-Fix半月板缝合的临床疗效与MRI造影评估愈合研究

    Institute of Scientific and Technical Information of China (English)

    龚熹; 余家阔; 敖英芳

    2010-01-01

    目的:了解关节镜下使用FasT-Fix系统进行半月板缝合的临床疗效与MRI造影下的愈合情况.方法:2006年4月至2007年7月,17例患者、18侧损伤半月板在我所应用Fast-Fix系统进行了关节镜下全内的半月板缝合,所有患者同时进行了交叉韧带重建,于术后平均11个月进行临床随访,依照Barrett标准评价半月板缝合的临床愈合情况,并对随访患者进行IKDC、Lysholm和Tegner评分.所有18侧半月板应用MR/造影评价半月板愈合情况.结果:18侧缝合的半月板有17侧得到了临床愈合,临床愈合率为94.4%.平均IKDC评分由术前的46.4分提高至术后的75.2分,平均Lysholm评分由术前的44.8分提高至术后的80.6分,平均Tegner评分由术前的2.5分提高至术后的5.4分.MRI造影显示18侧半月板中13侧为完全愈合,2侧为部分层厚不愈合,3侧为全层厚不愈合,总愈合率为83.3%,完全愈合率为72.2%.结论:应用Fast-Fix系统进行半月板缝合具有很好的临床效果,MRI造影显示有较高的愈合率.

  10. Value of special investigations of desion of the external tendon of the ankle joint

    International Nuclear Information System (INIS)

    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 is should only be performed for special cases and after critical interpretation of the functional X-ray pictures, because it is a rather invasive method. (orig.)

  11. Your Radiologist Explains Magnetic Resonance Angiography (MRA)

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    Full Text Available ... Pediatric Ultrasound Video: Angioplasty & vascular stenting Video: Arthrography Radiology and You About this Site RadiologyInfo.org is ... Explains Magnetic Resonance Angiography (MRA) Transcript Welcome to Radiology Info dot org Hello, I’m Dr. Elliot ...

  12. Your Radiologist Explains CT Colonography

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    Full Text Available ... Pediatric Ultrasound Video: Angioplasty & vascular stenting Video: Arthrography Radiology and You About this Site RadiologyInfo.org is ... Explains CT Colonography (Virtual colonoscopy) Transcript Welcome to Radiology Info dot org! Hi, I’m Dr. Elliot ...

  13. Your Radiologist Explains Nuclear Medicine

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    Full Text Available ... Pediatric Ultrasound Video: Angioplasty & vascular stenting Video: Arthrography Radiology and You About this Site RadiologyInfo.org is ... Your Radiologist Explains Nuclear Medicine Transcript Welcome to Radiology Info dot org Hello! I’m Dr. Ramji ...

  14. Arthrographic diagnosis of ruptured calcaneofibular ligament. I

    International Nuclear Information System (INIS)

    A new projection, oblique axial, is recommended for the arthrography of the acute sprained ankle for the correct diagnosis of a ruptured calcaneofibular ligament. Its value is experimentally confirmed. (Auth.)

  15. The ankle joint - value of different radiological examinations especially in external ligament injuries

    International Nuclear Information System (INIS)

    For a correct radiological positioning of the ankle joint the bimalleolar line is helpful as well for the A.P.-view as for the lateral view. For the examination of external ligament lacerations Radiography with functional test is not always sufficient. After critical comparison of functional radiographs, clinical symptoms and case history arthrography is necessary in certain cases to come to a final conclusion. Indications for arthrography are stated and explained. (orig.)

  16. US of the shoulder

    International Nuclear Information System (INIS)

    Twenty five healty people and 25 patients with shoulder pain underwent US control over a 12-month period: 24 patients with shoulder pain had rotator cuff and/or biceps tendon lesions. The US findings on rotator cuff and biceps tendon lesions are compared with those of arthrography and/or surgery (96% sensitivity). US is rapid, safe, non invasive, inexpensive and often more accurate, and its use is recommended for the routine examination of the shoulder joint insteat of arthrography

  17. Ranking of MR in the diagnosis of diseases of the shoulder joint

    International Nuclear Information System (INIS)

    In a prospective study 43 patients with shoulder pain were examined by sonography and MRI. The findings were controlled by plain radiography, arthrography, and CT arthrography. Joint effusions and humeral head defects were equally identified by MR and sonography. In the diagnosis of labrum lesions, rotator cuff lesions, subacromial spurs, and synovial inflammatory disease sonography was not as accurate as MR. A special MR scoring system improved the diagnosis of an impingement syndrome. (orig.)

  18. MR a rthrographaphy of the shoulder - to do or not to do

    International Nuclear Information System (INIS)

    Full text: Introduction: The shoulder is a complex joint, capable of the highest volume of movement in comparison with all other joints in the body. Injuries, repetitive microtrauma and age and wear of the joint are responsible for most problems in the shoulders. What you will learn: the compilation of standardized MR protocol for the study of the shoulder joint, the advantages and disadvantages of MR arthrography, the possible errors in the technical performance of MR arthrography, the necessity of preparation of the patient. Discussion: In the joint MRI imaging diagnostic success requires differentiation of complex anatomical structures and demonstration of subtle abnormalities. MR arthrography expands potentialities of the conventional MR images. In arthrography a contrast medium is introduced into the joint cavity, thereby achieving expansion of the cavity and a better differentiation of the articular structures and the articular and synovial surfaces. Conclusion: MRI and MR arthrography in particular are the methods of choice for pathological changes of the shoulder joint. MR arthrography is more sensitive and more specific method in the demonstration of the intra-articular structures, but the invasiveness of the procedure limited its routine application

  19. Magnetic resonance imaging and magnetic resonance arthography of the acetabular labrum: Comparison with surgical findings; Magnetresonanztomographie und Magnetresonanzarthrographie des Labrum acetabulare: Vergleich mit operativen Ergebnissen

    Energy Technology Data Exchange (ETDEWEB)

    Czerny, C. [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria). Abt. fuer Osteologie; Kramer, J. [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria). Abt. fuer Osteologie; Institut fuer bildgebende Diagnostik am Schillerpark, Linz (Austria); Neuhold, A. [Krankenhaus Rudolfinerhaus, Vienna (Austria). Inst. fuer bildgebende Diagnostik; Urban, M. [Krankenhaus Sozialmedizinisches Zentrum Ost, Vienna (Austria). Abt. fuer Radiodiagnostik; Tschauner, C. [Orthopaedisches Landeskrankenhaus Stolzalpe (Austria); Hofmann, S. [Krankenhaus Sozialmedizinisches Zentrum Ost, Vienna (Austria). Abt. fuer Radiodiagnostik; Orthopaedisches Landeskrankenhaus Stolzalpe (Austria)

    2001-08-01

    Aim of the study: To evaluate the accuracy of magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrography in detecting acetabular labral lesions in correlation to surgical findings. Patients and methods: Forty patients (40 hips) with chronic hip pain and a strong clinical suspicion of labral lesions were examined with MRI in the coronal and axial plane by obtaining T{sub 1} weighted and proton density-weighted spin echo sequences. Additionally, MR arthrography of the high joint in the coronal oblique and sagittal oblique plane was performed by obtaining T{sub 1}-weighted three-dimensional gradient echo sequences after the intraarticular injection of gadopentate dimeglumine. The labra were prospectively evaluated on the basis of morphology, signal intensity, the presence or absence of a tear, and their attachment to the acetabulum. All patients underwent surgery, and the MRI findings and MR arthrography findings were compared with the surgical results. Results: Surgically, 34 labral lesions, and 6 normal labra were detected. MRI correctly depicted labral lesions in 24 patients and two normal labra, and MR arthrography correctly depicted labral lesions in 30 patients and 5 normal labra compared with the surgical results. The sensitivity of MRI was 80%, the accuracy of MRI was 65%, the sensitivity of MR arthrography was 95%, and the accuracy of MR arthgrography was 88%. Conclusions: MR arthrography enables considerably more accurate detection of acetabular labral lesions than MRI. MR arthrography should be the method of choice for the diagnosis of the presence or absence of acetabular labral lesions in patients with chronic hip pain and a strong clinical suspicion of labral lesions. (orig.) [German] Ziel: Die Bestimmung der Wertigkeit der konventionellen Magnetresonanztomographie (MRT) und der Magnetresonanzarthrographie (MR-Arthrographie) in der Abklaerung von Laesionen des Labrum acetabulare im Vergleich mit Operationsbefunden (Goldstandard). Methode

  20. Double contrast CT arthrographic findings of shoulder instability

    International Nuclear Information System (INIS)

    Glenno-humeral joint is a ball and socket joint. It has the greatest range of movement among all the joints of the body. The greatest range of movement is inevitably accompanied by a considerable loss in stability. Thirty three persons underwent Double Contrast CT arthrography of the shoulder for the evaluation of suspected shoulder derangement. We performed 62 shoulder arthrography(33 abnormal shoulders and 29 normal shoulders) and reviewed their findings retrospectively. They had recurrent shoulder dislocation(30 shoulders) or nonspecific shoulder pain(3 shoulders). Injury of the glenoid labrum was seen in 28 shoulders at double contrast CT arthrography. Among 28 cases of the labral injury, labral detachment was seen in 15 cases, labral tear in 5 cases, and labral erosion in 8 cases. Double contrast CT arthrography also showed Hill-Sachs defection in 20 shoulders. The numbers of type 1, type 2, and type 3 capsulolabral attachment in 33 shoulder instability cases were 10, 16,and 7, respectivity, while, 16, 12, and , 1 in 29 normal controls. Type 2 and 3 are more common in shoulder instability group than normal control group. Operation was done in 18 shoulders. Comparing with operation findings, the sensitivity of double contrast CT arthrography in the detection of Hill-Sachs defect was 100% with the specificity of 71% and the accuracy of 89%. The sensitivity, specificity, and accuracy of double contrast CT arthrography in the detection of labral injury were 94%, 100%, and 95%, respectively. Double contrast CT arthrography is a minimally invasive and highly accurate technique for in the evaluation of glenohumeral instability

  1. Arthrographic examination for temporomandibular joint (TMJ) by limited cone beam X-CT for dental use (Ortho-CT)

    International Nuclear Information System (INIS)

    TMJ arthrography has been performed with a surgical X-ray television system (fluoroscope) and a tomographic apparatus for patients with disturbance of opening of the mouth. Limited cone beam X-CT for dental use (Ortho-CT) developed by Arai et al. is small and very effective for the small maxillofacial area. We performed TMJ arthrography by using Ortho-CT for TMD patients, and obtained good results, compared with those of MRI. Objects were 13 joints in 12 patients diagnosed as having TMD. As a result, there was a high percentage of agreement with figure and position of the articular disk and it was certain that Ortho-CT had the accuracy similar to that of MRI, because there was no statistically significant difference. We conclude that Ortho-CT is very effective for TMJ arthrography. (author)

  2. Diagnosis of TFCC lesions. Its clinical findings and diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Imaeda, Toshihiko; Nakamura, Ryogo; Shionoya, Kaoru; Goto, Yasuko; Hosokawa, Hisayo [Nagoya Univ. (Japan). Branch Hospital

    1996-12-01

    Thirty-five patients with persistent ulnar wrist pain after conservative treatment and with positive ulnocarpal stress test underwent several examinations. X-ray findings revealed a lunate ulcer or cyst in 20% and accumulation of isotopes in the ulnar wrist was identified in 94% by scintigraphy. Arthroscopy revealed triangular fibrocartilage lesions in 60%. Ulnocarpal stress test is sensitive enough to note arthroscopic pathology of TFC lesions. One hundred and two wrists had undergone MRI and radiocarpal arthrography before arthroscopic examination. Arthrography had a sensitivity of 85% and specificity of 100% in detection of TFC lesions. MRI had a sensitivity of 73% and specificity of 72%. These were lower than the corresponding values of arthrography. (author)

  3. Diagnosis of ligament injuries in the superior ankle joint

    International Nuclear Information System (INIS)

    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 muscel 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. (orig.)

  4. Diagnosis of ligament injuries in the superior ankle joint. Roentgendiagnostik der Bandlaesionen des oberen Sprunggelenks

    Energy Technology Data Exchange (ETDEWEB)

    Gebing, R.; Fiedler, V. (Staedtische Krankenanstalten Krefeld (Germany, F.R.). Inst. fuer Roentgendiagnostik)

    1991-12-01

    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 muscel 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. (orig.).

  5. MR imaging of the shoulder

    International Nuclear Information System (INIS)

    Magnetic resonance (MR) imaging (1.5-T unit) was performed in over 600 shoulders to evaluate shoulder pain. Ultrasound (US) and arthrography were performed in over 100 patients. Surgery was performed in over 75 patients. MR imaging offers information not well evaluated with other modalities, including bony impingement, tendinitis, bursitis, and osseous abnormalities, such as primary arthritis, avascular necrosis, occult fractures, and tumors. US and MR findings correlate well with surgical findings for medium to large rotator cuff tears. MR imaging with T2 weighting is superior for differentiating small tears from associated tendinitis. An algorithm for cost-effective shoulder imaging integrating US, MR imaging, arthrography, and computed tomographic arthrography are presented

  6. X-ray diagnosis in acute and chronic sport injuries

    International Nuclear Information System (INIS)

    Stress X-ray and arthrography are of importance in the diagnosis of joint injuries. Stress X-rays are of great value to testify instability of acromioclavicular joint, metacarpophalangeal joint of the thumb, but also the knee and the ankle joint. With arthrography it is possible to show up a rupture of the rotator cuff of the shoulder and also a lesion of the triangular disc of the wrist. Indication, technique and the interpretation of the stress X-rays and the arthrogramms are discussed. (orig.)

  7. MRI of atraumatic sports injuries of the shoulder

    International Nuclear Information System (INIS)

    MRI of operatively or arthroscopically proven atraumatic sports injuries of 12 shoulders were reviewed retrospectively. Although it is difficult to diagnose the lesions localised at the superior glenoid labrum and to decide whether rotator interval is injured or not by MRI, MRI could detect thickening of subacromial bursae or rotator cuff injuries due to impingement syndrome and glenoid labrum injuries, such as Bankart lesion. On our limited experience, MRI was more valuable examination than arthrography and CT arthrography. MRI is a useful modality for screening or preoperative evaluation of atraumatic sports injuries of the shoulder. (author)

  8. Imaging of hand injuries. Anatomic and radiodiagnostic considerations; Radiologie beim Handtrauma. Anatomie, Untersuchungsstrategie und Bildanalyse

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Herz- und Gefaessklinik GmbH Bad Neustadt, Bad Neustadt an der Saale (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie

    2011-03-15

    Imaging recommendations for assessing injuries of the forearm, wrist, metacarpus and the digits are given with respect to anatomic considerations. Furthermore, dedicated algorithms of advanced imaging are introduced with radiography as the primary diagnostic tool. High-resolution CT is used for detecting and staging the complex fractures of the radius and the wrist, whereas contrast-enhanced MRI serves for depicting the injured soft tissues. At the wrist, tears of the intrinsic ligaments and the TFCC are assessed with high accuracy when applying MR arthrography or CT arthrography. Dedicated radiologic tools as well as comprehensive reports are suggested in the management of the various hand injuries. (orig.)

  9. X-ray diagnosis in acute and chronic sport injuries

    Energy Technology Data Exchange (ETDEWEB)

    Martinek, H.; Egkher, E.; Schratter, H.

    1982-09-01

    Stress X-ray and arthrography are of importance in the diagnosis of joint injuries. Stress X-rays are of great value to testify instability of acromioclavicular joint, metacarpophalangeal joint of the thumb, but also the knee and the ankle joint. With arthrography it is possible to show up a rupture of the rotator cuff of the shoulder and also a lesion of the triangular disc of the wrist. Indication, technique and the interpretation of the stress X-rays and the arthrogramms are discussed.

  10. Painful/unstable shoulder

    International Nuclear Information System (INIS)

    This paper reports on the diagnostic performance of CT-arthrography of the painful/unstable shoulder that was evaluated in more than 300 patients. We have encountered a great variety of painful shoulder pathology, including impingement syndrome, cuff tear arthropathy, lesions of the long head of the biceps tendon, calcifying tendinitis, adhesive capsulitis, dead arm syndrome, and degenerative joint disease. Lesions related to instability include cases of capsular avulsions, disruption of the glenohumeral ligaments, labral pathology, glenoid fractures, Hill-Sachs lesions, and changes in glenoid angulation. CT-arthrography is an accurate exploration for both unstable and painful shoulders

  11. Chest X-Ray

    Medline Plus

    Full Text Available ... Pediatric Ultrasound Video: Angioplasty & vascular stenting Video: Arthrography Radiology and You About this Site RadiologyInfo.org is ... radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey ...

  12. [X-ray diagnosis of retropatellar diseases (author's transl)].

    Science.gov (United States)

    Wahlers, B

    1979-08-01

    The article reports on a comprehensive, stepwise diagnosis in diseases of the knee joints. This includes a description of the indication, the technique of taking x-ray films, and x-ray findings, as well as arthrography of the femoropatellar joint in retropatellar diseases such as chondropathia patellae, osteochondrosis dissecans, traumas of the knee joints and arthrosis deformans.

  13. The foot and ankle

    International Nuclear Information System (INIS)

    Imaging of the foot and ankle can be difficult because of the complex anatomy. Familiarity with the bony and ligamentous anatomy is essential for proper evaluation of radiographic findings. Therefore, pertinent anatomy is discussed as it applies to specific injuries. Special views, tomography, arthrography, and other techniques may be indicated for complete evaluation of foot and ankle trauma

  14. Interrelationship between mandibular congealer head position in trasncranial view and articular disc position

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Jae Hee; Choi, Soon Chul; You, Dong Soo [Dept. of Oral and Maxillofacial Radiology, Graduate School, Seoul National University, Seoul (Korea, Republic of)

    1995-08-15

    This study was designed to evaluate the interrelationship between the congealer head position in transcranial view and the articular disc position in the arthrography. The condylar positions were assessed by subjective method and linear measurement method on the transcranial view. The subjects for this study consisted of 24 symptomatic joints with normal disc position, 37 joints with anterior disc displacement with reduction and 44 joints with anterior disc displacement without reduction that were classified by arthrotomography under the fluoroscopic guidance. The interrelationship between the condylar head position in transcranial view and the articualr disc position in the arthrography was evaluated by Chi square test. The following results were obtained: 1. There was no significant interrelationship between the position of congealer head in closed mouth state on transcranial view and articular disc position in the arthrography (p>0.05). 2. There was no significant interrelationship between the changes of interarticular distance in 1 inch opening state and articular disc position in the arthrography (p>0.05). 3. There was no significant interrelationship between the position of condylar head related to the apex of articular eminence in 1 inch opening state and articular disc position in the arthrography (p>0.05). 4. There was significant interrelationship between the changes of interarticular distance that is assessed by linear measurement method in maximum opening state and articular disc position in the arthrography (p<0.05), but there was no significant interrelationship when the condylar head position was assessed by subjective method (p>0.05). 5. There was significant interrelationship between the degree of condylar translation in maximum opening state and articular disc position in the arthrography (p<0.01). 6. The correlation coefficient between two methods to assess the position of condylar head were 0.7989: the condylar head position in articular fossa

  15. [Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures].

    Science.gov (United States)

    Hohendorff, B; Eck, M; Mühldorfer, M; Fodor, S; Schmitt, R; Prommersberger, K-J

    2009-10-01

    Fractures of the distal radius, which currently are treated with palmar locking plates, are often accompanied by carpal lesions. Tears of the scapholunate interosseus ligament (SL) can affect the outcome. Between January 2007 and May 2008, 28 patients with distal intraarticular fractures of the radius were included in a prospective study. Preoperative CT-arthrography was performed. SL tears were found in 11 patients, with 10 partial and one complete rupture observed. A tear of the triangular fibrocartilage complex (TFCC) was detected in 16 patients. Every patient was operated with a palmar locking plate through a palmar approach between the flexor carpi radialis tendon and the radial artery. Then, a palmar wrist arthroscopy using a palmar portal was performed. Eleven SL tears with 9 partial and two total ruptures were diagnosed by arthroscopy. Ten lesions were associated with a C1-fracture with a fracture line projected onto the scapholunate interval. The TFCC was appraisable by palmar wrist arthroscopy only in 4 patients. Three of the SL tears detected by CT-arthrography could not be confirmed by palmar wrist arthroscopy. One complete rupture and one partial lesion confirmed by palmar wrist arthroscopy were found by CT-arthrography to be intact. Palmar wrist arthroscopy affords certainty when assessing the SL ligament. In this study, an assessment of ulnocarpal structures was not possible. For assessment of the ulnocarpal structures, CT-arthrography was superior to palmar wrist arthroscopy. However, the latter is an alternative during emergency treatment or when CT-arthrography is not available. PMID:19790024

  16. MR ARTHOGRAPHY OF THE GLENOHUMERAL JOINT : ITS ROLE IN THE EVALUATION OF SHOULDER INSTABILITY AND PERSISTENT PAIN

    Directory of Open Access Journals (Sweden)

    Thukral

    2015-05-01

    Full Text Available BACKGROUND : The purpose of the study was to evaluate the role of MR arthrography in identification and characterization of normal variants , rotator cuff tears and tears of labro - ligamentous complex of the glenohumeral joint and compare it with conventional MRI . AIMS AND OBJECTIVES : Identification , signal characterization and grading of rotator cuff tears and to detect , localize and characterize tears of the labroligamentous complex and to differentiate them from the normal variants . METHODS : Thirty three patients in the age group of 18 - 60 years with history of shoulder instability or persistent pain due to previous injury were prospectively evaluated with conventional MRI fol lowed by MR arthrography . Patients with active joint infection , contrast allergy and joint effusion were excluded from the study . Conventional MRI and MR arthrographic findings were recorded separately and then compared . RESULTS : Statistically significant difference was found between conventional MRI and MR arthrography in the identification and characterization of labro - ligamentous tears while no statistical difference was found between the two in detection of rotator cuff tears . High incidence of co - occur rence was found between hill - sachs defect and bankart lesions/variants . CONCLUSIONS : MR arthrography is superior to conventional MRI for the delineation of intra - articular structures of the glenohumeral joint and in the detection and characterization of labral tears . Since rotator cuff tears are commoner in older age group in comparison to labral tears which are commoner in patients aged less than 40 years , MR arthrography is the imaging modality of choice in younger age group , irrespective of the clinica l indication .

  17. Hip Imaging in Athletes: Sports Imaging Series.

    Science.gov (United States)

    Agten, Christoph A; Sutter, Reto; Buck, Florian M; Pfirrmann, Christian W A

    2016-08-01

    Hip or groin pain in athletes is common and clinical presentation is often nonspecific. Imaging is a very important diagnostic step in the work-up of athletes with hip pain. This review article provides an overview on hip biomechanics and discusses strategies for hip imaging modalities such as radiography, ultrasonography, computed tomography, and magnetic resonance (MR) imaging (MR arthrography and traction MR arthrography). The authors explain current concepts of femoroacetabular impingement and the problem of high prevalence of cam- and pincer-type morphology in asymptomatic persons. With the main focus on MR imaging, the authors present abnormalities of the hip joint and the surrounding soft tissues that can occur in athletes: intraarticular and extraarticular hip impingement syndromes, labral and cartilage disease, microinstability of the hip, myotendinous injuries, and athletic pubalgia. (©) RSNA, 2016. PMID:27429142

  18. MR Imaging of Ankle Impingement Syndromes

    Directory of Open Access Journals (Sweden)

    Seyed Hassan Mostafavi

    2010-05-01

    Full Text Available Ankle impingement syndromes are characterized by painful friction of joint tissues. This is both the cause and the effect of altered joint biomechanics. The leading causes of impingement lesions are posttraumatic ankle injuries, usually ankle sprains, resulting in chronic ankle pain. "nBased on anatomic and clinical viewpoints, there are five types of ankle impingement syndromes:"n1. Anterolateral"n2. Anterior"n3. Anteromedial"n4. Posteromedial"n5. Posterior"nCareful analyses of patient history and signs and symptoms at physical examination can suggest a specific diagnosis in most patients. MR imaging and MR arthrography are the most useful imaging methods for detecting the osseous and soft-tissue abnormalities present in these syndromes and for ruling out other potential causes of chronic ankle pain. "nThis presentation summarizes the MR imaging, and MR arthrography findings of ankle impingement syndromes.

  19. MRI of the wrist. Technical aspects and anatomic variants indicative of disease; MRT des Handgelenks. Technische Aspekte und anatomische Varianten mit Krankheitswert

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M. [Radiologie Haydnhaus, Bonn (Germany)

    2006-08-15

    In order to produce high quality MR images of the wrist and hand, it is of major importance to consider the technical aspects of the examination. In this article the basics of patient positioning, MR sequences, acquisition plane, and application of contrast media are discussed. Additional issues such as MR arthrography, MR angiography, and magnetic field strength are addressed as well as anatomical variants, which may result in painful conditions. These include in particular the variability in length of the ulna with possible consecutive impaction or impingement syndromes. (orig.) [German] Um qualitativ hochwertige MRT-Bilder des Handgelenks zu erzeugen, muss eine ausgefeilte Untersuchungstechnik eingesetzt werden. In diesem Artikel werden daher Grundsaetze der Patientenlagerung, Sequenzwahl, Schichtfuehrung sowie Kontrastmittelanwendung besprochen. Besondere Aspekte, wie MR-Arthrographie, -Angiographie und unterschiedliche Feldstaerken werden ebenso besprochen wie anatomische Besonderheiten und Varianten, die zu schmerzhaften Zustaenden am Handgelenk fuehren koennen. Dazu zaehlen besonders die variable Laenge der Ulna mit der moeglichen Folge eines Impaktions- oder Impingementsyndroms. (orig.)

  20. Imaging in carpal instability.

    Science.gov (United States)

    Ramamurthy, N K; Chojnowski, A J; Toms, A P

    2016-01-01

    Carpal instability is a complex and heterogeneous clinical condition. Management requires accurate identification of structural injury with an understanding of the resultant movement (kinematic) and load transfer (kinetic) failure. Static imaging techniques, such as plain film radiography, stress views, ultrasound, magnetic resonance, MR arthrography and computerized tomography arthrography, may accurately depict major wrist ligamentous injury. Dynamic ultrasound and videofluoroscopy may demonstrate dynamic instability and kinematic dysfunction. There is a growing evidence base for the diagnostic accuracy of these techniques in detecting intrinsic ligament tears, but there are limitations. Evidence of their efficacy and relevance in detection of non-dissociative carpal instability and extrinsic ligament tears is weak. Further research into the accuracy of existing imaging modalities is still required. Novel techniques, including four-dimensional computerized tomography and magnetic resonance, can evaluate both cross-sectional and functional carpal anatomy. This is a narrative review of level-III studies evaluating the role of imaging in carpal instability. PMID:26586689

  1. The post-arthro-CT of the wrist clinical evaluation

    CERN Document Server

    Scheurecker, G

    2001-01-01

    To compare the diagnostic effectiveness of post-arthro-CT (PACT) and 3-compartment wrist arthrography (AG) both separate and combined versus wrist arthroscopy for scapho-lunate ligament (SLL), luno-triquetral ligament (LTL) and triangular fibrocartilage (TFC) defects and chondromalacia of the carpal bones. Material and methods: in 58 patients (16-69 years) the affected wrist was examined initially by conventional 3-compartment wrist arthrography with digital subtraction technique during injection followed by digital stress images. Afterwards spiral arthro-CT was performed in the semi-coronal and axial plane with 1 mm slice thickness and secondary true-coronal and sagittal reconstructions. Within 1 month arthroscopy was performed in general anesthesia utilizing standard joint entry points combined with routine digital picture archiving. All examinations were evaluated for SLL, LTL and TFC defects, PACT and AS for ChM too. Results: AG versus AS: the following detection rates were observed (AG and AS positive/AG...

  2. Pseudotumoral ganglion cyst of a finger with unexpected remote origin: multimodality imaging

    Energy Technology Data Exchange (ETDEWEB)

    Bouilleau, Loic; Malghem, Jacques; Omoumi, Patrick; Simoni, Paolo; Vande Berg, Bruno C.; Lecouvet, Frederic E. [Universite Catholique de Louvain, Department of Radiology, Cliniques Universitaires Saint-Luc, Brussels (Belgium); Barbier, Olivier [Universite Catholique de Louvain, Department of Orthopaedic Surgery, Cliniques Universitaires Saint-Luc, Brussels (Belgium)

    2010-04-15

    The case of a ganglion cyst in the pulp of a fifth finger in an elderly woman initially mimicking a soft tissue tumor is described. Most typical sites of ganglion cysts are well documented at the wrist and in the vicinity of inter-phalangeal and metacarpo-phalangeal joints. In this case, ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated a cystic lesion within the pulp of the fifth finger and indicated carpal osteoarthritis as the distant - and unexpected - origin of the lesion. The suggested diagnosis of ganglion cyst was confirmed by computed tomography arthrography (CT arthrography) of the wrist, which showed opacification of the cyst on delayed acquisitions after intra-articular injection into the mid-carpal joint, through the fifth flexor digitorum tendon sheath. The communications between the degenerative carpal joint, the radio-ulnar bursa, the fifth flexor digitorum tendon sheath and the pedicle of the cyst were well demonstrated. (orig.)

  3. Imaging of superior labral anterior to posterior (SLAP) tears of the shoulder.

    Science.gov (United States)

    Simoni, P; Scarciolla, L; Kreutz, J; Meunier, B; Beomonte Zobel, B

    2012-12-01

    Superior labral anterior to posterior (SLAP) tears include a number of abnormal changes of the superior glenoid labrum. SLAP tears have been first reported in elite young atlete and are caused by repetitive overhead motion or by a fall on an outstretched arm. SLAP can lead to chronic pain and instability of shoulder. A diagnosis of SLAP may be difficult on the basis of clinical tests. Hence, modern imaging, including computed tomography arthrography (CTA), magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) play a key role in the diagnosis of SLAP. The large number of normal anatomic variants of the superior labrum and the surrounding structures make the interpretation of SLAP challenging on imaging and at arthroscopy. In this article the imaging of SLAP are discussed in detail along with relevant anatomy, anatomic variants and biomechanics.

  4. Clinical or radiological diagnosis of impingement

    International Nuclear Information System (INIS)

    Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques. (orig.)

  5. Pseudotumoral ganglion cyst of a finger with unexpected remote origin: multimodality imaging

    International Nuclear Information System (INIS)

    The case of a ganglion cyst in the pulp of a fifth finger in an elderly woman initially mimicking a soft tissue tumor is described. Most typical sites of ganglion cysts are well documented at the wrist and in the vicinity of inter-phalangeal and metacarpo-phalangeal joints. In this case, ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated a cystic lesion within the pulp of the fifth finger and indicated carpal osteoarthritis as the distant - and unexpected - origin of the lesion. The suggested diagnosis of ganglion cyst was confirmed by computed tomography arthrography (CT arthrography) of the wrist, which showed opacification of the cyst on delayed acquisitions after intra-articular injection into the mid-carpal joint, through the fifth flexor digitorum tendon sheath. The communications between the degenerative carpal joint, the radio-ulnar bursa, the fifth flexor digitorum tendon sheath and the pedicle of the cyst were well demonstrated. (orig.)

  6. Demonstration of an infected popliteal (Baker's) cyst with three-phase skeletal scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Wallner, R.J.; Dadparvar, S.; Croll, M.N.; Brady, L.W.

    1985-03-01

    A case is reported of an infected popliteal (Baker's) cyst demonstrated with triple phase skeletal scintigraphy. Although double-contrast arthrography and ultrasonography are currently the modalities most frequently employed to diagnose the presence of popliteal cysts, they may also be detected utilizing this radionuclide technique in the course of evaluation for knee joint disease or septic arthritis. Radionuclide studies may be more sensitive for the evaluation of associated inflammatory disease involving the knee joint.

  7. Significant use of diagnostic radiology for sport injuries and damages

    International Nuclear Information System (INIS)

    The diagnosis of a sport injury or a sport damage is usually made by the clinical investigation. However, the X-ray examination is indispensable. In addition to standard projections further radiologic techniques such as passive motion, tomography, computed tomography, arthrography or angiography are necessary. The relevant use of these X-ray methods with regard to sports injuries or damages of the particular regions of the locomotor system are described. (orig.)

  8. Atypical retroperitoneal extension of iliopsoas bursitis

    Energy Technology Data Exchange (ETDEWEB)

    Coulier, B.; Cloots, V. [Department of Diagnostic Imaging, Cliniques St. Luc, Rue St Luc 8, 5004, Bouge, Namur (Belgium)

    2003-05-01

    We report two rare cases of iliopsoas bursitis extending into the retroperitoneal space. The first lesion contained much gas, mimicking a retroperitoneal abscess, and the second was responsible for atypical inguinal pain. The diagnosis was made by contrast-enhanced CT in both cases and arthrography in the first case. Iliopsoas bursitis in these two patients, it is hypothesized, extended into the retroperitoneum, at least in part, by way of intraneural or perineural structures. (orig.)

  9. Imaging of hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  10. Clinical or radiological diagnosis of impingement; Klinische oder radiologische Diagnose des Impingements

    Energy Technology Data Exchange (ETDEWEB)

    Kloth, J.K.; Weber, M.A. [Universitaetsklinikum Heidelberg, Klinik fuer diagnostische und interventionelle Radiologie, Heidelberg (Germany); Zeifang, F. [Universitaetsklinikum Heidelberg, Zentrum fuer Orthopaedie, Unfallchirurgie und Paraplegiologie, Heidelberg (Germany)

    2015-03-01

    Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques. (orig.) [German] Das Impingementsyndrom der Schulter ist ein haeufiges Einklemmungsphaenomen von Sehnen oder Bursen mit typischem klinischem Befund. Wichtige radiologische Verfahren sind Sonographie, MRT und MR-Arthrographie. Projektionsradiographie und CT sind ideal, um knoecherne Veraenderungen aufzuzeigen. Die CT-Arthrographie dient zudem als Ersatzverfahren bei Kontraindikationen fuer die MRT. Diese genannten Modalitaeten koennen in der Primaerdiagnostik die Diagnose eines Impingementsyndroms stuetzen und dessen Ursache aufzeigen. Zudem werden bildgebend Folgen der Einklemmung festgestellt und in Zusammenschau von klinischer Symptomatik und radiologischem Befund Therapieentscheidungen getroffen. Die Sensitivitaet und Spezifitaet der zuvor genannten bildgebenden Verfahren in Bezug auf die diagnostische Aufarbeitung einer klinisch evidenten Impingementsymptomatik

  11. Graded stress radiography in acute injury to the lateral ligaments of the ankle

    International Nuclear Information System (INIS)

    The diagnostic accuracy of graded stress radiography in 26 patients with acute injury to the lateral ankle ligaments has been compared with findings at arthrography and surgery. Measuring talar tilt angles and anterior talar displacement over a range of pressures applied to the distal tibia using a commercially available stress device allows diagnostic distinction between isolated anterior talofibular ligament injury and a combined lesion that involves the calcaneofibular ligament. The results compare well with arthrographic and surgical findings. (orig.)

  12. Arthrographic study of the Wiberg's CE angle in cadavers of children under 3 years old

    International Nuclear Information System (INIS)

    Forty hip arthrographies in cadavers of children under 3 years of age are presented. The articular relationships of the hip through the definition of the morphology of the proximal femoral epyphysis are evaluated. The location of point 'C' and the evaluation of 'CE' angle in this age group are related. The results of the arthrographic 'CE' osseous angle are compared with Salvati's method and with Massie and Howorth's method. (M.A.C.)

  13. Lumbar spine joint synovial cysts of intraspinal development. CT scan imaging

    Energy Technology Data Exchange (ETDEWEB)

    Vallee, C.; Chevrot, A.; Benhamouda, M. and others

    CT scan imaging findings are described in 22 patients with lumbar spine joint synovial cysts, of intraspinal development, provoking sciatica or lumbosciatica from nerve compression in spinal canal. Diagnosis was suggested by a mass at the posterior joint level, of variable density, sometimes with peripheral calcification, presenting a vacuum appearance on occasions, and with enhanced image with contrast. Differential diagnosis is from excluded hernia and postoperative fibrosis. Posterior intra-articular arthrography can confirm diagnosis and allow treatment with prolonged action corticoid infiltrations.

  14. Systematics of shoulder instability; Systematik der Schulterinstabilitaet

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, K.F.; Maehringer-Kunz, A. [Johannes-Gutenberg-Universitaet Mainz, Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Mainz (Germany)

    2015-03-01

    Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to the causative factors as the pathogenesis of instability plays an important role with respect to treatment options. Instabilities are classified into traumatic and atraumatic instabilities as part of a multidirectional instability syndrome and into microtraumatic instabilities. For diagnostics plain radiographs (''trauma series'') are performed to document shoulder dislocation and its successful repositioning. Direct magnetic resonance (MR) arthrography is the most important imaging modality for delineation of the different injury patterns of the labral-ligamentous complex and bony structures. Monocontrast computed tomography (CT) arthrography with the use of multidetector CT scanners represents an alternative imaging modality; however, MR imaging should be preferred in the work-up of shoulder instabilities due to the mostly younger age of patients. (orig.) [German] Unter einer Schulterinstabilitaet versteht man jede zu Beschwerden fuehrende Translation des Humeruskopfs in Relation zur Gelenkpfanne waehrend einer aktiven Bewegung der Schulter. Glenohumerale Instabilitaeten werden heute nach ihrer Aetiologie eingeteilt, da bei der Wahl der Therapie der Entstehungsmechanismus der Instabilitaet eine wichtige Rolle spielt. Danach unterscheidet man primaer traumatisch von atraumatisch entstandenen Instabilitaeten sowie Mikroinstabilitaeten. Bei der Diagnostik dienen konventionelle Roentgenuebersichtsaufnahmen nur noch zur Dokumentation einer Luxation und zur Beurteilung der Reposition. Die durch eine Instabilitaet hervorgerufenen Verletzungsfolgen am labroligamentaeren Komplex und den knoechernen Strukturen werden heute bevorzugt mit der direkten MR-Arthrographie dargestellt. Hierbei koennen unterschiedliche Verletzungsmuster dargestellt werden. Nach

  15. Dosimetry of computerized tomography in the evaluation of hip dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Guyer, B.; Bassano, D.A.; Levinsohn, E.M.; Smith, D.S.; Cady, R.B.

    1984-07-01

    The usefulness of computerized tomography (CT) in the assessment of hip dysplasia has recently been given attention in the literature and concern regarding radiation dose has been raised. This study was undertaken to measure the radiation dose, both in and out of plaster, for plain films, arthrography, tomography, and CT. A method is suggested to reduce dosage by 80% without compromising diagnostic information. Our experience with 25 scans of patients aged 4 months to 39 years is presented.

  16. Clinical and Radiological Evaluation after Arthroscopic Rotator Cuff Repair Using Suture Bridge Technique

    OpenAIRE

    Lee, Kwang Won; Seo, Dong Wook; Bae, Kyoung Wan; Choy, Won Sik

    2013-01-01

    Background We retrospectively assessed the clinical outcomes and investigated risk factors influencing retear after arthroscopic suture bridge repair technique for rotator cuff tear through clinical assessment and magnetic resonance arthrography (MRA). Methods Between January 2008 and April 2011, sixty-two cases of full-thickness rotator cuff tear were treated with arthroscopic suture bridge repair technique and follow-up MRA were performed. The mean age was 56.1 years, and mean follow-up per...

  17. Classification of normal labral variants and labral injuries; Klassifikation von Normvarianten des Labrums und Labrumverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Waldt, S. [Klinikum rechts der Isar, Technische Universitaet Muenchen, Institut fuer diagnostische und interventionelle Radiologie, Muenchen (Germany); Bruegel, M. [Radiologie am Stiglmaierplatz, Muenchen (Germany)

    2015-03-01

    The glenoid labrum is an important stabilizer of the glenohumeral joint. Labral injuries affect the stability of the shoulder joint to varying degrees depending on the localization, the extension and the structures involved. Because of the complex anatomy and the high variability of the glenoid labrum, in-depth knowledge concerning normal variations and labral injury patterns is required as well as high-resolution imaging with intra-articular contrast in order to discriminate anatomical variants from pathological findings. Therefore, magnetic resonance (MR) and alternatively computed tomography (CT) arthrography have become established as the imaging methods of choice. In this review MR arthrographic findings of normal labral variants and different labral injury patterns are portrayed. (orig.) [German] Das Labrum glenoidale ist ein wichtiger Stabilisator des Glenohumeralgelenks. Verletzungen des Labrums beeintraechtigen in Abhaengigkeit von der Lokalisation, der Ausdehnung und den beteiligten Strukturen die Stabilitaet des Schultergelenks in unterschiedlichem Masse. Die komplexe Anatomie und die hohe anatomische Variabilitaet erfordern detaillierte Kenntnisse und eine hochaufgeloeste bildgebende Darstellung mit intraartikulaerer Kontrastmittelgabe, um pathologische Befunde von Normvarianten zu unterscheiden. Die MR-Arthrographie, alternativ auch die CT-Arthrographie, haben sich als bildgebende Verfahren der Wahl etabliert. In dieser Uebersichtsarbeit werden MR-arthrographische Befunde von Normvarianten und labralen Verletzungsmustern gegenuebergestellt. (orig.)

  18. Micro-CT Arthrographic Analysis of Monosodium Iodoacetate- Induced Osteoarthritis in Rat Knees

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jong Won [Samsung Medical Center, Sungkyunkwan University, Seoul (Korea, Republic of); Kang, Heung Sik [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Hong, Sung Hwan [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2010-10-15

    To evaluate the arthrographic findings of MIA-induced osteoarthritis in rat knees using the micro-CT arthrography. Intra-articular monosodium iodoacetate (MIA) injection-induced arthritis was induced in the right knees of twelve rats; their left knees served as the control group. Eight weeks after MIA injection, micro-CT arthrography was performed on each knee. We measured the thickness of retro-patellar cartilages, the distances of tibio-femoral joint space, subchondral bone plate thickness, tibial epiphyseal height, and transverse patellar diameter. Subchondral trabecular bone indices were measured in the tibial lateral condylar epiphysis. The data were analyzed statistically using a paired t-test. The retro-patellar articular cartilage showed thinning on the right side that had been induced to develop osteoarthritis. The right knees showed a significant reduction in the distance of the tibio-femoral joint space, prominent patellar osteophytes, and the resorption of subchondral bone. Among the subchondral trabecular bone indices, percent bone volume, and trabecular thickness was reduced on the right side. The articular cartilage thickness of MIA-induced arthritis model could be measured using micro- CT arthrography. It was possible to evaluate the osteoarthritic findings including the change in subchondral bone plate thickness, osteophyte formation, and subchondral bone resorption, as well as quantitatively analyze the trabecular bone indices.

  19. Differences between radial and ulnar deviation of the wrist in the study of the intrinsic intercarpal ligaments: magnetic resonance imaging and gross anatomic inspection in cadavers

    Energy Technology Data Exchange (ETDEWEB)

    Gheno, Ramon; Buck, Florian M.; Nico, Marcelo A.C.; Trudell, Debra J.; Resnick, Donald [VA San Diego Medical Center, Department of Radiology, San Diego, CA (United States)

    2010-08-15

    To demonstrate how radial and ulnar deviation of the wrist can affect the visualization of the intrinsic intercarpal ligaments using magnetic resonance (MR) imaging, MR arthrography and gross anatomic inspection in cadavers. The detectability of the intrinsic intercarpal ligaments of ten fresh human wrists was analyzed in coronal, axial and sagittal images in the neutral position and in radial and ulnar deviation with MR imaging and MR arthrography. The findings were then correlated with gross anatomic inspection. Additionally, quantitative measurements including the radiocarpal distances and capitate angles were performed. Differences were noted in the visual conspicuity of only the intercarpal ligaments of the proximal carpal row with different techniques and wrist positions. The average width of the radiocarpal joint was 0.62 mm, 1.55 mm and 2.0 mm (radial side) and 3.78 mm, 2.25 mm and 1.16 mm (ulnar side) in radial deviation, neutral position, and ulnar deviation of the wrist, respectively. Statistically, these maneuvers produced significant opening in the ulnar side during radial deviation (Student's t-test; P = 0.0005) and in the radial side in ulnar deviation (P = 0.007). Significant differences in the width of the radiocarpal joint were observed during radial and ulnar deviation of the wrist, influencing the visualization of the intrinsic ligaments, mainly the scapholunate and lunotriquetral ligaments. The use of MR arthrography with radial and/or ulnar deviation has the potential to improve diagnosis in clinical cases in which injury to one or both of these ligaments is suggested. (orig.)

  20. Synovial plicae of the knee on computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Boven, F.; De Boeck, M.; Potvliege, R.

    1983-06-01

    Computed tomography (CT) of the knee was performed in 160 patients following double-contrast arthrography. Seventy-five synovial folds on the medial wall of the knee joint were found, and 63 of these plicae could be considered mediopatellar plicae. In 10 on the 63 cases, long, thick, mediopatellar plicae were found, which could lead to a mechanical internal derangement. Twelve synovial folds did not conform to the classic description of a mediopatellar plica. These folds probably represent synovial tissue reaction, since they were most commonly seen in patients who had undergone meniscectomy.

  1. Synovial folds in the knee joint. The plica parapatellaris medialis

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, H.

    1987-12-01

    Stimulated by arthroscopic insight into central abnormalities of the knee joint and by the large number of unexplained case of 'anterior knee pain', we have studied the synovia in more than 2000 contrast examinations of the joint. Surprisingly, and contrary to the views expressed in the literature, the clinically significant plica parapatellaris medialis was seen as frequently during pneumo-arthrography as during more complex procedures. Abnormalities in the synovial fold emerged as a discreet disease identified as the 'medial shelf syndrome' and should be included in the differential diagnosis of causes of pain round the lower end of the femur and patella.

  2. Traumatic injuries of the hip.

    LENUS (Irish Health Repository)

    Marshall, Nina

    2009-11-01

    Traumatic lesions of the hip in athletes may be clinically challenging because of the overlap in clinical presentation due to differing pathologies and the presence of multiple injuries. Imaging of the hip in the athlete has undergone a recent resurgence of interest and understanding related to the increasing accessibility and use of hip arthroscopy, which expands the treatment options available for intra-articular pathology. MR imaging and MR arthrography have a unique role in diagnosis of these pathologies, guiding the surgeon, arthroscopist, and referring clinician in their management of bony and soft tissue injury.

  3. The significance of imaging methods in the diagnosis of periarticular diseases of the shoulder caused by sports injuries

    International Nuclear Information System (INIS)

    Numerous kinds of sports lead to lesions of the periarticular tissue of the shoulder, which can result in the supraspinatus syndrome or incomplete and complete rupture of the rotator cuff. Standard radiography is of limited use in the diagnosis of periarticular diseases of the shoulder. Osseous alterations in the greater tubercle and undersurface of the acromion can be explained as a supraspinatus syndrome or a long-standing rupture of the rotator cuff in connection with high positioning of the head of the humerus. A rupture of the rotator cuff is demonstrated by arthrography of the shoulder joint, a diagnostic method that we think is necessary despite regular examinations with ultrasonography. (orig.)

  4. Sport injuries of the knee in young people

    International Nuclear Information System (INIS)

    The biggest number of injuries of the knee are in highly result interested sportsmen. The portion of girls has reached 30%. More than 50% of all injuries regard the ligaments and the menisci. Especially in these cases and in combined lesions gives the arthrography good results. All possibilities of investigations should be used for acute injured sportsmen, because of the specific readiness of risks and the dissimulation of young sportspeople and because of the danger of too late established diagnosis and within those of late damages. (orig.)

  5. Imaging of bursae around the shoulder joint

    Energy Technology Data Exchange (ETDEWEB)

    Bureau, N.J. [Department of Radiology, Hotel-Dieu de Montreal Hospital, Montreal, Quebec (Canada); Dussault, R.G. [Department of Radiology, Health Sciences Center, University of Virginia, Charlottesville, Virginia (United States); Keats, T.E. [Department of Radiology, Health Sciences Center, University of Virginia, Charlottesville, Virginia (United States)

    1996-08-01

    The authors present a review of the anatomy of the major bursae around the shoulder joint and discuss the use of the different imaging modalities which demonstrate their radiologic features. The calcified subacromial-subdeltoid bursa has a characteristic appearance on plain radiographs. When inflamed it can be visualized by ultrasound and magnetic resonance imaging. Calcific bursitis may involve the subcoracoid bursa. This bursa may mimic adhesive capsulitis of the shoulder or complete rotator cuff tear when injected inadvertently during shoulder arthrography. Less well known are three coracoclavicular ligament bursae. These are also subject to calcific bursitis and have a typical radiologic appearance. (orig.). With 6 figs.

  6. Localized form of pigmented villonodular synovitis of the knee: the meniscal mime.

    Science.gov (United States)

    Bouguennec, N; Meyer, A; Graveleau, N

    2014-04-01

    The localized form of pigmented villonodular synovitis of the knee is a rare condition with non-specific symptoms. This makes diagnosis especially difficult when the meniscus is affected. A full assessment with several imaging modalities can help support the preoperative diagnosis. But in the case reported here, the full clinical and paraclinical assessment (X-rays, CT arthrography and MRI) was wrong--the localized form of pigmented villonodular synovitis had mimicked a lateral meniscus injury and was only detected during arthroscopy. The lesion was excised surgically and the diagnosis was confirmed through postoperative histopathology.

  7. Radiology of total hip replacement

    Energy Technology Data Exchange (ETDEWEB)

    Griffiths, H.J.; Lovelock, J.E.; McCollister Evarts, C.; Geyer, D.

    1984-06-01

    The radiology of total hip replacement (THR) and its complications is reviewed in conjunction with a long-term follow-up study on 402 patients with 501 prostheses. The indications, contraindications, biomechanics, and operative management of these patients is discussed. Clinical complications such as deep vein thrombosis, pulmonary embolism, and hemorrhage are mentioned. Postoperative infections including granulomatous pseudotumors, dislocations and fractures, true loosening of the prosthesis, and heterotopic bone formation (HBF) are discussed and illustrated. The importance of differentiating the lucent line from true loosening is stressed. Mechanical and other clinical complications which are largely ignored by radiologists are also discussed. The uses of arthrography and bone scanning are included.

  8. The painful hip: new concepts

    Energy Technology Data Exchange (ETDEWEB)

    Blankenbaker, Donna G.; Tuite, Michael J. [University of Wisconsin Medical School, Department of Radiology, Division of Musculoskeletal Imaging, Madison, WI (United States)

    2006-06-15

    Hip pain is a common condition, and the work-up often includes imaging. This article reviews the normal MR anatomy of the hip and the imaging findings of internal derangements, snapping hip, and femoral acetabular impingement. We will describe the role of MR arthrography in evaluating the patient with suspected labral and articular cartilage abnormalities, as well as the pitfalls in interpretation. We will review the causes of a snapping hip, and the role of sonography in evaluating and guiding treatment of the snapping iliopsoas tendon. We will also review the radiographic and MRI signs of femoroacetabular impingement (FAI), a cause of early degenerative joint disease and hip pain. (orig.)

  9. [Chondropathy of the patella. Experiences with 100 medializations].

    Science.gov (United States)

    Villiger, K J

    1976-10-01

    After a brief reference to the biomechanics of the patellofemoral joint, the anamnesis and the clinical and the radiologic symptomatology of chondropathia and the possibilities of its therapy are described. Patellofemoral arthrography is very helpful for the diagnosis. The technique of our operation is also described. After close study of current available literature and careful control of our 100 medialization cases, the results after 6, 12, 24, and 36 months are shown in tabular form. The operation is recommended for primary chondropathia patellae with lateroposition or lateral-tipped patella.

  10. Radionuclide bone imaging as a means of differentiating loosening and infection in patients with a painful total hip prosthesis

    International Nuclear Information System (INIS)

    Twenty patients with 23 painful total hip prostheses were examined by radionuclide imaging (20 cases), arthrography (11 cases), needle aspriation (9 cases), and surgery (19 cases) for the purpose of assessing loosening and/or infection. Bone imaging was most accurate, showing three main distributions of activity: (a) ectopic calcification, (b) focal increased activity at the upper and lower ends of the femoral prosthesis, and (c) diffuse activity. These findings suggest that infection and loosening can be differentiated in many instances. None of the patients with focal activity had infection, compared to 2 of the 3 patients with diffuse uptake

  11. Imaging Evaluation of Superior Labral Anteroposterior (SLAP) Tears.

    Science.gov (United States)

    Grubin, Jeremy; Maderazo, Alex; Fitzpatrick, Darren

    2015-10-01

    Superior labral anteroposterior (SLAP) tears are common injuries that are best evaluated with magnetic resonance arthrography (MRA), as it provides the most detailed evaluation of the bicipital labral complex. Given the variety and complexity of SLAP tears, distention of the joint with intra-articular dilute gadolinium contrast properly separates the intra-articular biceps tendon, superior labrum, glenoid cartilage and glenohumeral ligaments to optimize assessment of these structures. This allows for increased diagnostic confidence of the interpreting radiologist and provides a better road map for the surgeon prior to arthroscopy. Indirect MRA and high-field magnetic resonance imaging are sensitive and specific alternative modalities if MRA cannot be performed.

  12. High frequency of labral pathology in dysplastic hips with a CE angle between 20-25

    DEFF Research Database (Denmark)

    Jakobsen, Stig Storgaard; Hartig-Andreasen, Charlotte; Mikkelsen, Lone Rømer;

    Background: Hip dysplasia becomes symptomatic due to labral pathology and secondary muscular pain. A CE angle pathologic and defined as dysplasia in PAO centres in Denmark. However, it is debated whether a CE angle between 20 and 25 is borderline. Purpose / Aim of Study: We aimed...... to investigate the degree of labral pathology in symptomatic patients with CE between 20 and 25 compared with patients with CE ... of osteoarthritis 0 or 1. All patients had a magnetic resonance arthrography (MRA) performed. The MRA was assessed for labral pathology in terms of degeneration, hypertrophic changes, tears and paralabral cysts. Labral lesions were graded according to the Czerny classification. Findings / Results: In the group...

  13. Distal humeral physeal injuries in child abuse: MR imaging and ultrasonography findings

    International Nuclear Information System (INIS)

    Distal humeral physeal injuries, in particular, fracture-separation of the distal humeral epiphysis, can be seen in abused infants. Detection of physeal injury in an infant of toddler may indicate the possibility of unsuspected abuse, particularly when an appropriate history explaining the circumstance of the fracture is lacking. In addition, the extent of injury can be difficult to characterize on plain radiographs. Ultrasonography (US) and MR imaging (MRI) may be of value in diagnosis and may obviate the need for intraoperative arthrography. We present MRI findings in three abused children with distal humeral physeal injuries. Sonographic correlation is also presented in one case. (orig.)

  14. Magnetic resonance imaging of the shoulder: a review of potential sources of diagnostic errors

    International Nuclear Information System (INIS)

    Shoulder magnetic resonance (MR) imaging and MR arthrography are frequently utilized in the evaluation of shoulder pain and instability. The clinical scenario and imaging findings may be confusing to clinicians and radiologists and may present diagnostic challenges for those involved in evaluating and treating shoulder pathology. Often rotator cuff and labral abnormalities may be coexistent, clinical manifestations of denervation syndromes may be confusing to clinicians, and normal anatomic variations, imaging pitfalls, and various artifacts may cause dilemmas for the radiologist. This article will review the most frequently encountered mimickers and pitfalls of MR imaging of the shoulder. (orig.)

  15. Capitate-lunate instability: recognition by manipulation under fluoroscopy.

    Science.gov (United States)

    White, S J; Louis, D S; Braunstein, E M; Hankin, F M; Greene, T L

    1984-08-01

    Videotape fluoroscopy was used to diagnose a previously undescribed carpal dissociation, the capitate lunate instability pattern. In eight patients with midcarpal pain and clicking, the examiner simultaneously applied pressure to the scaphoid tuberosity while applying longitudinal traction and flexion to the wrist under fluoroscopic control. This maneuver revealed dorsal subluxation of the proximal carpal row and capitate lunate subluxation in each of the eight patients. Plain radiography and arthrography were not helpful in the diagnosis. All eight cases were managed conservatively. Videotape fluoroscopy is the best radiologic method of diagnosing capitate-lunate instability.

  16. [Acute perilunar dislocations: algorithm for treatment].

    Science.gov (United States)

    Towfigh, H

    2001-01-01

    In most cases, perilunar dislocations of the wrist are caused by high speed accidents. Usually these injuries occur by a fall on the dorsiflexed superextension of the hand. The instability caused by injuries of various erticular structures (ligament, bone) show various developmental stages. Clinical symptoms are reduced and painful movement, instability of the carpus, snapping and swelling. The diagnosis is established by X-ray, cinematography, arthrography MRT or CT. Perilunar instability with or without associated fractures and particularly de Quervain must be reduced and treated operatively including suture of the ligament and stabilization of the fracture. PMID:11824286

  17. Migrating bone shards in dissecting Charcot joints.

    Science.gov (United States)

    Forrester, D M; Magre, G

    1978-06-01

    Extensive periarticular calcification is characteristic of Charcot joints. Fragmentation of the articular margins of bone contributes to the bony detritus, but the majority forms de novo in the joint capsule. Occasionally the calcific debris is seen far removed from the joint. Dissection of a chronically distended joint along muscle planes is most commonly associated with the inflammatory joint disease of rheumatoid arthritis. Its occurrence in Charcot joints is documented by arthrography, which demonstrates continuity of the joint space and the distant calcifications. PMID:418652

  18. Scaphotrapezial ligament: normal arthro-CT and arthro-MRI appearance with anatomical and clinical correlation.

    Science.gov (United States)

    Holveck, A; Wolfram-Gabel, R; Dosch, J C; Sanda, R; Antunes, A B F; Decock, S; Zorn, P; Foessel, L; Bierry, G; Clavert, P; Dietemann, J L; Kahn, J L

    2011-08-01

    The purpose of our study was to demonstrate and describe the MR and arthro-CT anatomic appearance of the scaphotrapezial ligament and illustrate some of the pathologies involving this structure. This ligament consists of two slips that originate from the radiopalmar aspect of the scaphoid tuberosity and extend distally, forming a V shape. The ulnar fibers, which are just radial to the flexor carpi radialis sheath, inserted along the trapezial ridge. The radial fibers were found to be thinner and inserted at the radial aspect of the trapezium. Twelve fresh cadaver wrists were dissected, with close attention paid to the scaphotrapezio-trapezoidal (STT) joint. An osseoligamentous specimen was dissected with removal of all musculotendinous structures around the STT joint and was performed with high-resolution acquisition in a 128-MDCT scanner. Samples of the wrist area were collected from two fetal specimens. A retrospective study of 55 patients with wrist pain that were submitted to arthrography, arthro-CT, and arthro-MRI imaging was performed (10 patients on a 3-T superconducting magnet and 45 patients on a 1.5-T system). Another ten patients had high-resolution images on a 3-T superconducting magnet without arthrographic injection. MR arthrography and arthro-CT improved visualization and provided detailed information about the anatomy of the scaphotrapezial ligament. Knowledge of the appearance of this normal ligament on MRI allows accurate diagnosis of lesions and will aid when surgery is indicated or may have a role in avoiding unnecessary immobilization. PMID:21455837

  19. Magnetic resonance imaging of the triangular fibrocartilage complex. Usefulness of the fat suppression MRI

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Toshiyasu [Fujita Health Univ., Nagoya (Japan). Second Hospital; Yabe, Yutaka; Horiuchi, Yukio; Kikuchi, Yoshito; Makita, Satoo

    1996-08-01

    Advances in magnetic resonance imaging (MRI) now allow for the visualization of small structures, such as the triangular fibrocartilage complex (TFCC) of the wrist. Recent investigators suggested that MRI is useful in delineation of the TFCC itself and its abnormality, and supported that diagnostic value of MRI for the TFCC tears is almost equal to those of arthrography and arthroscopy. In contrast, there were several reports that representation of the TFCC in MRI was less worth than in arthrography. Further, it was reported that MRI was not useful because abnormal findings existed at normal volunteers` wrists. Recent development of the pulse sequence is remarkable, such as gradient echo, fast spin echo and fat suppression method. However, as the previous MR studies of the TFCC mainly using conventional spin echo pulse sequence, there were a few comparison of each pulse sequence and we do not know how each pulse sequence delineates the TFCC. Therefore, we studied MRI of the TFCC using several pulse sequence in normal volunteers, and compared MR slices of the TFCC with corresponding histological sections to evaluate shape detectability of MRI. (J.P.N.)

  20. Clinical and Arthroscopic Findings of Acute Anterior Cruciate Ligament Tears of the Knee

    Directory of Open Access Journals (Sweden)

    Kenji Shirakura

    1995-01-01

    Full Text Available Clinical, arthrographic, and arthroscopic findings in 53 patients with acutely torn anterior cruciate ligaments (ACLs were documented. Arthroscopy and instability tests under anesthesia were performed on all patients within 2 weeks after the initial injury. Twenty-three patients complained of extension blocks, and localized tenderness on the medial side was revealed in 26 patients at the initial examination. Aspiration from joints exhibited hemarthrosis in 52 patients. Arthroscopy revealed ACL ruptures in all patients. Four Segond's fractures, 26 meniscus tears (8 medial and 18 lateral, 1 osteochondral fracture, and 19 medial collateral ligament ruptures were revealed. Arthroscopy detected only 1 of the 5 ruptures of the posteromedial corner of the medial meniscus, which were noted on arthrography. Three ACL stumps were protruding among the femorotibial joint, which seemed to be restricting full extension. Statistical analysis showed that tenderness on the medial side was not revealed more frequently in knees with medial collateral ligament injuries than in the others. The volume of aspirated fluids in knees with no leakage in arthrography significantly increased over those with leakages (p < 0.05. Diagnosis of ACL injuries should be completed by clinical, arthrographic, and arthroscopic examinations.

  1. Advanced imaging of the scapholunate ligamentous complex.

    Science.gov (United States)

    Shahabpour, Maryam; Staelens, Barbara; Van Overstraeten, Luc; De Maeseneer, Michel; Boulet, Cedric; De Mey, Johan; Scheerlinck, Thierry

    2015-12-01

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.

  2. Interventional articular and para-articular knee procedures.

    Science.gov (United States)

    Lalam, Radhesh K; Winn, Naomi; Cassar-Pullicino, Victor N

    2016-01-01

    The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sport-related injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and soft-tissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess. PMID:26682669

  3. Imaging techniques for the injured ankle joint and tarsal bones

    International Nuclear Information System (INIS)

    In the case of injuries of the ankle joint, an imaging technique is expected to reveal the state of the bones, ligaments, and articular cartilage. Irrespective of novel imaging techniques, a plain radiography will be made in order to obtain a first picture of the injury. Examples are given, showing that further orientation along the Lauge-Hansen classification scheme of this type of injury helps to completely ascertain the damage to the Articulatio talocruralis. Further examinations applying specific methods such as arthrography will detect possible, isolated syndesmosis ruptures; lesions of the ligaments can also be directly detected by CT or MRT. The articular cartilage and its lesions can be visualized by a combination of CT and arthrography, but are better shown by the completely non-invasive MRT. This latter method also gives insight into pathological processes with the bone. It allows to detect necrotic bone regions and their re-vitalisation in patients with osteochondrosis dissecans of the talus. In addition, MRT allows to detect and accurately localize bone transformation processes, as e.g. in the case of undetected bone fracture, or defects due to false distribution of weight. (orig.)

  4. Advanced imaging of the scapholunate ligamentous complex

    Energy Technology Data Exchange (ETDEWEB)

    Shahabpour, Maryam; Maeseneer, Michel de; Boulet, Cedric; Mey, Johan de [Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Brussels (Belgium); Staelens, Barbara; Scheerlinck, Thierry [Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedics and Traumatology, Brussels (Belgium); Overstraeten, Luc van [Hand and Foot Surgery Unit (HFSU), Tournai (Belgium)

    2015-12-15

    The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies. (orig.)

  5. Unusual variation of the rotator interval: insertional abnormality of the pectoralis minor tendon and absence of the coracohumeral ligament

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Shin Jae; Ha, Doo Hoe; Lee, Sang Min [CHA University, Department of Radiology, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do (Korea, Republic of)

    2010-12-15

    To evaluate the anomalous insertion of the pectoralis minor tendon with absence of the coracohumeral ligament on MR arthrography and to demonstrate the associated findings seen with this anatomical variation. We retrospectively reviewed the 335 MR arthrograms of the shoulder joint (mean age 37.8 years) performed from March 2000 to February 2008. Images were evaluated with attention to anomalous insertion of the pectoralis minor tendon and the coracohumeral ligament. Anomalous insertion of the pectoralis minor tendon was demonstrated in 5 out of 335 shoulders (1.5%). The pectoralis minor tendons crossed over the coracoid process and attached directly to a glenohumeral joint capsule, and the coracohumeral ligament was absent in these 5 patients. In these patients, injected contrast material was noted to extend over the coracoid process along the course of the pectoralis minor tendon. Among 5 patients, 3 patients (60%) were diagnosed with SLAP (superior labrum anterior to posterior) lesions. Anomalous insertion of the pectoralis minor tendon to the glenohumeral joint capsule and associated absence of the coracohumeral ligament is well demonstrated on MR arthrography. It is an unusual variant of the pectoralis minor muscle insertion, and may be a possible contributing factor in the development of a SLAP lesion. (orig.)

  6. Shoulder instability; Schulterinstabilitaeten

    Energy Technology Data Exchange (ETDEWEB)

    Kreitner, Karl-Friedrich [Mainiz Univ. (Germany). Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie

    2014-06-15

    In the shoulder, the advantages of range of motion are traded for the disadvantages of vulnerability to injury and the development of instability. Shoulder instability and the lesion it produces represent one of the main causes of shoulder discomfort and pain. Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to their causative factors as the pathogenesis of instability plays an important role with respect to treatment options: instabilities are classified in traumatic and atraumatic instabilities as part of a multidirectional instability syndrome, and in microtraumatic instabilities. Plain radiographs ('trauma series') are performed to document shoulder dislocation and its successful reposition. Direct MR arthrography is the most important imaging modality for delineation the different injury patterns on the labral-ligamentous complex and bony structures. Monocontrast CT-arthrography with use of multidetector CT scanners may be an alternative imaging modality, however, regarding the younger patient age, MR imaging should be preferred in the diagnostic work-up of shoulder instabilities. (orig.)

  7. MR arthrographic assessment of suspected posteroinferior labral lesions using flexion, adduction, and internal rotation positioning of the arm: preliminary experience

    International Nuclear Information System (INIS)

    Imaging the shoulder in the position of flexion, adduction, and internal rotation (FADIR) may be useful in characterizing lesions of the posteroinferior labrum. The purpose of this preliminary study is to illustrate the diagnostic utility of FADIR positioning in the assessment and characterization of posteroinferior labral tears. In the FADIR position, the arm is placed across the chest, with the hand on the contralateral shoulder and palm facing outwards. FADIR positioning was performed if there was a subtle or equivocal abnormality of the posteroinferior labrum on conventional MR arthrography sequences. A retrospective review of the charts of 9 people who were imaged using FADIR positioning in addition to routine MR arthrographic sequences of the shoulder was performed. The review included the indication for the study, documentation of presence of clinical posterior instability, and surgical correlation, where available. In all 9 patients, FADIR positioning helped confirm, exclude, or better characterize a posteroinferior labral abnormality by increasing the diagnostic confidence. Flexion, adduction, and internal rotation positioning appears to be a useful adjunct in evaluating patients with equivocal or subtle posteroinferior labral abnormalities on conventional MR arthrography sequences. (orig.)

  8. Shoulder instability

    International Nuclear Information System (INIS)

    In the shoulder, the advantages of range of motion are traded for the disadvantages of vulnerability to injury and the development of instability. Shoulder instability and the lesion it produces represent one of the main causes of shoulder discomfort and pain. Shoulder instability is defined as a symptomatic abnormal motion of the humeral head relative to the glenoid during active shoulder motion. Glenohumeral instabilities are classified according to their causative factors as the pathogenesis of instability plays an important role with respect to treatment options: instabilities are classified in traumatic and atraumatic instabilities as part of a multidirectional instability syndrome, and in microtraumatic instabilities. Plain radiographs ('trauma series') are performed to document shoulder dislocation and its successful reposition. Direct MR arthrography is the most important imaging modality for delineation the different injury patterns on the labral-ligamentous complex and bony structures. Monocontrast CT-arthrography with use of multidetector CT scanners may be an alternative imaging modality, however, regarding the younger patient age, MR imaging should be preferred in the diagnostic work-up of shoulder instabilities. (orig.)

  9. Interventional articular and para-articular knee procedures.

    Science.gov (United States)

    Lalam, Radhesh K; Winn, Naomi; Cassar-Pullicino, Victor N

    2016-01-01

    The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sport-related injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and soft-tissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess.

  10. Diagnosis of shoulder impingement syndrome; Diagnostik des Schulterimpingementsyndroms

    Energy Technology Data Exchange (ETDEWEB)

    Hodler, J. [Orthopaedische Universitaetsklinik Balgrist, Zuerich (Switzerland)

    1996-12-01

    This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs many overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff. (orig.) [Deutsch] Grundlage des Impingementsyndroms ist eine Kompression des Supraspinatus am akromioklavikularen Bogen vor allem bei Flexion

  11. [Radiological examinations that have disappeared].

    Science.gov (United States)

    Puylaert, Carl B A J; Puylaert, Julien B C M

    2011-01-01

    If a radiologist from 1950 could travel in time to 2011, he or she would be baffled to see how few of the radiological examinations he was familiar with, remain. We review the radiological examinations that have disappeared since X-rays were discovered, and include the causes of their disappearance. Barium studies have mainly been replaced by endoscopy, oral cholecystography by ultrasound, and intravenous urography by CT-scan. Angiography by means of a direct puncture of carotid artery and aorta has been replaced by Seldinger angiography. Pneumencephalography and myelography have been replaced by CT and MRI. Bronchography has been replaced by bronchoscopy and CT-scan, arthrography by MRI and arthroscopy. Many other radiological examinations have been replaced by ultrasound, CT or MRI. PMID:21447222

  12. Computed tomography in sport injuries

    International Nuclear Information System (INIS)

    Computed tomography (CT) provides axial slices plane and shows excellent details of bones and different soft tissues, favoring its use in traumatic lesions caused by sporting activities. Complex anatomical structures such as the shoulder, the vertebral column, the pelvis, the knee, the tarsal and carpal bones are often better recognized in detail than by conventional radiography. Fracture lines, localization of bone fragments and involvement of soft tissues are clearly demonstrated. Luxations and bone changes leading to luxations can be shown. CT arthrography provides for the first time a direct visualization of joint cartilage and of cruciate ligaments in the knee joint, so traumatic lesions such as chondropathia patellae or rupture of the cruciate ligaments are shown with a high degree of reliability. (orig.)

  13. Shoulder injuries in overhead sports

    International Nuclear Information System (INIS)

    Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes. (orig.)

  14. MR imaging in sports-related glenohumeral instability

    International Nuclear Information System (INIS)

    Sports-related shoulder pain and injuries represent a common problem. In this context, glenohumeral instability is currently believed to play a central role either as a recognized or as an unrecognized condition. Shoulder instabilities can roughly be divided into traumatic, atraumatic, and microtraumatic glenohumeral instabilities. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement syndromes and chronic damage to intraarticular structures. Magnetic resonance (MR) arthrography is superior to conventional MR imaging in the diagnosis of labro-ligamentous injuries, intrinsic impingement, and SLAP (superior labral anteroposterior) lesions, and thus represents the most informative imaging modality in the overall assessment of glenohumeral instability. This article reviews the imaging criteria for the detection and classification of instability-related injuries in athletes with special emphasis on the influence of MR findings on therapeutic decisions. (orig.)

  15. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft.

    Science.gov (United States)

    Trindade, Christiano A C; Sawyer, Gregory A; Fukui, Kiyokazu; Briggs, Karen K; Philippon, Marc J

    2015-02-01

    The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft.

  16. Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?

    Science.gov (United States)

    Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

    2014-06-28

    Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report.

  17. Imaging strategies for knee injuries

    International Nuclear Information System (INIS)

    Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery. (orig.)

  18. Who controls imaging studies at community hospitals in the United States

    International Nuclear Information System (INIS)

    Survey data were collected in early 1989 from 187 large, nonacademic community hospitals to determine the degree to which community hospital radiologists (CHRs) control 22 noninterventional imaging studies that represent possible areas of conflict with other specialties. The data show that CHRs have almost total control of bone radiography, arthrography, emergency radiography, breast needle localization, all neuroradiological studies except myelography, all CT studies, and all MR imaging studies. They control obstetrical US in 76% of hospitals, prostate US in 73%, and percutaneous lung biopsy in 72%. Nonradiologists and CHRs have nearly equivalent roles in myelography, vascular US, cardiac nuclear medicine, and urethrography. CHRs control these procedures in 51%, 46%, 43%, and 46% of hospitals respectively, with many of the remainder reporting various shared arrangements

  19. Arthroscopic capsule reconstruction in the hip using iliotibial band allograft.

    Science.gov (United States)

    Trindade, Christiano A C; Sawyer, Gregory A; Fukui, Kiyokazu; Briggs, Karen K; Philippon, Marc J

    2015-02-01

    The hip capsule has been identified as an important static stabilizer of the hip joint. Despite the intrinsic bony stability of the hip socket, the capsule plays a key role in hip stability, particularly at the extremes of motion, and the iliofemoral ligament is the most important stabilizer in extension and external rotation. Patients who do not undergo capsular closure or plication may continue to complain of hip pain and dysfunction postoperatively, likely because of microinstability or muscle invagination into the capsular defect, and high-resolution magnetic resonance imaging or magnetic resonance arthrography will identify the capsular defect. Seen primarily in the revision setting, capsular defects can cause recurrent stress at the chondrolabral junction. An attempt at secondary closure can be challenging because of capsular limb adherence to the surrounding soft tissues. Therefore reconstruction may be the only possible surgical solution for this problem. We describe our new surgical technique for arthroscopic hip capsular reconstruction using iliotibial band allograft. PMID:25973378

  20. Diagnostic value of high-resolution CT and MR compared with standard procedures in meniscal tears

    Energy Technology Data Exchange (ETDEWEB)

    Schuler, M.; Naegele, M.; Lienemann, A.; Muench, O.; Siuda, S.; Hahn, D.; Lissner, J.

    1987-04-01

    The knees of 20 patients with evidence of meniscal tears were examined via high-resolution computed tomography (HRCT); 10 of these were studied by MRI. The HRCT study was performed directly after double-contrast arthrography (AG). For comparison with HRCT, slice orientation for MRI examination was in transverse view; gradient echo sequences using the FISP technique were applied instead of spin echo sequences. All results were correlated to the arthroscopy (AS) findings. In 95% of the cases AG and AS results agreed, HRCT/AS in 85% and MRI/AS in 70%. In certain cases HRCT provided additional information which influenced appropriate surgical treament. MRI is a noninvasive nonionising method but gives a less exact documentation of the lesion than AG and HRCT. The gradient echo mode is superior to the SE mode in respect of outlining meniscal structures, at least in transverse view.

  1. Radiologic analysis of femoral acetabular impingement: from radiography to MRI

    Energy Technology Data Exchange (ETDEWEB)

    Dwek, Jerry R. [University of California at San Diego, Department of Radiology, Rady Children' s Hospital and Health Center, San Diego, CA (United States); San Diego Imaging, San Diego, CA (United States); Monazzam, Shafagh [Rady Children' s Hospital and Health Center, Department of Orthopedics, San Diego, CA (United States); Chung, Christine B. [University of California at San Diego, Department of Radiology, San Diego, CA (United States)

    2013-03-15

    Femoral acetabular impingement is a set of morphologic abnormalities that are considered to be a major cause of degenerative disease in the hip joint. Early changes are already present in adolescence when it is the pediatric radiologist who must assess current damage with the aim of averting progression to more severe and debilitating osteoarthritis. A multimodality approach is used for diagnosis, that includes conventional radiography and CT to assess the osseous structures. MR arthrography is the primary advanced imaging modality for assessment of morphologic changes as well as injuries of the labrum and articular cartilage. Details of radiologic imaging are offered to guide the radiologist and provide an avenue for the accurate description of the osseous and articular alterations and injury. (orig.)

  2. Research progress of ulna impaction syndrome%尺骨撞击综合征诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    马炜; 田文

    2014-01-01

    Ulna impaction syndrome ( UIS ) is a degenerative process caused by excessive stress bearing across the ulnar aspect of the wrist, with a series of pathological and clinical changes. Recent studies demonstrate that the biomechanical changes caused by ulnar variance play a crucial role in the process. Currently, the diagnosis of UIS is made by clinical manifestations, physical examinations and imaging examinations, such as the X-ray, Computed Tomography ( CT ), Magnetic Resonance Imaging ( MRI ) and so on. Besides, some special examinations are recommended if necessary, including arthrography, ultrasound and arthroscopy. Depending on the special conditions of patients, either conservative treatment or surgery is effective. The traditional procedures include ulnar shortening osteotomy and Wafer procedure. With the advancement of modern technologies and instruments, some new procedures are created based on them, which lead to the improvement of surgical results.

  3. Imaging methods for knee-joint diagnostics. Bildgebende Verfahren zur Diagnostik von Kniegelenksverletzungen und -erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Haller, W. (Klinikum rechts der Isar, Muenchen (Germany, F.R.). Orthopaedische Klinik und Poliklinik); Lehner, K. (Klinikum rechts der Isar, Muenchen (Germany, F.R.). Inst. fuer Roentgendiagnostik)

    1989-06-01

    Imaging methods are essential tools for orthopedic diagnostics. For examination of knee-joint disorder, X-ray radiography in four planes is a standard task. Special diagnostic methods are available and can be selected according to the case, and sonography is a method very likely to gain significance. In case of suspected fracture, conventional tomography is the method of choice, although arthroscopy is discussed in this context as a primary examination. CT or NMR imaging are indicated for evaluation of tumors near the knee joint, and latest results show that magnetic resonance tomography is useful for examination of the cruciate ligaments or the cartilage, and CT for imaging of the menisci. CT assisted arthrography for sliding path and cartilage analysis already is an established method for diagnostic evaluation of the chondropathia patellae. (orig./MG).

  4. [Computer tomography of sports injuries].

    Science.gov (United States)

    Reiser, M; Rupp, N

    1984-01-01

    Computed tomography (CT) provides axial slices plane and shows excellent details of bones and different soft tissues, favoring its use in traumatic lesions caused by sporting activities. Complex anatomical structures such as the shoulder, the vertebral column, the pelvis, the knee, the tarsal and carpal bones are often better recognized in detail than by conventional radiography. Fracture lines, localization of bone fragments and involvement of soft tissues are clearly demonstrated. Luxations and bone changes leading to luxations can be shown. CT arthrography provides for the first time a direct visualization of joint cartilage and of cruciate ligaments in the knee joint, so traumatic lesions such as chondropathia patellae or rupture of the cruciate ligaments are shown with a high degree of reliability.

  5. Computed tomography in sport injuries

    Energy Technology Data Exchange (ETDEWEB)

    Reiser, M.; Rupp, N.

    1984-01-01

    Computed tomography (CT) provides axial slices plane and shows excellent details of bones and different soft tissues, favoring its use in traumatic lesions caused by sporting activities. Complex anatomical structures such as the shoulder, the vertebral column, the pelvis, the knee, the tarsal and carpal bones are often better recognized in detail than by conventional radiography. Fracture lines, localization of bone fragments and involvement of soft tissues are clearly demonstrated. Luxations and bone changes leading to luxations can be shown. CT arthrography provides for the first time a direct visualization of joint cartilage and of cruciate ligaments in the knee joint, so traumatic lesions such as chondropathia patellae or rupture of the cruciate ligaments are shown with a high degree of reliability.

  6. Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?

    Science.gov (United States)

    Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

    2014-06-28

    Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report. PMID:24976930

  7. The diagnosis of ligament injuries of the ankle joint using pressure during exposures

    International Nuclear Information System (INIS)

    Pressure exerted against the ankle joint during lateral exposures shows a typical form of subluxation of the talus in respect of the tibia if there has been rupture of the anterior fibulo-talar ligament. This displacement can be quantified by using the standard technique of Seiler and Holzrichter. Retrospective evaluation of exposures carried out with pressure in 206 patients with stretching or rupture of the ligaments of the ankle joint have shown that stretching can be diagnosed if the joint space reaches 7 mm, and a rupture can be diagnosed with a joint space of 11 mm. If there is a difference of more than 5 mm in the joint space of the two joints, a rupture is present. With these criteria, 85% of all ligament injuries can be correctly diagnosed. In the remaining 15%, early arthrography provides the necessary information. (orig.)

  8. Diagnostic imaging of the hand. 3. rev. and enl. ed.

    International Nuclear Information System (INIS)

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  9. [Imaging strategies for knee injuries].

    Science.gov (United States)

    Hegenscheid, K; Puls, R; Rosenberg, C

    2012-11-01

    Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery. PMID:23154845

  10. Diagnostic imaging of the hand. 3. rev. and enl. ed.; Bildgebende Diagnostik der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Herz und Gefaessklinik GmbH, Bad Neustadt (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Lanz, Ulrich

    2015-07-01

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  11. Closed rupture of the flexor tendons caused by carpal bone and joint disorders.

    Science.gov (United States)

    Yamazaki, H; Kato, H; Hata, Y; Nakatsuchi, Y; Tsuchikane, A

    2007-12-01

    We analysed 21 patients with closed rupture of the flexor tendons caused by carpal bone and joint disorders. The tendon that ruptured depended on the location of the bone perforation into the carpal tunnel. Radiocarpal arthrography was performed in 13 patients and capsular perforation was demonstrated by contrast medium leakage into the carpal canal in 11 patients. This proved a useful diagnostic test. The flexor tendon(s) were reconstructed with free tendon graft in 17 patients, cross-over transfer of flexor tendons from adjacent digits in two and buddying to an adjacent flexor tendon in one patient. Postoperative total active range of motion in the fingers after 13 free tendon graft reconstructions averaged 213 degrees (range 170-265 degrees ). The active range of motion of the thumb-interphalangeal joint after free tendon graft reconstruction in three cases improved from 0 degrees to 33 degrees on average (range 10 degrees -40 degrees ).

  12. SLAP lesions: Anatomy, clinical presentation, MR imaging diagnosis and characterization

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Debra [University of California San Diego, Department of Radiology, 200 W. Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); MedRay Imaging and Fraser Health Authority, Vancouver, BC (Canada)], E-mail: cbchung@ucsd.edu; Mohana-Borges, Aurea; Borso, Maya; Chung, Christine B. [University of California San Diego, Department of Radiology, 200 W. Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States)

    2008-10-15

    ABSTRACT: Superior labral anterior posterior (SLAP) tears are an abnormality of the superior labrum usually centered on the attachment of the long head of the biceps tendon. Tears are commonly caused by repetitive overhead motion or fall on an outstretched arm. SLAP lesions can lead to shoulder pain and instability. Clinical diagnosis is difficult thus imaging plays a key diagnostic role. The normal anatomic variability of the capsulolabral complex can make SLAP lesions a diagnostic challenge. Concurrent shoulder injuries are often present including rotator cuff tears, cystic changes or marrow edema in the humeral head, capsular laxity, Hill-Sachs or Bankart lesion. The relevant anatomy, capsulolabral anatomic variants, primary and secondary findings of SLAP tears including MR arthrography findings, types of SLAP lesions and a practical approach to labral lesions are reviewed.

  13. Diagnostic evaluation of degenerative and post-traumatic lesions of the spine and joints. 2. rev. ed.; Orthopaedisch-traumatologische Gelenk- und Wirbelsaeulendiagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Jerosch, J.; Castro, W.H.M. (eds.)

    2002-07-01

    This second, completely revised and updated edition in one volume offers the following advantages: It covers and explains all applicable diagnostic methods. - Differentiation between standard and special methods. - Guidance and pinpointed information explaining the performance of the methods, together with a systematic representation of indications. - Standard reporting forms, appearances and Scores. (orig./CB) [German] Unterscheidung von Standard- und Spezialuntersuchungen. Alle gaengigen Verfahren, auch viele Spezialverfahren, sind beruecksichtigt. Vorschlag von Untersuchungsgaengen fuer bestimmte Situationen. Detaillierte Beschreibung zur Durchfuehrung der einzelnen Verfahren. Gleichwertige Darstellung der klinischen Untersuchung. Nicht bekannte Tests und Techniken nachschlagen koennen. Indikationen fuer die einzelnen Verfahren werden systematisch dargestellt. Hinweise zum gezielten und Kosten sparenden Einsatz. Umfassende Information. In jedem Kapitel finden Sie Angaben zu: klinische Untersuchung einschliesslich Anamnese, Funktionspruefungen und neurologische Untersuchung. Roentgen, Sonographie, CT, MRT, Szintigraphie, - ggf. weitere spezielle Verfahren wie Arthrographie, Pedobarographie, Myelographie, Diskographie, Infiltrationsdiagnostik, Videorasterstereographie. Neu in der 2. Auflage - Jetzt zusammengefasst in einem Band - Diagnostik bei Endoprothesenlockerung - Standardisierte Befundungsboegen - Darstellung der gaengigen Gelenk-Scores. (orig.)

  14. A radiologist`s guide to the imaging in the diagnosis and treatment of developmental dysplasia of the hip. Pt. 1. General considerations, physical examination as applied to real-time sonography and radiography

    Energy Technology Data Exchange (ETDEWEB)

    Gerscovich, E.O. [Department of Radiology, University of California, Davis Medical Center, 2516 Stockton Blvd., Ticon II Building, Sacramento, CA 95817 (United States)

    1997-07-07

    Developmental dysplasia of the hip (DDH) has a broad spectrum of presentation with the minor findings resolving spontaneously and the most severe ones resulting in disability, if not diagnosed early in life. Diagnosis in the first few months of life allows conservative treatment with complete resolution in most cases. Suspicion of DDH is based on ethnic, family, and pregnancy history, and on physical examination of the newborn. Imaging assists in the diagnosis and follows the treatment. Different modalities have their own advantages and disadvantages. This article deals with the description of the disease, risk factors, statistics, the physical examination as applied to real-time sonography, and imaging (plain radiography, arthrography, computed tomography, and magnetic resonance imaging). (orig.). With 26 figs., 1 tab.

  15. Proximal Focal Femoral Deficiency

    Directory of Open Access Journals (Sweden)

    Vishal Kalia, Vibhuti

    2008-01-01

    Full Text Available Proximal focal femoral deficiency (PFFD is a developmental disorder of the proximal segment of thefemur and of acetabulum resulting in shortening of the affected limb and impairment of the function. It isa spectrum of congenital osseous anomalies characterized by a deficiency in the structure of the proximalfemur. The diagnosis is often made by radiological evaluation which includes identification and descriptionof PFFD and evaluation of associated limb anomalies by plain radiographs. Contrast arthrography orMagnetic Resonance Imaging is indicated when radiological features are questionable and to disclose thepresence and location of the femoral head and any cartilagenous anlage. The disorder is more commonlyunilateral and is apparent at birth. However, bilateral involvement is rarely seen. Therapy of the disorder isdirected towards satisfactory ambulation and specific treatment depending on the severity of dysplasia.

  16. Arthroscopy of the wrist: anatomy and classification of carpal instability.

    Science.gov (United States)

    Cooney, W P; Dobyns, J H; Linscheid, R L

    1990-01-01

    Carpal instability can be defined as the lack of ligamentous and skeletal support adequate to maintain a wrist stable to external forces of pinch and grasp. This instability may be static or dynamic. It has been classified as (a) carpal instability, dissociated (CID), a situation in which one or more of the ligaments are torn, and (b) carpal instability, nondissociative (CIND), a situation in which the ligaments are intact but stretched. Carpal instability can also be the result of carpal bone malalignment from various causes. Arthroscopy can be particularly useful in assessing carpal instability, however arthrography with contrast medium, fluoroscopy, and stress loading should precede this arthroscopic assessment. Arthroscopy allows visualization of the volar radiocarpal and ulnocarpal ligaments of the wrist, and the arthroscopic examination can be combined with manual manipulation of the carpal bones to detect laxity of those ligaments, to examine stability of the scapholunate and lunotriquetral interosseous ligaments, and to show instability of the distal radioulnar joint.

  17. The utility of MR imaging of the shoulder joint: comparison of the MR imaging between conventional MR imaging and arthrographic MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Dong Sik; Ryu, Kyung Nam; Kim, Ihn Sub; Rhee, Yong Girl [Kyunghee Univ., College of Medicine, Seoul (Korea, Republic of)

    1998-09-01

    To evaluate the diagnostic value of MRI of the shoulder. Between January and June 1997, shoulder MRI and arthroscopy were performed in a total of 48 patients with shoulder pain (n=3D30) or shoulder instability (n=3D18). Forty-five were males and three were females; their ages ranged from 16 to 67 (mean 32.5) years. The period between shoulder MRI and arthroscopy was between one and 390 (mean, 42.2) days. Twenty-six patents underwent MR arthrography (AMR), and 22 conventional MRI(CMR). Each image was analyzed for rotator cuff injury, glenoid labral injury, SLAP lesion, and biceps tendon injury. On arthroscopy, one disease was found in 34 patients, two were found in six, three diseases were found in seven, and one patient had four diseases. Arthroscopic diagnosis was as follows:rotator cuff injury, 29;SLAP lesion, 12;glenoid labral injury, 10;biceps tendon injury, 4;subacromial bursitis, 2;chronic synovitis, 1;adhesive capsulitis, 1;superior glenohumeral ligament injury, 1;normal, 1. For rotator cuff injury, the sensitivity of MRI was 65.5% and specificity was 93.0% (AMR:66.7%, 95.8%, CMR:65.2%, 86.4%). For SLAP lesion, sensitivity was 58.3% and specificity was 97.2% (AMR:66.7%, 100%, CMR:50%, 93.8%);for glenoid labral injury, sensitivity was 80.0% and specificity was 89.5% (AMR:85.7%, 84.2%, CMR:66.7%, 94.7%), and for biceps tendon injury, the false negative rate was 100%. In cases involving glenoid labral injury, the diagnostic accuracy of shoulder MRI was relatively high;in rotator cuff injury and SLAP lesion, however, diagnosis was limited, and in biceps tendon injury was difficult. We suggest, however, that MR arthrography has certain diagnostic advantages over conventional MRI.=20.

  18. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow

    Energy Technology Data Exchange (ETDEWEB)

    Shahabpour, M. [Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels (Belgium)], E-mail: Maryam@shahabpour.uzbrussel; Kichouh, M.; Laridon, E. [Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels (Belgium); Gielen, J.L. [Department of Radiology, Universitair Ziekenhuis Antwerpen, Universiteit Antwerpen, Wilrijkstraat 10, 2650 Edegem (Belgium); De Mey, J. [Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels (Belgium)

    2008-02-15

    There are no clear guidelines for diagnostic imaging of articular and soft tissue pathologies of the shoulder and elbow. Several methods are used, including magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA) and ultrasound (US). Their cost-effectiveness is still unclear. We performed a meta-analysis of the relevant literature and discussed the role of MR imaging of the shoulder and elbow compared with other diagnostic imaging modalities. For the shoulder impingement syndrome and rotator cuff tears, MRI and US have a comparable accuracy for detection of full-thickness rotator cuff tears. MRA and US might be more accurate for the detection of partial-thickness tears than MRI. Given the large difference in cost of MR and US, ultrasound may be the most cost-effective diagnostic method for identification of full-thickness tears in a specialist hospital setting (Evidence level 3). Both MRA and CT arthrography (CTA) are effective methods for the detection of labrum tears. More recently, multidetector CTA has offered the advantages of thinner slices than with MRA in a shorter examination time. Still, MRA has the advantage towards CTA to directly visualize the affected structures with a better evaluation of extent and location and to detect associated capsuloligamentous injuries. For the elbow pathologies, plain MRI or MRA have the advantage towards CTA to detect occult bone injuries. CTA is better for the assessment of the thin cartilage of the elbow. Both US and MRI are reliable methods to detect chronic epicondylitis; US is more available and far more cost-effective (Evidence level 2). MRA can differentiate complete from partial tears of the medial collateral ligament. US or MRI can detect partial and complete biceps tendon tears and/or bursitis. MRI can provide important diagnostic information in lesions of the ulnar, radial, or median nerve.

  19. Diagnostic imaging of shoulder impingement; Bildgebende Diagnostik des Schultergelenkes bei Impingement

    Energy Technology Data Exchange (ETDEWEB)

    Merl, T. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Weinhardt, H. [Klinikum Rechts der Isar, Muenchen (Germany). Klinik und Poliklinik fuer Orthopaedie; Oettl, G. [Klinikum Rechts der Isar, Muenchen (Germany). Klinik und Poliklinik fuer Orthopaedie; Lenz, M. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Riel, K.A. [Klinikum Rechts der Isar, Muenchen (Germany). Klinik und Poliklinik fuer Orthopaedie

    1996-01-01

    Magnetic resonance imaging is a method that has been advancing in the last few years to the modality of choice for diagnostic evaluation of the bone joints, as the method is capable of imaging not only the ossous but also the soft tissue components of the joint. MRI likewise has become an accepted method for diagnostic evaluation of syndromes of the shoulder, with high diagnostic accuracy in detecting rotator cuff lesions, or as an efficient MRI arthrography for evaluation of the instability or lesions of the labrocapsular complex. In the evaluation of early stages of shoulder impingement, the conventional MRI technique as a static technique yields indirect signs which in many cases do not provide the diagnostic certainty required in order to do justice to the functional nature of the syndrome. In these cases, functional MRI for imaging of the arm in abducted position and in rotational movement may offer a chance to early detect impingement and thus identify patients who will profit from treatment at an early stage. [Deutsch] Die Magnetresonanztomographie hat sich in den letzten Jahren zur Methode der Wahl in der Diagnostik der Gelenke entwickelt, sie erlaubt neben der Abbildung aller knoechernen auch die Abbildung aller Weichteilelemente eines Gelenkes. Auch in der Diagnostik der Schultergelenkserkrankungen besitzt die Magnetresonanztomographie einen festen Stellenwert mit hoher diagnostischer Treffsicherheit in der Beurteilung der Rotatorenmanschette, als MR-Arthrographie auch in der Beurteilung der Instabilitaet bzw von Laesionen des labrokapsulaeren Komplexes. In der Bewertung frueher Stadien des Impingement ist die klassische Magnetresonanztomographie als statische Methode auf indirekte Zeichen angewiesen, die in vielen Faellen nicht ausreichende Sicherheit bieten und dem funktionellen Charakter des Krankheitsbildes nicht ausreichend Rechnung tragen. Hier koennte die funktionelle Magnetresonanztomographie unter Abbildung des Arms in Abduktion und Rotation eine

  20. Midcarpal instability: a radiological perspective

    Energy Technology Data Exchange (ETDEWEB)

    Toms, Andoni Paul [Norfolk and Norwich University Hospital NHS Trust, Department of Radiology, Norwich, Norfolk (United Kingdom); Radiology Academy, Cotman Centre, Norwich, Norfolk (United Kingdom); Chojnowski, Adrian [Norfolk and Norwich University Hospital NHS Trust, Department of Orthopaedic Surgery, Norwich, Norfolk (United Kingdom); Cahir, John G. [Norfolk and Norwich University Hospital NHS Trust, Department of Radiology, Norwich, Norfolk (United Kingdom)

    2011-05-15

    Midcarpal instability (MCI) is the result of complex abnormal carpal motion at the midcarpal joint of the wrist. It is a form of non-dissociative carpal instability (CIND) and can be caused by various combinations of extrinsic ligament injuries that then result in one of several subtypes of MCI. The complex patterns of injury and the kinematics are further complicated by competing theories, terminology and classifications of MCI. Palmar, dorsal, ulna midcarpal instability, and capitolunate or chronic capitolunate instability are all descriptions of types of MCI with often overlapping features. Palmar midcarpal instability (PMCI) is the most commonly reported type of MCI. It has been described as resulting from deficiencies in the ulna limb of the palmar arcuate ligament (triquetrohamate-capitate) or the dorsal radiotriquetral ligaments, or both. Unstable carpal articulations can be treated with limited carpal arthrodesis or the ligamentous defects can be treated with capsulorrhaphy or ligament reconstruction. Conventional radiographic abnormalities are usually limited to volar intercalated segment instability (VISI) patterns of carpal alignment and are not specific. For many years stress view radiographs and videofluoroscopy have been the methods of choice for demonstrating carpal instability and abnormal carpal kinematics respectively. Dynamic US can be also used to demonstrate midcarpal dyskinesia including the characteristic triquetral ''catch-up'' clunk. Tears of the extrinsic ligaments can be demonstrated with MR arthrography, and probably with CT arthrography, but intact yet redundant ligaments are more difficult to identify. The exact role of these investigations in the diagnosis, categorisation and management of midcarpal instability has yet to be determined. (orig.)

  1. Shoulder injuries in overhead sports; Schultergelenkverletzungen bei Ueberkopfsportarten

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, K. [Technische Universitaet Muenchen (Germany). Institut fuer Roentgendiagnostik

    2010-05-15

    Overhead sport places great demands on the shoulder joint. Shoulder pain in overhead athletes and throwers can in the majority of cases be attributed to lesions resulting from chronic overuse of tendons and capsuloligamentous structures or to sequels of microinstability and secondary impingement. Due to its great impact on therapeutic decisions, imaging in athletes with unclear shoulder pain is a challenge. In this connection, magnetic resonance (MR) arthrography represents the cross-sectional imaging modality of first choice, as it allows depiction and exclusion of pathologic alterations of all relevant joint structures with sufficient confidence. This article reviews the biomechanical and clinical aspects and MR arthrographic features of the most common shoulder pathologies in overhead athletes, including biceps tendinopathy, superior labral anterior-posterior (SLAP) lesions, rotator cuff lesions, as well as extrinsic and intrinsic impingement syndromes. (orig.) [German] Ueberkopfsportarten stellen grosse Anforderungen an das Schultergelenk. Schulterbeschwerden bei Ueberkopf- und Wurfsportlern koennen in der Mehrzahl der Faelle auf eine chronische Ueberlastung von Sehnen und Kapsel-Band-Strukturen oder auf die Folgen einer Mikroinstabilitaet und sekundaerer Impingementsyndrome zurueckgefuehrt werden. Wegen ihres grossen Einflusses auf die Therapieentscheidung stellt die Bildgebung bei Athleten mit unklaren Schulterbeschwerden eine Herausforderung dar. Die MR-Arthrographie ist in diesem Zusammenhang als Schnittbildverfahren der ersten Wahl anzusehen, da sie den Nachweis bzw. Ausschluss pathologischer Veraenderungen aller relevanten Gelenkstrukturen mit ausreichender Sicherheit ermoeglicht. Dieser Artikel gibt eine Uebersicht ueber biomechanische und klinische Aspekte sowie MR-arthrographische Befunde der haeufigsten Schultergelenkpathologien bei Ueberkopfsportlern, wie Bizepstendinopathie, Superior-labral-anterior-posterior- (SLAP-)Laesionen, Laesionen der

  2. The utility of MR imaging of the shoulder joint: comparison of the MR imaging between conventional MR imaging and arthrographic MR imaging

    International Nuclear Information System (INIS)

    To evaluate the diagnostic value of MRI of the shoulder. Between January and June 1997, shoulder MRI and arthroscopy were performed in a total of 48 patients with shoulder pain (n=3D30) or shoulder instability (n=3D18). Forty-five were males and three were females; their ages ranged from 16 to 67 (mean 32.5) years. The period between shoulder MRI and arthroscopy was between one and 390 (mean, 42.2) days. Twenty-six patents underwent MR arthrography (AMR), and 22 conventional MRI(CMR). Each image was analyzed for rotator cuff injury, glenoid labral injury, SLAP lesion, and biceps tendon injury. On arthroscopy, one disease was found in 34 patients, two were found in six, three diseases were found in seven, and one patient had four diseases. Arthroscopic diagnosis was as follows:rotator cuff injury, 29;SLAP lesion, 12;glenoid labral injury, 10;biceps tendon injury, 4;subacromial bursitis, 2;chronic synovitis, 1;adhesive capsulitis, 1;superior glenohumeral ligament injury, 1;normal, 1. For rotator cuff injury, the sensitivity of MRI was 65.5% and specificity was 93.0% (AMR:66.7%, 95.8%, CMR:65.2%, 86.4%). For SLAP lesion, sensitivity was 58.3% and specificity was 97.2% (AMR:66.7%, 100%, CMR:50%, 93.8%);for glenoid labral injury, sensitivity was 80.0% and specificity was 89.5% (AMR:85.7%, 84.2%, CMR:66.7%, 94.7%), and for biceps tendon injury, the false negative rate was 100%. In cases involving glenoid labral injury, the diagnostic accuracy of shoulder MRI was relatively high;in rotator cuff injury and SLAP lesion, however, diagnosis was limited, and in biceps tendon injury was difficult. We suggest, however, that MR arthrography has certain diagnostic advantages over conventional MRI.=20

  3. Diagnosis of shoulder impingement syndrome

    International Nuclear Information System (INIS)

    This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs many overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff. (orig.)

  4. Imaging strategies for knee injuries; Bildgebungsstrategie bei Kniegelenkverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Hegenscheid, K.; Puls, R.; Rosenberg, C. [Ernst-Moritz-Arndt-Universitaet Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany)

    2012-11-15

    Injuries of the knees are common. The Ottawa knee rule provides decisional support to determine whether radiographs are indicated or not. With the use of ultrasound it is possible to detect defects of the extensor ligaments and the anterior cruciate ligament. Furthermore, it is possible to detect indirect signs of an intra-articular fracture, e.g. lipohemarthrosis. In complex fractures, e.g. tibial plateau fractures, further diagnostic procedures with multislice computed tomography (CT) are needed for accurate classification and preoperative planning. Multislice CT with CT angiography enables three-dimensional reconstruction of the knee and non-invasive vascular imaging for detection of vascular injury. Magnetic resonance imaging (MRI) is the gold standard for detection of occult fractures and injuries of the ligaments and menisci. Higher field strengths can be used to improve the diagnostics of cartilage lesions. Virtual MR arthrography is superior to conventional MRI for detection of cartilage lesions especially after meniscus surgery. (orig.) [German] Verletzungen des Kniegelenks sind haeufig. Die Ottawa Knee Rule bietet eine Entscheidungshilfe dahingehend, ob Roentgenaufnahmen indiziert sind. Mittels Sonographie koennen Verletzungen des Streckapparats und vorderen Kreuzbandes erkannt werden. Ebenso gelingt der Nachweis eines Lipohaemarthros als indirektes Zeichen einer intraartikulaeren Fraktur. Bei komplexen Frakturen, z. B. Tibiaplateaufrakturen, ist eine weiterfuehrende Diagnostik mittels Multislice-CT zur Klassifizierung und praeoperativen Planung notwendig. Die Multislice-CT mit gleichzeitiger CT-Angiographie ermoeglicht die Anfertigung dreidimensionaler Rekonstruktionen und die nichtinvasive Gefaessdarstellung. Die Magnetresonanztomographie (MRT) ist der Goldstandard zum Nachweis okkulter Frakturen und Verletzungen an Baendern und Menisken. Bei hoeheren Feldstaerken verbessert sich die Diagnostik von Knorpellaesionen. Die virtuelle MR-Arthrographie ist

  5. MR findings associated with positive distraction of the hip joint achieved by axial traction

    Energy Technology Data Exchange (ETDEWEB)

    Suter, Aline; Dietrich, Tobias J.; Maier, Matthias; Pfirrmann, Christian W.A. [Radiology, Orthopedic University Hospital Balgrist, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Dora, Claudio [Orthopedic University Hospital Balgrist, Orthopedic Surgery, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2015-06-01

    To determine which MR-arthrography findings are associated with positive hip joint distraction. One hundred patients with MR arthrography of the hip using axial traction were included. Traction was applied during the MR examination with an 8 kg (females) or 10 kg (males) water bag, attached to the ankle over a deflection pulley. Fifty patients showing joint space distraction were compared to an age- and gender-matched control group of 50 patients that did not show a joint distraction under axial traction. Two radiologists assessed the neck-shaft angle, lateral and anterior center-edge (CE) angles, CE angles in the transverse plane, extrusion index of the femoral head, acetabular depth, alpha angle, acetabular version, ligamentum teres, joint capsule and ligaments, iliopsoas tendon and the labrum. Mean joint space distraction in the study group was 0.9 ± 0.6 mm. Patients with positive joint space distraction had significantly higher neck-shaft angles (control group 131.6 ± 5.4 /study group 134.1 ± 6.1 , p < 0.05), smaller lateral CE angles (38.1 ± 5.9 /34.6 ± 7.2 , p < 0.05), smaller overall transverse CE angles (161.4 ± 9.9 /153.6 ± 9.6 , p < 0.001), smaller acetabular depth (4.1 ± 2.4 mm/5.8 ± 2.5 mm, p < 0.01), higher alpha angles (53.5 ± 7.8 /59.2 ± 10.1 , p < 0.01) and a thicker ligamentum teres (4.7 ± 1.4 mm/5.4 ± 1.8 mm, p < 0.05). The other parameters revealed no significant differences. ICC values for interobserver agreement were 0.71-0.95 and kappa values 0.43-0.92. Increased neck-shaft angles, small CE angles, small acetabular depth, higher alpha angles and a thick ligamentum teres are associated with positive joint distraction. (orig.)

  6. Clinical utility of ultrasound guidance for intra-articular knee injections: a review

    Directory of Open Access Journals (Sweden)

    Berkoff DJ

    2012-03-01

    Full Text Available David J Berkoff1, Larry E Miller2,3, Jon E Block31Department of Orthopedics, University of North Carolina School of Medicine, Chapel Hill, NC; 2Miller Scientific Consulting Inc, Arden, NC; 3The Jon Block Group, San Francisco, CA, USAAbstract: Intra-articular corticosteroid and hyaluronic acid injections provide short-term symptom amelioration for arthritic conditions involving structural damage or degenerative changes in the knee. Conventional palpation-guided anatomical injections frequently result in inaccurate needle placement into extra-articular tissue and adjacent structures. The purpose of this review was to determine the effect of ultrasound guidance on the accuracy of needle placement, clinical outcomes, and cost-effectiveness in comparison with anatomical landmark-guided intra-articular large joint injections, with particular emphasis on the knee. A total of 13 relevant studies were identified; five studied the knee, seven studied the shoulder, one used both the knee and shoulder, and none studied the hip. Ultrasound was used in seven studies; the remaining studies utilized air arthrography, fluoroscopy, magnetic resonance arthrography, or magnetic resonance imaging. Across all studies (using all imaging modalities and all joints, needle placement accuracy ranged from 63% to 100% with ultrasound and from 39% to 100% with conventional anatomical guidance. Imaging guidance improved the accuracy of intra-articular injections of the knee (96.7% versus 81.0%, P < 0.001 and shoulder (97.3% versus 65.4%, P < 0.001. In particular, ultrasound guidance of knee injections resulted in better accuracy than anatomical guidance (95.8% versus 77.8%, P < 0.001, yielding an odds ratio of 6.4 (95% confidence interval 2.9–14. Ultrasound guidance notably improves injection accuracy in the target intra-articular joint space of large joints including the knee. The enhanced injection accuracy achieved with ultrasound needle guidance directly improves

  7. Shoulder instability; Schultergelenkinstabilitaet

    Energy Technology Data Exchange (ETDEWEB)

    Sailer, J.; Imhof, H. [Abteilung Osteoradiologie, Univ.-Klinik fuer Radiodiagnostik Wien (Austria)

    2004-06-01

    Shoulder instability is a common clinical feature leading to recurrent pain and limitated range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging. (orig.) [German] Die Schultergelenkinstabilitaet ist haeufig fuer wiederholt auftretende Schmerzen sowie eine eingeschraenkte Beweglichkeit im Glenohumeralgelenk verantwortlich. Sie kann als Folge eines vorangegangenen Traumas, einer generellen Hyperlaxitaet oder infolge wiederholter Mikrotraumen entstehen. Die Differenzierung zwischen traumatischer und atraumatischer Form der Gelenkinstabilitaet erfordert eine sorgfaeltige Anamnese und eine genaue klinische Untersuchung. Die Gelelenklaxitaet als Differenzialdiagnose muss von der echten Instabilitaet unterschieden werden, die Instabilitaet wird dann im Rahmen des klinischen Status nach Grad und Richtung der glenohumeralen Translation unterteilt. Zur Diagnose knoecherner Laesionen werden das konventionelle Roentgen sowie die CT herangezogen. MRT sowie MR-Arthrographie dienen zur Detektion

  8. MR findings associated with positive distraction of the hip joint achieved by axial traction

    International Nuclear Information System (INIS)

    To determine which MR-arthrography findings are associated with positive hip joint distraction. One hundred patients with MR arthrography of the hip using axial traction were included. Traction was applied during the MR examination with an 8 kg (females) or 10 kg (males) water bag, attached to the ankle over a deflection pulley. Fifty patients showing joint space distraction were compared to an age- and gender-matched control group of 50 patients that did not show a joint distraction under axial traction. Two radiologists assessed the neck-shaft angle, lateral and anterior center-edge (CE) angles, CE angles in the transverse plane, extrusion index of the femoral head, acetabular depth, alpha angle, acetabular version, ligamentum teres, joint capsule and ligaments, iliopsoas tendon and the labrum. Mean joint space distraction in the study group was 0.9 ± 0.6 mm. Patients with positive joint space distraction had significantly higher neck-shaft angles (control group 131.6 ± 5.4 /study group 134.1 ± 6.1 , p < 0.05), smaller lateral CE angles (38.1 ± 5.9 /34.6 ± 7.2 , p < 0.05), smaller overall transverse CE angles (161.4 ± 9.9 /153.6 ± 9.6 , p < 0.001), smaller acetabular depth (4.1 ± 2.4 mm/5.8 ± 2.5 mm, p < 0.01), higher alpha angles (53.5 ± 7.8 /59.2 ± 10.1 , p < 0.01) and a thicker ligamentum teres (4.7 ± 1.4 mm/5.4 ± 1.8 mm, p < 0.05). The other parameters revealed no significant differences. ICC values for interobserver agreement were 0.71-0.95 and kappa values 0.43-0.92. Increased neck-shaft angles, small CE angles, small acetabular depth, higher alpha angles and a thick ligamentum teres are associated with positive joint distraction. (orig.)

  9. Combined use of contrast media containing iodine and gadolinium for imaging and intervention. A hitherto widely ignored topic in radiological practice; Kombinierter zeitnaher Einsatz jod- und gadoliniumhaltiger Kontrastmittel in der diagnostischen und interventionellen Radiologie. Ein bisher vernachlaessigtes Kapitel der radiologischen Praxis

    Energy Technology Data Exchange (ETDEWEB)

    Golder, W.

    2012-02-15

    The synchronous use of chemically different contrast media in the same body compartment is a challenge for the radiologist, whether it is scheduled or unexpected. However, to inject contrast media containing iodine and gadolinium at the same time can be a prerequisite for the examination of several organs or organ systems. Unlike other topics of contrast-enhanced imaging procedures, the difficulties encountered with double contrast injections have been widely ignored in the literature. In the absence of reliable data from experimental and clinical studies the radiologist is dependent on case reports, information provided by the contrast media manufacturers, personal communications, mostly scanty personal experiences and a skilful time management, in order to overcome the situation. Only the combination of X-ray, computed tomography and magnetic resonance arthrography can be performed without another thought. However, the more or less synchronous vascular application of contrast media containing iodine and gadolinium requires vigilance. The more seriously ill the patient is, the more caution is advised even if the decision on the combined administration has to be reached urgently. The following overview gives a description of the properties of contrast media containing iodine and gadolinium as far as interactions following simultaneous administration are concerned. Subsequently, the clinically relevant situations and constellations are outlined and analyzed. (orig.) [German] Die kombinierte Gabe zweier chemisch verschiedener Kontrastmittel stellt fuer den Radiologen eine Herausforderung dar. Der mehr oder weniger zeitgleiche Einsatz jod- und gadoliniumhaltiger Kontrastmittel kann sowohl geplant sein als auch bei der Untersuchung einer Reihe von Organen/Organsystemen unvorhergesehen notwendig werden. Im Gegensatz zu anderen Themen der kontrastverstaerkten Diagnostik ist dem Problem der Doppelinjektion in der Literatur bisher wenig Aufmerksamkeit geschenkt worden

  10. IMAGING OF ROTATOR CUFF PATHOLOGY- IS ULTRASOUND AS GOOD AS MRI

    Directory of Open Access Journals (Sweden)

    Vinot

    2015-12-01

    Full Text Available Aim of this study is to compare the diagnostic accuracy of ultrasound versus MRI in detecting rotator cuff pathology. Rotator cuff pathology involves group of disorder, which progresses from bursitis to tendinitis to partial tear and full thickenss tear. The most commonly affected tendon is the supraspinatus tendon. In our prospective study of 35 patients as initial ultrasound was followed by MRI sensitivity, specificity and accuracy for diagnosis of full thickness tear of supraspinatus when USG was compared to MRI was 100%, whereas sensitivity, specificity and accuracy of diagnosing partial thickness tear using ultrasound compared to MRI are 100%, 78% and 84%. There is no significant p value difference on comparing ultrasound with MRI on detecting tears. Ultrasound and MRI showed almost similar diagnostic accuracy in associated findings like tendon retraction, muscle atrophy, bursal effusion. Ultrasound also has additional value of dynamic evaluation, which is useful in evaluating subacromial and subcoracoid impingement. Modality choice for the evaluation of rotator cuff pathology should be based on several factors like availability, patient preference and clinical information being sought. The high resolution sonography is an attractive screening modality for rotator cuff in patients presenting with painful shoulder. A well performed ultrasound examination in most cases obviates the need for more invasive diagnostic tests like arthrography and cumbersome and expensive MRI examinations.

  11. A Current Review of the Meniscus Imaging: Proposition of a Useful Tool for Its Radiologic Analysis

    International Nuclear Information System (INIS)

    The main objective of this review was to present a synthesis of the current literature in order to provide a useful tool to clinician in radiologic analysis of the meniscus. All anatomical descriptions were clearly illustrated by MRI, arthroscopy, and/or drawings. The value of standard radiography is extremely limited for the assessment of meniscal injuries but may be indicated to obtain a differential diagnosis such as osteoarthritis. Ultrasound is rarely used as a diagnostic tool for meniscal pathologies and its accuracy is operator-dependent. CT arthrography with multiplanar reconstructions can detect meniscus tears that are not visible on MRI. This technique is also useful in case of MRI contraindications, in postoperative assessment of meniscal sutures and the condition of cartilage covering the articular surfaces. MRI is the most accurate and less invasive method for diagnosing meniscal lesions. MRI allows confirming and characterizing the meniscal lesion, the type, the extension, its association with a cyst, the meniscal extrusion, and assessing cartilage and subchondral bone. New 3D-MRI in three dimensions with isotropic resolution allows the creation of multiplanar reformatted images to obtain from an acquisition in one sectional plane reconstructions in other spatial planes. 3D MRI should further improve the diagnosis of meniscal tears

  12. Three-dimensional magnetic resonance imaging analysis of hip morphology in the assessment of femoral acetabular impingement

    Energy Technology Data Exchange (ETDEWEB)

    Kavanagh, E.C. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Read, P.; Carty, F.; Zoga, A.C. [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Parvizi, J. [The Rothman Institute of Orthopedics, Philadelphia, PA (United States); Morrison, W.B., E-mail: William.Morrison@Jefferson.edu [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States)

    2011-08-15

    Aim: To determine a possible association between femoral-acetabular impingement (FAI) volume and the development of labral tear using a three-dimensional (3D) model reconstruction of the acetabulum and the femoral head. Materials and methods: Magnetic resonance arthrography images of the hip in 42 patients with pain and suspected labral tear were acquired using a 1.5 T MRI machine. Using 3D analysis software, outlines of the acetabular cup and femoral head were drawn and 3D reconstruction obtained. To control for differences in patient size, ratios of acetabulum : femoral head volume (AFV) and acetabulum : femoral head surface area (AFA) were used for analysis. The association between volume of acetabulum : femoral head and FAI was investigated using ANOVA analysis. Results: There were 19 men and 23 women with a mean age of 39 years (range 18-78 years). The average AFV was 0.64 (range 0.37-1.05, SD 0.16) and AFA was 0.73 (range 0.36-1.26, SD 0.23). Herniation pit was significantly associated with a small AFV. Conclusion: Femoral neck herniation pits are associated with a low AFV. Gross volume and surface area ratios do not appear to correlate with labral tears or cartilage loss. This technique will enable more advanced analysis of morphological variations associated with FAI.

  13. Validation of a standardized mapping system of the hip joint for radial MRA sequencing

    Energy Technology Data Exchange (ETDEWEB)

    Klenke, Frank M.; Hoffmann, Daniel B.; Cross, Brian J.; Siebenrock, Klaus A. [Bern University Hospital, Department of Orthopedic Surgery, Inselspital, Bern (Switzerland)

    2014-10-14

    Intraarticular gadolinium-enhanced magnetic resonance arthrography (MRA) is commonly applied to characterize morphological disorders of the hip. However, the reproducibility of retrieving anatomic landmarks on MRA scans and their correlation with intraarticular pathologies is unknown. A precise mapping system for the exact localization of hip pathomorphologies with radial MRA sequences is lacking. Therefore, the purpose of the study was the establishment and validation of a reproducible mapping system for radial sequences of hip MRA. Sixty-nine consecutive intraarticular gadolinium-enhanced hip MRAs were evaluated. Radial sequencing consisted of 14 cuts orientated along the axis of the femoral neck. Three orthopedic surgeons read the radial sequences independently. Each MRI was read twice with a minimum interval of 7 days from the first reading. The intra- and inter-observer reliability of the mapping procedure was determined. A clockwise system for hip MRA was established. The teardrop figure served to determine the 6 o'clock position of the acetabulum; the center of the greater trochanter served to determine the 12 o'clock position of the femoral head-neck junction. The intra- and inter-observer ICCs to retrieve the correct 6/12 o'clock positions were 0.906-0.996 and 0.978-0.988, respectively. The established mapping system for radial sequences of hip joint MRA is reproducible and easy to perform. (orig.)

  14. Evaluation of the patient with hip pain.

    Science.gov (United States)

    Wilson, John J; Furukawa, Masaru

    2014-01-01

    Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication. Lateral hip pain occurs with greater trochanteric pain syndrome. Clinical examination tests, although helpful, are not highly sensitive or specific for most diagnoses; however, a rational approach to the hip examination can be used. Radiography should be performed if acute fracture, dislocations, or stress fractures are suspected. Initial plain radiography of the hip should include an anteroposterior view of the pelvis and frog-leg lateral view of the symptomatic hip. Magnetic resonance imaging should be performed if the history and plain radiograph results are not diagnostic. Magnetic resonance imaging is valuable for the detection of occult traumatic fractures, stress fractures, and osteonecrosis of the femoral head. Magnetic resonance arthrography is the diagnostic test of choice for labral tears. PMID:24444505

  15. Comparison of radiologic imaging techniques for diagnosis of fragmented medial coronoid process of the cubital joint in dogs

    International Nuclear Information System (INIS)

    Thirty cubital joints from 16 dogs suspected of having a fragmented medial coronoid process were examined. Four breeds accounted for 87.5% of the cases: German Shepherd Dog (25%), Labrador Retriever (25%), Rottweiler (18.75%), and Golden Retriever (18.75%). Seventy-five percent of the dogs were male. Mean age of affected dogs was 13.6 months. Plain-film radiography, xeroradiography, linear tomography, arthrography, and computed tomography were performed on each cubital joint prior to surgical exploration of the joint. Three reviewers evaluated each diagnostic study and independently determined whether a fragment from the medial coronoid process could be seen. The consensus opinion was compared with the finding at surgery. Abnormalities of the medial coronoid process were detected in 25 of 30 joints at surgery. Fragmented coronoid process was found in 17 of 30 joints, and wear lesions were observed in 8 of 30 joints. Computed tomography had the highest accuracy (86.7%), sensitivity (88.2%), and negative-predictive value (84.6%) of the 5 imaging modalities evaluated (P < 0.05). Specificity and positive-predictive value of all imaging techniques were high. There was no significant difference between the diagnostic ability of plain-film radiography, xeroradiography, or linear tomography of the cubital joint. The combination of plain-film radiography and linear tomography provided an improvement in accuracy, approaching that of computed tomography

  16. Radiological evaluation of the skeleton: traumatology of the distal forearm, wrist, and hand; Radiologische Skelettdiagnostik: Traumatologie des distalen Unterarmes, der Handgelenke und der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Neumann, K. [Universitaetsklinikum Essen (Germany). Zentralinstitut fuer Roentgendiagnostik; Langer, R. [Universitaetsklinikum Essen (Germany). Zentralinstitut fuer Roentgendiagnostik

    1996-07-01

    Plain X-ray films including some special radiographic views are still the basis of the radiological evaluation of injuries of the distal forearm, the wrist, and the hand. Especially, in the diagnosis of fractures of the distal radius the exact positioning of the arm and hand is essential. For the description of fractures of the distal forearm the AO classification of fractures should be used, which is comprehensive and universally applicable. Conventional tomography and computed tomography (CT) of the radio-ulnar joint and the wrist are used in patients with persisting complaints or equivocal findings on plain radiographs, and difficult anatomical situations. Suspected ligamentous injuries of the wrist including tears of the triangular fibrocartilage complex (TFCC) are evaluated by wrist arthrography or magnetic resonance imaging (MRI), the latter requiring a highly skilled imaging and interpretation technique. MRI is the method of choice for the detection of osteonecrosis. Ultrasound examinations are of minor importance in the work up of wrist and hand injuries. (orig.) [Deutsch] Fuer die radiologische Beurteilung von Verletzungen des distalen Unterarmes, des Handgelenkes und der Hand steht die konventionelle Roentgenuntersuchung einschliesslich einiger Spezialeinstellungen nach wie vor im Vordergrund. Bei der Beschreibung insbesondere der distalen Radiusfrakturen sollten die historische Benennung oder aeltere Einteilungen zugunsten der allgemeingueltigen und umfassenderen AO-Klassifikation verlassen werden. Die Computertomographie und Magnetresonanztomographie kommen in der Frakturdiagnostik bei unklaren anatomischen Verhaeltnissen oder konventionell nicht zufriedenstellend erklaerbaren Beschwerden zur Anwendung. Vermutete ligamentaere Verletzungen der Handwurzel lassen sich arthrographisch oder magnetresonanztomographisch abklaeren. (orig.)

  17. Musculoskeletal interventional radiology: ultrasound and CT.

    Science.gov (United States)

    Martel Villagrán, J; Bueno Horcajadas, Á; Agrela Rojas, E

    2016-05-01

    We aim to describe imaging-guided (ultrasound and CT) interventional techniques in the musculoskeletal system that can be performed by general radiologists, whether in hospitals, primary care clinics, private offices, or other settings. The first requirement for doing these procedures is adequate knowledge of the anatomy of the musculoskeletal system. The second requirement is to inform the patient thoroughly about the technique, the risks involved, and the alternatives available in order to obtain written informed consent. The third requirement is to ensure that the procedure is performed in accordance with the principles of asepsis in relation to the puncture zone and to all the material employed throughout the procedure. The main procedures that can be done under ultrasound guidance are the following: fine needle aspiration cytology (FNAC), core needle biopsy (CNB), diagnostic and/or therapeutic arthrocentesis, drainage of juxta-articular fluid collections, drainage of abscesses, drainage of hematomas, treatment of Baker's cyst, treatment of ganglia, treatment of bursitis, infiltrations and treatment of plantar fasciitis, plantar fibrosis, epicondylitis, Achilles tendinopathy, and Morton's neuroma, puncture and lavage of calcifications in calcifying tendinopathy. We also review the following CT-guided procedures: diagnosis of spondylodiscitis, FNAC of metastases, arthrography, drainages. Finally, we also mention more complex procedures that can only be done in appropriate settings: bone biopsies, treatment of facet joint pain, radiofrequency treatment. PMID:27134018

  18. Injuries about the hip in the adolescent athlete.

    Science.gov (United States)

    Kovacevic, David; Mariscalco, Michael; Goodwin, Ryan C

    2011-03-01

    Athletic injuries in or around the hip in the adolescent athlete encompass possible causes such as a single, traumatic event to those of repetitive microtrauma. The injuries may involve the bone or the soft tissues, with former involving the epiphysis, apophysis, metaphysis, or diaphysis, whereas the latter includes muscles and tendons. With the improvements in surgical technique and instrumentation for hip arthroscopy and the development of magnetic resonance arthrography, clinicians have been able to diagnose and treat labral tears, hip instability, snapping hip, loose bodies, chondral injuries, and femoroacetabular impingement. The clinician needs to consider acquired conditions that may have coincidentally become apparent as a result of the adolescent's participation in an organized sports program. These include slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, and pathologic lesions and fractures. This study reviews the more common acute and chronic overuse injuries in or around the hip in the adolescent athlete and discusses hip injury prevention in this active patient population. PMID:21293240

  19. Cationic gadolinium chelate for magnetic resonance imaging of cartilaginous defects.

    Science.gov (United States)

    Nwe, Kido; Huang, Ching-Hui; Qu, Feini; Warden-Rothman, Robert; Zhang, Clare Y; Mauck, Robert L; Tsourkas, Andrew

    2016-05-01

    The ability to detect meniscus defects by magnetic resonance arthrography (MRA) can be highly variable. To improve the delineation of fine tears, we synthesized a cationic gadolinium complex, (Gd-DOTA-AM4 )(2+) , that can electrostatically interact with Glycosaminoglycans (GAGs). The complex has a longitudinal relaxivity (r1) of 4.2 mM(-1) s(-1) and is highly stable in serum. Its efficacy in highlighting soft tissue tears was evaluated in comparison to a clinically employed contrast agent (Magnevist) using explants obtained from adult bovine menisci. In all cases, Gd-DOTA-AM4 appeared to improve the ability to detect the soft tissue defect by providing increased signal intensity along the length of the tear. Magnevist shows a strong signal near the liquid-meniscus interface, but much less contrast is observed within the defect at greater depths. This provides initial evidence that cationic contrast agents can be used to improve the diagnostic accuracy of MRA. Copyright © 2016 John Wiley & Sons, Ltd.

  20. A Current Review of the Meniscus Imaging: Proposition of a Useful Tool for Its Radiologic Analysis

    Directory of Open Access Journals (Sweden)

    Nicolas Lefevre

    2016-01-01

    Full Text Available The main objective of this review was to present a synthesis of the current literature in order to provide a useful tool to clinician in radiologic analysis of the meniscus. All anatomical descriptions were clearly illustrated by MRI, arthroscopy, and/or drawings. The value of standard radiography is extremely limited for the assessment of meniscal injuries but may be indicated to obtain a differential diagnosis such as osteoarthritis. Ultrasound is rarely used as a diagnostic tool for meniscal pathologies and its accuracy is operator-dependent. CT arthrography with multiplanar reconstructions can detect meniscus tears that are not visible on MRI. This technique is also useful in case of MRI contraindications, in postoperative assessment of meniscal sutures and the condition of cartilage covering the articular surfaces. MRI is the most accurate and less invasive method for diagnosing meniscal lesions. MRI allows confirming and characterizing the meniscal lesion, the type, the extension, its association with a cyst, the meniscal extrusion, and assessing cartilage and subchondral bone. New 3D-MRI in three dimensions with isotropic resolution allows the creation of multiplanar reformatted images to obtain from an acquisition in one sectional plane reconstructions in other spatial planes. 3D MRI should further improve the diagnosis of meniscal tears.

  1. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle.

    LENUS (Irish Health Repository)

    Henari, Shwan

    2011-10-01

    The medial deltoid ligament is the primary stabilizing structure in the ankle joint following lateral malleolar fracture. However, medial deltoid ligament ruptures are difficult to diagnose using current imaging modalities. We hypothesized that ultrasonography can be used to accurately allow early clinical assessment of ankle fracture stability, thereby negating the need to perform plain film stress views of the acutely injured ankle. This prospective study included 12 patients (age range, 18-72) with supination external rotation fractures requiring operative fixation. Following induction of anesthesia, ultrasonography examination was performed, followed by an arthrogram under fluoroscopic screening. Radiographs, ultrasonography, and arthrographic findings were compared. There was 100% correlation between ultrasonography and arthrogram findings. Ultrasonography accurately diagnosed medial deltoid rupture with a sensitivity of 100% and specificity of 100%. Plain film radiographs of the ankle had a sensitivity of 57.1% and a specificity of 60%. The difference between these was significant (χ(2)=.0091). This study demonstrates diagnostic ultrasonography to be an accurate diagnostic modality in assessing medial deltoid ligament integrity in patients with supination external rotation fractures. It offers the same sensitivity and specificity as arthrography without the need for additional invasive procedures. Its relative ease of use and lack of ionizing radiation make it a potentially useful tool, particularly in a busy trauma service.

  2. SLAP tear associated with a minimally displaced proximal humerus fracture.

    Science.gov (United States)

    Kendall, Corey B; Tanner, Stephanie L; Tolan, Stefan J

    2007-12-01

    Nondisplaced proximal humerus fracture may be associated with soft tissue injury. This case report examines 2 cases of superior labral anterior-posterior (SLAP) tears in association with nondisplaced fractures of the proximal humerus. In the first case, the patient fell from a jet ski, causing a traction injury to his arm. A greater tuberosity fracture was identified. Magnetic resonance imaging (MRI) did not reveal a definitive labral tear. After conservative management had failed, a type IV SLAP tear and a small rotator cuff tear were arthroscopically identified and repaired. In the second case, a power company lineman fell from a lift and attempted to hold on with his dominant arm. A nondisplaced greater tuberosity and a surgical neck fracture were discovered. MR arthrography revealed no evidence of SLAP tear. Four months after injury, a type II SLAP tear was arthroscopically identified and repaired. In these 2 cases, the presence of the fracture likely slowed operative intervention because pain was attributed to the fracture itself, and not to the SLAP tear. If patients do not follow the usual course of improvement after a proximal humerus fracture from a superior traction mechanism, consideration should be given to associated superior labral tears that may require surgical intervention.

  3. US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay.

    Science.gov (United States)

    Guerini, H; Fermand, M; Godefroy, D; Feydy, A; Chevrot, A; Morvan, G; Gault, N; Drapé, J L

    2012-02-01

    The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination.A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT).

  4. Advanced imaging in femoroacetabular impingement: current state and future prospects

    Directory of Open Access Journals (Sweden)

    Bernd eBittersohl

    2015-07-01

    Full Text Available Symptomatic femoroacetabular impingement (FAI is now a known precursor of early osteoarthritis (OA of the hip. In terms of clinical intervention, the decision between joint preservation and joint replacement hinges on the severity of articular cartilage degeneration. The exact threshold during the course of disease progression when the cartilage damage is irreparable remains elusive. The intention behind radiographic imaging is to accurately identify the morphology of osseous structural abnormalities and to accurately characterize the chondrolabral damage as much as possible. However, both plain radiographs and computed tomography (CT are insensitive for articular cartilage anatomy and pathology. Advanced magnetic resonance imaging (MRI techniques include magnetic resonance arthrography (MRA and biochemically sensitive techniques of delayed gadolinium-enhanced MRI of cartilage (dGEMRIC, T1rho, T2/T2* mapping and several others. The diagnostic performance of these techniques to evaluate cartilage degeneration could improve the ability to predict an individual patient-specific outcome with non-surgical and surgical care. This review discusses the facts and current applications of biochemical MRI for hip joint cartilage assessment covering the roles of dGEMRIC, T2/T2*, and T1rho mapping. The basics of each technique and their specific role in FAI assessment are outlined. Current limitations and potential pitfalls as well as future directions of biochemical imaging are also outlined.

  5. Rotational abnormalities of the hip joint; Rotationsfehler des Hueftgelenks

    Energy Technology Data Exchange (ETDEWEB)

    Tschauner, C.; Hofmann, S. [Orthopaedische Abteilung des Allgemeinen und Orthopaedischen, Landeskrankenhauses, Stolzalpe (Austria); Fock, C.M. [Abt. Radiologie, Landeskrankenhaus Wagna (Austria); Raith, J. [Universitaetsklinik fuer Radiologie und Zentralroentgeninstitut, Graz (Austria)

    2002-06-01

    Changes or limitations of the rotational range of motion of the hip are a non-specific clinical sign. There is a big variety of underlying morphological pathologies resulting in a symptomatic alteration of hip rotation. They need to be assessed by imaging techniques: based on plain radiographs (including specialized projections), often CT or MRI are necessary to visualize the underlying changes of shape, rotation and offset of the articulating surfaces, which might result in a painful ''femoroacetabular impingement'' as a trigger of secondary osteoarthritis. Highly sophisticated MR-arthrography-protocols are able to visualize conventionally ''obscure'' but biomechanically relevant morphological changes, that might be individually normalized by joint-preserving corrective surgery. (orig.) [German] Der Rotationsfehler des Hueftgelenks ist ein klinisches Symptom. Dieses klinische Symptom ist vieldeutig, denn es koennen ihm die vielfaeltigsten pathomorphologischen Veraenderungen, sei es einzeln, sei es in Kombination, zugrunde liegen. Wenn die klinische Symptomatik Schmerzen und/oder Veraenderungen der Rotationsfaehigkeit aufweist, muss eine eingehende bildgebende Analyse der zugrundeliegenden Formveraenderungen durchgefuehrt werden. Beginnend mit dem Nativroentgen (einschliesslich spezieller Projektionen) als Basisdiagnostik kann heute neben der CT und der konventionellen MRT insbesondere die Magnetresonanzarthrographie in differenzierter Technik versteckte Baufehler sichtbar und damit einer gelenkerhaltend-korrektiven orthopaedisch-chirurgischen Therapie zugaenglich machen. (orig.)

  6. MRI and ultrasound in children with juvenile chronic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Lamer, S.; Sebag, G.H

    2000-02-01

    In this era of advancing imaging technology, a knowledge of the relative values of available imaging techniques is necessary to optimize the management of children with juvenile chronic arthritis (JCA). After clinical examination, plain films remain the initial investigation. The need for radiation protection must be a priority in children with JCA. Conventional radiographs allow grouping of the various arthritides (on the base of the distribution and pattern of joint space changes) and staging of disease progression. Ultrasound (US) is very sensitive in the detection of joint effusions, especially in the hip, and guides fluid aspiration. US and Doppler can be used for the evaluation of synovial hypertrophy and activity. Arthrography and to a certain extent nuclear studies have been replaced by magnetic resonance imaging (MRI). MRI can demonstrate articular cartilage, joint effusion, synovial hypertrophy, cortical and medullary bone, cartilage and bone perfusion, and fibrocartilaginous structures (menisci and ligaments). Contrast enhanced MRI is the most sensitive modality to determine whether an arthritic condition is present. However, it does not assist in establishing a specific diagnosis. MRI determines accurately the activity and the extent of the disease and is particularly useful in the early detection of articular damage. Finally, MRI is of major importance in the evaluation of response to local therapy (especially steroids) and the detection of complications.

  7. Wrist arthroscopy: a prospective analysis of 53 post-traumatic carpal injuries.

    Science.gov (United States)

    Sennwald, G R; Zdravkovic, V

    1997-09-01

    We carried out a prospective study of 53 consecutive patients who had sustained a serious wrist injury. Patients who presented with a previous condition or who had undergone surgery to the wrist were excluded. History, clinical findings, standard radiographs and arthrography were correlated with the uninjured side and with arthroscopic findings. The radiolunate (RL) angle of the injured wrist differed significantly from that of the "normal" wrist (p = 0.088). POssible correlations within the whole group were studied by multivariate analysis, particularly k-means clustering, a procedure which enables the detection of natural groups. We found that ligamentous tears at the triquetrum in the midcarpal joint significantly (p = 0.004) affected the equilibrium of the proximal row defined by clustering with the RL and scapholunate (SL) angles. The use of multivariate analysis techniques in combination with cross tabulation for the surgery of intracarpal ligamentous abnormalities seen at arthroscopy might help us to define better the function of the ligaments of the wrist. These findings, of little help in daily practice, might be important for clinical research.

  8. Ultrasonographic Diagnosis of the Hand and Wrist Joint

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ik; Choi, Sang Hee [Kangnnam Sacredheart Hospital, Hallym University Medical Center, Seoul (Korea, Republic of)

    2006-12-15

    Ultrasonographic examination of the hand and wrist is simple and easy due to their superficial anatomy, and easy accessibility. Ultrasound is indicated to evaluate persistent pain and swelling when the radiographic examination is normal. Although their anatomy is simple, the pathologic conditions of the hand and wrist are quite diverse. Although plain radiographs, CT, arthrography, and MRI have traditionally been used to evaluate the hand and wrist, nowadays, ultrasound is now being ordered with increasing frequency to scan the hand and wrist as it is a cost-effective and accurate modality for the diagnosis of focal pathology in those areas. A high-frequency linear array transducer should be used to scan the upper extremity. Available transducers up to 12 MHz provide excellent resolution. Color and power Doppler images are useful in hyperemic changes and tumor vascularity. Sonographic panorama imaging also has the advantage of demonstrating the whole extension of the lesion and of enabling a dynamic study of the hand and wrist. This action during sonographic examination not only help to diagnosis to examiner to the anatomic structures, but also localize the pathologic process to a target organ. This chapter will describe the sonographic findings associated with the most common hand and wrist pathologic conditions

  9. Carpal instability

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R.; Froehner, S.; Coblenz, G.; Christopoulos, G. [Institut fuer Diagnostische und Interventionelle Radiologie, Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany)

    2006-10-15

    This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads (''dyskinetics'') or suffers from abnormal motion of its bones during movement (''dyskinematics''). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being ''occult'' for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the handsurgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis. (orig.)

  10. Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Schaeffeler, Christoph; Mueller, Dirk; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Orthopedics and Traumatology, Munich (Germany); Wolf, Petra [Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Munich (Germany)

    2011-07-15

    To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint with MR arthrography (MR-A) of the shoulder. MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon insertion were depicted. Anatomical locations were determined and depths of tears were classified. 112/305 patients showed RC tears, including 63 patients with 68 footprint tears. 34 PASTA lesions were detected with 20/34 involving the anterior supraspinatus (SSP) tendon and 17/34 PASTA lesions were grade I lesions. Most CID lesions (14/23) occurred at the posterior SSP and 20/23 were classified as grade I or II. 9 FT and 2 reverse PASTA lesions were found. Statistical analysis revealed no difference in anatomical location (p = 0.903) and no correlation with overhead sports activity (p = 0.300) or history of trauma (p=0.928). There were significantly more PASTA lesions in patients <40 years of age (p = 0.029). Most RC tears detected with MR-A involve the SSP footprint and are articular-sided with predominance in younger patients, but concealed lesions are not as uncommon as previously thought. (orig.)

  11. Modern radiological postoperative diagnostics of the hip joint in children and adults; Moderne radiologische postoperative Diagnostik des Hueftgelenks im Kindes- und Erwachsenenalter

    Energy Technology Data Exchange (ETDEWEB)

    Weber, M.A.; Thierjung, H.; Kloth, J.K. [Heidelberg University Hospital (Germany). Diagnostic and Interventional Radiology; Egermann, M. [Heidelberg University Hospital (Germany). Center for Orthopedics

    2015-07-15

    The assessment of bone healing and loosening of endoprosthesis material was long the primary indication for postoperative projection radiography and CT imaging of the hip joint following trauma and endoprosthesis implantation. With the increasing number of joint-preserving surgery, e. g. of surgical hip luxation and hip arthroscopy for the treatment of femoroacetabular impingement (FAI), high-resolution imaging of intra-articular pathologies before and after surgery has become increasingly important. In this review article, diagnostic imaging of the hip joint is presented following common trauma surgery and orthopedic surgery interventions. The imaging modalities of projection radiography, CT and MRI including direct MR-arthrography are discussed with regard to their diagnostic capability in the postoperative assessment of the hip joint. Among others topics, imaging is discussed following hip arthroplasty, following surgical hip luxation and arthroscopic interventions for the treatment of FAI, as well as following core decompression for avascular necrosis of the femoral head. Moreover, orthopedic interventions of the hip joint in children and adolescents are presented and the dedicated reporting of postoperative imaging is outlined.

  12. Detection of occult infection following total joint arthroplasty using sequential technetium-99m HDP bone scintigraphy and indium-111 WBC imaging

    International Nuclear Information System (INIS)

    Preoperative exclusion or confirmation of periprosthetic infection is essential for correct surgical management of patients with suspected infected joint prostheses. The sensitivity and specificity of [111In]WBC imaging in the diagnosis of infected total joint prostheses was examined in 28 patients and compared with sequential [/sup 99m/Tc]HDP/[111In]WBC scintigraphy and aspiration arthrography. The sensitivity of preoperative aspiration cultures was 12%, with a specificity of 81% and an accuracy of 58%. The sensitivity of [111In]WBC imaging alone was 100%, with a specificity of 50% and an accuracy of 65%. When correlated with the bone scintigraphy and read as sequential [/sup 99m/Tc]HDP/[111In]WBC imaging, the sensitivity was 88%, specificity 95%, and accuracy 93%. This study demonstrates that [111In]WBC imaging is an extremely sensitive imaging modality for the detection of occult infection of joint prostheses. It also demonstrates the necessity of correlating [111In]WBC images with [/sup 99m/Tc]HDP skeletal scintigraphy in the detection of occult periprosthetic infection

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

    International Nuclear Information System (INIS)

    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. 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 indilated 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 on 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. Despite the limited nature of this study, it shows clearly that MRI is the procedure of choice. (orig./MG)

  14. Acetabular labral tears: contrast-enhanced MR imaging under continuous leg traction

    Energy Technology Data Exchange (ETDEWEB)

    Nishii, T. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Nakanishi, K. [Dept. of Radiology, Osaka Univ. Medical School, Suita (Japan); Sugano, N. [Dept. of Orthopaedic Surgery, Osaka Univ. Medical School, Suita (Japan); Naito, H. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Tamura, S. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Ochi, T. [Dept. of Orthopaedic Surgery, Osaka Univ. Medical School, Suita (Japan)

    1996-05-01

    The objective of this study was to evaluate the effects of continuous leg traction on contrast-enhanced MR imaging of the hip joint and to determine whether MR imaging under these conditions is useful for demonstrating acetabular labral tears. Nineteen hips underwent MR imaging with a T1-weighted spin-echo sequence, followed by MR imaging under continuous leg traction after intravenous injection of gadolinium-DTPA. Joint fluid enhancement and labral contour detection were evaluated. Eleven hips had labral tears shown by conventional arthrography, arthroscopy and macroscopic surgical findings. Assessment of labral tears by MR imaging was correlated with the diagnosis based on these standard techniques. Joint fluid enhancement was obtained in all hips at 30 min after injection. Superior and inferior labral surfaces were completely delineated in 1 hip on the unenhanced MR images, and in 7 and 13 hips, respectively, on the enhanced images under traction. The enhanced images under traction depicted 9 of the 11 labral tears. Comparison between the unenhanced image and the enhanced image under traction avoided mistaking undercutting of the labrum for a tear in 4 hips. Contrast-enhanced MR imaging under traction was valuable for detecting labral tears non-invasively and without radiation. Follow-up examinations using this method in patients with acetabular dysplasia can help to clarify the natural course of labral disorders and enable better treatment planning. (orig./MG)

  15. Cationic gadolinium chelate for magnetic resonance imaging of cartilaginous defects.

    Science.gov (United States)

    Nwe, Kido; Huang, Ching-Hui; Qu, Feini; Warden-Rothman, Robert; Zhang, Clare Y; Mauck, Robert L; Tsourkas, Andrew

    2016-05-01

    The ability to detect meniscus defects by magnetic resonance arthrography (MRA) can be highly variable. To improve the delineation of fine tears, we synthesized a cationic gadolinium complex, (Gd-DOTA-AM4 )(2+) , that can electrostatically interact with Glycosaminoglycans (GAGs). The complex has a longitudinal relaxivity (r1) of 4.2 mM(-1) s(-1) and is highly stable in serum. Its efficacy in highlighting soft tissue tears was evaluated in comparison to a clinically employed contrast agent (Magnevist) using explants obtained from adult bovine menisci. In all cases, Gd-DOTA-AM4 appeared to improve the ability to detect the soft tissue defect by providing increased signal intensity along the length of the tear. Magnevist shows a strong signal near the liquid-meniscus interface, but much less contrast is observed within the defect at greater depths. This provides initial evidence that cationic contrast agents can be used to improve the diagnostic accuracy of MRA. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26853708

  16. Early radiological diagnostics for scapholunate dissociation (SLD); Radiologische Fruehdiagnostik der skapholunaeren Dissoziation (SLD)

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R.; Froehner, S.; Fodor, S.; Christopoulos, G. [Herz- und Gefaessklinik GmbH, Institut fuer Diagnostische und Interventionelle Radiologie, Bad Neustadt an der Saale (Germany); Kalb, K.H. [Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany). Klinik fuer Handchirurgie

    2006-08-15

    The partial tear of the scapholunate ligament (pre-dynamic stage of SLD) as well as the complete tear (dynamic stage) does not lead to carpal malalignment. However, if the completely ruptured ligament is accompanied by lesions of the extrinsic ligaments, both the scaphoid and the lunate are malaligned already at rest (static stage of SLD). Later, osteoarthritis will develop, beginning in the radioscaphoid compartment, progressing to the midcarpal joint, and ending in a carpal collapse (osteoarthrotic stage of SLD). Dynamic SLD is detectable only in stress views and in cinematography. The high utility of MRI for directly visualizing the injured ligament is emphasized: reparation tissue is focally enhanced at the rupture site by intravenously applied contrast agent; the individual segments of the scapholunate ligament can be visualized in direct MR arthrography, therefore allowing differentiation of partial and complete ligamentous tears. (orig.) [German] Die Teilruptur des Lig. scapholunatum (praedynamisches Stadium) und die isolierte Komplettruptur (dynamisches Stadium) fuehren zu keiner karpalen Gefuegestoerung in Ruhe. Erst wenn die Komplettruptur von Laesionen der extrinsischen Bandstabilisatoren begleitet wird, stehen das Skaphoid und Lunatum bereits in Ruhe in Fehlstellung (statisches Stadium). Spaeter kommt es zur Handgelenkarthrose, zuerst radioskaphoidal, dann mediokarpal mit Ausbildung eines karpalen Kollapses (arthrotisches Stadium). Die dynamische Instabilitaet ist nur mit Stressaufnahmen und kinematographisch nachweisbar. Die MRT vermag das rupturierte Lig. scapholunatum direkt darzustellen: Intravenoes verabreichtes Kontrastmittel reichert sich fokal am Reparationsgewebe der Rupturstelle an; mit der direkten MR-Arthrogaphie koennen die Bandsegmente besser abgegrenzt und Partial- von Komplettrupturen unterschieden werden. (orig.)

  17. Whole-body computed tomography

    International Nuclear Information System (INIS)

    The textbook covers all aspects of the modern (spiral) CT methods: The technical principle, evaluation modalities and artefacts, specific diagnostic examinations such as CT angiography, CTAP, CT arthrography, CT-guided biopsy, as well as the principles guiding the analysis of the tomographic images are explained in the initial chapter on fundamentals. Further methodological information is given in the second chapter discussing the various examination strategies, and the value of the material is enhanced by a wealth of diagnostic image reproductions of latest available standard. The chapters devoted to the body organs of interest are arranged by organs and cover information on the normal anatomy, diagnostic examination techniques, contrast agent performance and, as a very important part, the full-detail CT morphology, supplemented by information describing the anatomy, pathophysiology and clinical aspects of relevance to the diagnostic decisions. There are as well many practical hints which readers may find useful in their practical work. Every chapter contains tables summarizing and showing at a glance information on indications, specific examination techniques, including the scan parameters for the spiral CT, and on differential diagnoses. (orig./CB)

  18. Imaging for osteoarthritis.

    Science.gov (United States)

    Hayashi, D; Roemer, F W; Guermazi, A

    2016-06-01

    Osteoarthritis (OA) is a widely prevalent disease worldwide and, with an increasing ageing society, is a challenge for the field of physical and rehabilitation medicine. Technologic advances and implementation of sophisticated post-processing instruments and analytic strategies have resulted in imaging playing a more and more important role in understanding the disease process of OA. Radiography is still the most commonly used imaging modality for establishing an imaging-based diagnosis of OA. The need for an effective non-surgical OA treatment is highly desired, but despite on-going research efforts no disease-modifying OA drugs have been discovered or approved to date. MR imaging-based studies have revealed some of the limitations of radiography. The ability of MR to image all relevant joint tissues within the knee and to visualize cartilage morphology and composition has resulted in MRI playing a key role in understanding the natural history of the disease and in the search for new therapies. Our review will focus on the roles and limitations of radiography and MRI with particular attention to knee OA. The use of other modalities (e.g. ultrasound, nuclear medicine, computed tomography (CT), and CT/MR arthrography) in clinical practice and OA research will also be briefly described. Ultrasound may be useful to evaluate synovial pathology in osteoarthritis, particularly in the hand. PMID:26797169

  19. Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

    International Nuclear Information System (INIS)

    This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician's degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair

  20. Accuracy of non assisted glenohumeral joint injection in the office setting

    International Nuclear Information System (INIS)

    Purpose: The diagnostic and therapeutic success of shoulder joint injection depends on its accuracy. Two recent studies reported high success (93–96%) for non-imaging-assisted anterior injection in anesthetized patients. This study examined the accuracy of anterior shoulder injection in awake patients under conditions similar to the office setting. Methods: The study group consisted of 166 consecutive patients with shoulder pain who underwent diagnostic magnetic resonance arthrography at a tertiary medical center in 2011–2012. As part of the examination, contrast material was injected into the glenohumeral joint via an anterior approach by a certified musculoskeletal radiologist without any image assistance. Success was defined as contrast material limited to the intra-articular joint on the scan, without scatter to the periauricular tissue. Results: A successful injection was verified by magnetic resonance arthography in 163 patients (98.2%). Conclusions: Non-assisted anterior shoulder injection is highly accurate (98.2%) in the hands of an experienced radiologist, even in awake patients

  1. Shoulder instability

    International Nuclear Information System (INIS)

    Shoulder instability is a common clinical feature leading to recurrent pain and limitated range of motion within the glenohumeral joint. Instability can be due a single traumatic event, general joint laxity or repeated episodes of microtrauma. Differentiation between traumatic and atraumatic forms of shoulder instability requires careful history and a systemic clinical examination. Shoulder laxity has to be differentiated from true instability followed by the clinical assessment of direction and degree of glenohumeral translation. Conventional radiography and CT are used for the diagnosis of bony lesions. MR imaging and MR arthrography help in the detection of soft tissue affection, especially of the glenoid labrum and the capsuloligamentous complex. The most common lesion involving the labrum is the anterior labral tear, associated with capsuloperiostal stripping (Bankart lesion). A number of variants of the Bankart lesion have been described, such as ALPSA, SLAP or HAGL lesions. The purpose of this review is to highlight different forms of shoulder instability and its associated radiological findings with a focus on MR imaging. (orig.)

  2. Sonography of the painful shoulder: role of the operator's experience

    Energy Technology Data Exchange (ETDEWEB)

    Corroller, Thomas Le; Cohen, Michel; Champsaur, Pierre [Hopital Sainte-Marguerite, Service d' Imagerie Medicale, Marseille (France); Aswad, Richard [Clinique Juge, Service de Chirurgie Orthopedique, Marseille (France); Pauly, Vanessa [Hopital Sainte-Marguerite, D.I.M., Marseille (France)

    2008-11-15

    The aim of our study was to determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7%for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears ({kappa}=0.90), supraspinatus tendinosis ({kappa} =0.80), abnormalities of the long head of biceps tendon ({kappa}=0.84), subacromial bursa abnormalities ({kappa}=0.89), and acromioclavicular osteoarthritis ({kappa}=0.81). The agreement was only moderate for partial-thickness tears ({kappa}=0.63) and intratendinous tears ({kappa}=0.57). Our results show that in moderately experienced hands as in experts' hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher. (orig.)

  3. Cystic Lesions in the Greater Tuberosity of the Humerus: The Relation to Rotator Cuff Tears and Age

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Gang Deuk; Oh, Jung Taek [Wonkwang University Hospital, Iksan (Korea, Republic of)

    2008-12-15

    This study was designed to investigate the location of cystic lesions in the greater tuberosity of the humerus and the relationship to rotator cuff tears and age. A total of 78 patients (age range, 19-82 years; mean age, 51 years) who underwent arthroscopy or open surgery after MR arthrography (MRA) for a painful shoulder were enrolled in the study. The location of the cystic lesions were classified as 'A' for a supraspinatus insertion site, as 'C' for an infraspinatus insertion site, as 'B' for both a supraspinatus and infraspinatus insertion site, as 'BG' for a site posterior to the bicipital groove and as 'P' for a site at the bare area of the humeral head. The location of cystic lesions and supraspinatus and infraspinatus tears were evaluated on MRA. Statistical analyses used the chi-squared test and logistic regression. 'BG' and 'A' cystic lesions were related to the presence of a supraspinatus tear, 'C' cystic lesions were related to the presence of an infraspinatus tear and 'B' cystic lesions were related to the presence of both supraspinatus and infraspinatus tears (p < 0.05). 'P' cystic lesions were not related to the presence of rotator cuff tears. The incidence of cystic lesions increased with age, but with no statistical correlation. Cystic lesions at the supraspinatus and infraspinatus insertion sites are useful to predict the presence of a rotator cuff tear, but cystic lesions were not age related

  4. Differentiating subluxation from developmental dislocation of the hip

    Directory of Open Access Journals (Sweden)

    Joao O. Tavares

    2012-02-01

    Full Text Available The radiological and clinical picture of a developmental hip dislocation and a severe subluxation are identical. According to Leveuf and Wiberg the diagnosis can only be made by arthrography. The differential diagnosis is critical, as treatment differs dependent on the diagnosis. In this study, the diagnosis of subluxation was based on a plain radiograph of the pelvis. A radiograph of the pelvis with the hips abducted at least 45° and internally rotated (AIR view was used to differentiate these two entities. In subluxations, the femoral head will relocate into the acetabulum with perfect or near perfect reconstitution of the Shenton’s line. It will fail to do so in true dislocations. Five patients, mean age 14.6 months (range 9 to 20 months, presented with delayed diagnosis of hip dysplasia. The examination revealed minimal or no limitation of hip abduction, a leg length discrepancy, and a Trendelenburg gait in the three walking age girls. The radiograph suggested a hip dislocation. The diagnosis of hip subluxation was based on the relocation of the femoral head with the abduction/internal rotation radiograph. All were successfully treated with an Ilfeld abduction splint. None had examination with general anesthesia, arthrograms, traction or immobilization in spica cast. Avoiding over diagnosis of hip dislocation in cases of subluxation is important. This is necessary to prevent overtreatment and to accurately assess the results of treatment. The abduction/internal rotation view may achieve this goal while avoiding diagnostic and therapeutic procedures, such as arthrograms, cast immobilization and surgery.

  5. Patterns of Age-Associated Degeneration Differ in Shoulder Muscles

    Science.gov (United States)

    Raz, Yotam; Henseler, Jan F.; Kolk, Arjen; Riaz, Muhammad; van der Zwaal, Peer; Nagels, Jochem; Nelissen, Rob G. H. H.; Raz, Vered

    2015-01-01

    Shoulder complaints are common in the elderly and hamper daily functioning. These complaints are often caused by tears in the muscle-tendon units of the rotator cuff (RC). The four RC muscles stabilize the shoulder joint. While some RC muscles are frequently torn in shoulder complaints others remain intact. The pathological changes in RC muscles are poorly understood. We investigated changes in RC muscle pathology combining radiological and histological procedures. We measured cross sectional area (CSA) and fatty infiltration from Magnetic Resonance Imaging with Arthrography (MRA) in subjects without (N = 294) and with (N = 109) RC-tears. Normalized muscle CSA of the four RC muscles and the deltoid shoulder muscle were compared and age-associated patterns of muscle atrophy and fatty infiltration were constructed. We identified two distinct age-associated patterns: in the supraspinatus and subscapularis RC muscles CSAs continuously declined throughout adulthood, whereas in the infraspinatus and deltoid reduced CSA was prominent from midlife onwards. In the teres minor, CSA was unchanged with age. Most importantly, age-associated patterns were highly similar between subjects without RC tear and those with RC-tears. This suggests that extensive RC muscle atrophy during aging could contribute to RC pathology. We compared muscle pathology between torn infraspinatus and non-torn teres minor and the deltoid in two patients with a massive RC-tear. In the torn infraspinatus we found pronounced fatty droplets, an increase in extracellular collagen-1, a loss of myosin heavy chain-1 expression in myofibers and an increase in Pax7-positive cells. However, the adjacent intact teres minor and deltoid exhibited healthy muscle features. This suggests that satellite cells and the extracellular matrix may contribute to extensive muscle fibrosis in torn RC. We suggest that torn RC muscles display hallmarks of muscle aging whereas the teres minor could represent an aging

  6. Patterns of Age-Associated Degeneration Differ in Shoulder Muscles.

    Science.gov (United States)

    Raz, Yotam; Henseler, Jan F; Kolk, Arjen; Riaz, Muhammad; van der Zwaal, Peer; Nagels, Jochem; Nelissen, Rob G H H; Raz, Vered

    2015-01-01

    Shoulder complaints are common in the elderly and hamper daily functioning. These complaints are often caused by tears in the muscle-tendon units of the rotator cuff (RC). The four RC muscles stabilize the shoulder joint. While some RC muscles are frequently torn in shoulder complaints others remain intact. The pathological changes in RC muscles are poorly understood. We investigated changes in RC muscle pathology combining radiological and histological procedures. We measured cross sectional area (CSA) and fatty infiltration from Magnetic Resonance Imaging with Arthrography (MRA) in subjects without (N = 294) and with (N = 109) RC-tears. Normalized muscle CSA of the four RC muscles and the deltoid shoulder muscle were compared and age-associated patterns of muscle atrophy and fatty infiltration were constructed. We identified two distinct age-associated patterns: in the supraspinatus and subscapularis RC muscles CSAs continuously declined throughout adulthood, whereas in the infraspinatus and deltoid reduced CSA was prominent from midlife onwards. In the teres minor, CSA was unchanged with age. Most importantly, age-associated patterns were highly similar between subjects without RC tear and those with RC-tears. This suggests that extensive RC muscle atrophy during aging could contribute to RC pathology. We compared muscle pathology between torn infraspinatus and non-torn teres minor and the deltoid in two patients with a massive RC-tear. In the torn infraspinatus we found pronounced fatty droplets, an increase in extracellular collagen-1, a loss of myosin heavy chain-1 expression in myofibers and an increase in Pax7-positive cells. However, the adjacent intact teres minor and deltoid exhibited healthy muscle features. This suggests that satellite cells and the extracellular matrix may contribute to extensive muscle fibrosis in torn RC. We suggest that torn RC muscles display hallmarks of muscle aging whereas the teres minor could represent an aging

  7. [Examination of the knee joint. The value of clinical findings in arthroscopic control].

    Science.gov (United States)

    Steinbrück, K; Wiehmann, J C

    1988-01-01

    Purely clinical examination of the knee joint can, at best, only be regarded as a "screening procedure". Diagnosis with the aid of apparatus (sonography, arthrography, CT, NMR) produces better results. However, arthroscopy performed by an experienced examiner confirms the diagnosis in cases of suspected meniscus injury or isolated lesions of the cruciate ligaments and leads to early and therefore optimal therapy. In a retrospective study 300 arthroscopies performed in 1985 were selected and evaluated. In 1986/87, a further 300 patients were clinically examined prospectively, according to the same criteria, and findings were compared with the arthroscopy performed the following day. Clinically, in 287 patients with multiple diagnoses, internal meniscus lesions were diagnosed in 162 cases (54%), external meniscus lesions in 38 (13%), chondropathia patellae in 54 (18%), and old ruptures of the cruciate ligaments in 46 (15%). In 13 patients no diagnosis could be established. Arthroscopically, pathology of the internal meniscus was found in 98 (33%) of the 300 patients, of the external meniscus in 40 (13%), cartilage damage in 103 (34%), old cruciate ligament ruptures in 51 (17%), and recent anterior cruciate ligament ruptures in 156 (52%); in 40 cases findings were normal. At 78%, the highest positive predictive value (proportion of tentative clinical diagnoses confirmed by arthroscopy) was found in cases of old ruptures of the anterior cruciate ligament, followed by external meniscus lesions (61%) and internal meniscus lesions (55%); i.e., only 55 out of 100 clinically suspected internal meniscus lesions are diagnosed by arthroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. The value of ultrasonography in the diagnosis and clinical treatment of rotator cuff tear%超声诊断肩袖撕裂的临床指导价值研究

    Institute of Scientific and Technical Information of China (English)

    史淼; 张改英; 亓恒涛; 滕剑波

    2011-01-01

    目的:探讨肩袖撕裂的超声特征,评价超声检查肩袖撕裂的应用价值及对临床治疗的指导意义.方法:对临床怀疑有肩袖损伤的66例患者(70个肩关节)进行超声检查,并与手术、肩关节造影或磁共振结果进行比较.结果:肩袖撕裂的主要超声表现为:肩袖内局灶性异常回声,肩袖部分缺失,肩袖不显示.超声诊断的敏感性为98%(54/55),特异性为81%(17/21),准确性为93%(65/70).结论:超声诊断肩袖撕裂有很高的应用价值,对临床治疗有很好的指导意义.%Objective:To study the ultrasonographic characteristics of rotator cuff tear and to evaluate the value of ultrasonography in the diagnosis and clinical treatment of rotator cuff tear. Methods: Sixty-six patients suspected as rotator cuff tear were detected by ultrasound. Sonographic examinations were compared with surgery, arthrography or MRL Results:Sonographic characteristics included focal abnormal echogenicity within the cuff , focal defect of the rotator cuff , invisibility of the cuff. The sensitivity of sonography in detecting rotator cuff tear was 98% (54/55), the specificity was 81 % (17/21) , and the accuracy was 93 % (65/70). Conclusion : Sonography is the preferred examination method in the diagnosis and clinical treatment of rotator cuff tear.

  9. Correlation of condylar mobility and arthrotomography in patients with internal derangements of the temporomandibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Sook; You, Dong Soo; Park, Tae Won; Choi, Soon Chul [Dept. of Oral and Maxillofacial Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1994-08-15

    Arthrography of the temporomandibular joint is a useful method of demonstrating the tissue abnormalities related to disc dysfunction. In this study, 19 asymptomatic joints, 31 joints with anterior disc displacement with reduction, 31 joints with anterior disc displacement without reduction which were classified by arthrotomography under fluoroscopy were evaluated to determine the linear measurement of anterior recess of inferior joint space and the relationship between the condylar anterior translation and the severity of the internal derangements. Their fluoroscopic images were also evaluated to describe the characteristics of condylar paths in internal derangements of the temporomandibular joints. The results were as follows; 1. The mean lengths of the anterior recess in asymptomatic group, reduction group, and non-reduction group were 8.7 {+-} 1.6 mm, 11.2 {+-} 1.7 mm, 12.8 {+-} 1.7 mm respectively. The length of the anterior recess was increased according to the severity of the internal derangements (P<0.05). 2. Linear measurements if anterior movement of condyle on maximum mouth opening were 13.1 {+-} 4,2 mm, 15.9 {+-} 4,1 mm, 5.0 {+-} 3.7 mm in asymptomatic group, reduction group, and non-reduction group respectively. Compared with asymptomatic group, reduction group showed hypermobility of the condyle and not-reduction group showed hypomobility. 3. Condyles moved beyond the crest of articular eminence in 80% of reduction group and did not it in 70% of not-reduction group. 4. The condyle moved mainly superiorly in reduction group (66%)and horizontally in asymptomatic group (47%). There were no cases to move superiorly in not-reduction group.

  10. Arthroscopic intervention in early hip disease.

    Science.gov (United States)

    McCarthy, Joseph C; Lee, Jo-Ann

    2004-12-01

    Advancement in diagnostic and therapeutic applications for hip arthroscopy have dispelled previous myths about early hip disease. Arthroscopic findings have established the following facts: Acetabular labral tears do occur; acetabular chondral lesions do exist; tears are most frequently anterior and often associated with sudden twisting or pivoting motions; and labral tears often occur in association with articular cartilage lesions of the adjacent acetabulum or femoral head, and if present for years, contribute to the progression of delamination process of the chondral cartilage. Magnetic resonance arthrography represents an improvement over conventional magnetic resonance imaging, it does have limitations when compared with direct observation. Although indications for hip arthroscopy are constantly expanding, the most common indications include: labral tears, loose bodies, chondral flap lesions of the acetabular or femoral head, synovial chondromatosis, foreign body removal, and crystalline hip arthropathy (gout, pseudogout, and others). Contraindications include conditions that limit the potential for hip distraction such as joint ankylosis, dense heterotopic bone formation, considerable protrusio, or morbid obesity. Complication rates have been reported between 0.5 and 5%, most often related to distraction and include sciatic or femoral nerve palsy, avascular necrosis, and compartment syndrome. Transient peroneal or pudendal nerve effects and chondral scuffing have been associated with difficult or prolonged distraction. Meticulous consideration to patient positioning, distraction time and portal placement are essential. Judicious patient selection and diagnostic expertise are critical to successful outcomes. Candidates for hip arthroscopy should include only those patients with mechanical symptoms (catching, locking, or buckling) that have failed to respond to conservative therapy. The extent of articular cartilage involvement has the most direct relationship

  11. Ultrasonography for non-displaced and mini-displaced humeral lateral condyle fractures in children

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jing-dong; CHEN Hua

    2008-01-01

    Objective: To evaluate the value of ultrasonography in non-displaced and mini-displaced humeral lateral condyle fractures in children.Methods: Nine children aged 2-9 years with non-displaced or mini-displaced humeral lateral condyle fractures were examined by high-resolution ultrasonography.The fracture line through the joint surface was visualized by ultrasonography in 6 case,in which closed reduction and percutaneous pinning was performed on 3 patients and other 3 patients did not receive the treatment because of patients' or their parents'refusal.In the remaining 3 children,ultrasonography did not reveal the cartilaginous trochle involvement at the joint surface and conservative treatment was adopted.Results: The average follow-up period was 8 months.The sonographic findings were confirmed by magnetic resonance imaging in one child who received conservative treatment and another child who received percutaneous pinning.The elbow function and fractttre healing were good in cases received closed reduction and percutaneous pinning.Among the three cases who refused to receive closed reduction and internal f'txation,re-displacement occurred in 1 case and delayed union in 1 case.All three cases receiving conservative treatment had good results both in elbow function and fracture healing.Conclusion: High-resolution ultrasonography enable to reveal non-displaced and mini-displaced humeral lateral condyle fractures as well as to ascertain whether the cartilaginous trochlea humeri was involved.For these cases,arthrography or magnetic resonance imaging is unnecessary.

  12. Arthroscopic repair of type II SLAP lesions: Clinical and anatomic follow-up

    Directory of Open Access Journals (Sweden)

    John N Trantalis

    2015-01-01

    Full Text Available Aims: The aim was to evaluate the clinical and anatomic outcome of arthroscopic repair of type II SLAP lesions. Materials and Methods: The senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients with a mean age of 40.0 ± 12 years. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using several shoulder outcome measures. Patients were evaluated by magnetic resonance imaging arthrogram at a minimum of 1-year postoperatively. Statistical Analysis Used: Two-tailed paired t-test were used to determine significant differences in preoperative and postoperative clinical outcomes scores. In addition, a Fisher′s exact test was used. Results: At a mean follow-up of 54-month, the mean American Shoulder and Elbow Surgeons Shoulder Index (ASES scores improved from 52.1 preoperatively to 86.1 postoperatively (P < 0.0001 and the Simple Shoulder Test (SST scores from 7.7 to 10.6 (P < 0.0002. Twenty-two out of the 25 patients (88% stated that they would have surgery again. Of the 21 patients who had postoperative magnetic resonance imaging arthrographys (MRAs, 9 patients (43% demonstrated dye tracking between the labrum bone interface suggestive of a recurrent tear and 12 patients (57% had a completely intact repair. There was no significant difference in ASES, SST, and patient satisfaction scores in patients with recurrent or intact repairs. Conclusions: Arthroscopic repair of type II SLAP lesions demonstrated improvements in clinical outcomes. However, MRA imaging demonstrated 43% of patients with recurrent tears. MRA results do not necessarily correlate with clinical outcome.

  13. Efficacy of labral repair, biceps tenodesis, and diagnostic arthroscopy for SLAP Lesions of the shoulder: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Mowinckel Petter

    2010-10-01

    Full Text Available Abstract Background Surgery for type II SLAP (superior labral anterior posterior lesions of the shoulder is a promising but unproven treatment. The procedures include labral repair or biceps tenodesis. Retrospective cohort studies have suggested that the benefits of tenodesis include pain relief and improved function, and higher patient satisfaction, which was reported in a prospective non-randomised study. There have been no completed randomised controlled trials of surgery for type II SLAP lesions. The aims of this participant and observer blinded randomised placebo-controlled trial are to compare the short-term (6 months and long-term (2 years efficacy of labral repair, biceps tenodesis, and placebo (diagnostic arthroscopy for alleviating pain and improving function for type II SLAP lesions. Methods/Design A double-blind randomised controlled trial are performed using 120 patients, aged 18 to 60 years, with a history for type II SLAP lesions and clinical signs suggesting type II SLAP lesion, which were documented by MR arthrography and arthroscopy. Exclusion criteria include patients who have previously undergone operations for SLAP lesions or recurrent shoulder dislocations, and ruptures of the rotator cuff or biceps tendon. Outcomes will be assessed at baseline, three, six, 12, and 24 months. Primary outcome measures will be the clinical Rowe Score (1988-version and the Western Ontario Instability Index (WOSI at six and 24 months. Secondary outcome measures will include the Shoulder Instability Questionnaire (SIQ, the generic EuroQol (EQ-5 D and EQ-VAS, return to work and previous sports activity, complications, and the number of reoperations. Discussion The results of this trial will be of international importance and the results will be translatable into clinical practice. Trial Registration [ClinicalTrials.gov NCT00586742

  14. Sonography of the painful shoulder: role of the operator's experience

    International Nuclear Information System (INIS)

    The aim of our study was to determine the role of the operator's experience in the sonographic evaluation of the painful shoulder and to validate assumptions about its technical performance in routine practice. Two radiologists, respectively standard and expert sonographic operators, independently and prospectively scanned 65 patients with clinical suspicion of rotator cuff lesion. Magnetic resonance arthrography was the reference standard. The sensitivity of the expert ultrasound operator was 95.3% for full-thickness rotator cuff tears (41/43), 70.6% for partial-thickness tears (12/17), 64.3% for intratendinous tears (9/14), 100% for abnormality of the long head of biceps tendon (seven of seven), 88.9% for supraspinatus tendinosis (16/18), 96.4% for subacromial bursa abnormalities (53/55), and 91.7%for acromioclavicular joint osteoarthritis (33/36). The two sonographic operators were in very good agreement about full-thickness rotator cuff tears (κ=0.90), supraspinatus tendinosis (κ =0.80), abnormalities of the long head of biceps tendon (κ=0.84), subacromial bursa abnormalities (κ=0.89), and acromioclavicular osteoarthritis (κ=0.81). The agreement was only moderate for partial-thickness tears (κ=0.63) and intratendinous tears (κ=0.57). Our results show that in moderately experienced hands as in experts' hands, sonography has a low level of interobserver variability for full-thickness rotator cuff tears. Considering partial-thickness and intratendinous rotator cuff tears, our data suggest that interobserver variability is higher. (orig.)

  15. Osteochondritis Dissecans of the Hip

    Energy Technology Data Exchange (ETDEWEB)

    Linden, B. [Hoeglands Hospital, Eksjoe (Sweden). Dept. of Orthopedic Surgery; Jonsson, K. [Univ. Hospital, Lund (Sweden). Center for Medical Imaging and Physiology; Redlund-Johnell, I. [Univ. Hospital, Malmoe (Sweden). Dept. of Diagnostic Radiology

    2003-03-01

    Purpose: To investigate the clinical and radiological characteristics of osteochondritis dissecans (OD) of the hip and the outcome of this condition after treatment. Material and Methods: Twelve male and 3 female patients with OD were retrospectively studied. Six patients had a history of Legg-Calve-Perthes disease (LCPD) and among them 2 also had had a trauma to the hip. A further 5 had had trauma and 1 a developmental dislocation of the hip (DDH). The remaining 3 patients had no history of previous hip disease or trauma. All patients were examined with plain radiography, 7 with MR, 3 with CT and 2 with hip arthrography. Results: All OD lesions were detected at plain radiography, and most of them were located near the fovea. At MR the lesions had low signal intensity at T1-weighted sequences, and 6/7 had edema or fluid collection in or adjacent to the lesion on T2-weighted sequences. The early treatment in 7 patients was surgery, 2 had had conservative treatment and 6 no treatment. At follow-up 12 years after radiological diagnosis, 5 patients had hip arthrosis, 4 of whom were treated with arthroplasty. All but 3 had reduced hip rotation and all but 2 (with arthroplasty) had load pain. Three of the patients with earlier surgery had not developed arthrosis. Conclusions: OD lesions are usually well seen with plain radiography. There is a great risk of developing early arthrosis and it seems that early surgery is connected with arthrosis development. Thus only symptomatic treatment is recommended.

  16. Magnetic resonance imaging findings compared with histological findings of the labrum in hip osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kanezaki, Shiho; Nakamura, Shigeru; Matsushita, Takashi [Teikyo University School of Medicine, Department of Orthopaedic Surgery, Itabashi-ku, Tokyo (Japan); Yamamoto, Asako; Osawa, Marie [Teikyo University School of Medicine, Department of Radiology, Itabashi-ku, Tokyo (Japan)

    2015-06-01

    Patients with disorders such as acetabular dysplasia or femoroacetabular impingement are at risk of developing hip osteoartbritis. Assessment of the cartilage and labrum in the hip joint based on magnetic resonance imaging (MRI) has been challenging because of the low signal-to-noise ratio (SNR) due to its deep location, ball and socket structure, and small volume of those structures compared with the whole joint size. To achieve better imaging assessment, direct MR. arthrography (d-MRA) and other techniques such as T2* mapping, T2 mapping, Tlrho, and delayed gadolinium-enhanced MRI (dGEMRIC) have been developed along with the increasing use of high-field MRI. In patients with no apparent osteoarthritic changes such as joint space narrowing or osteophyte and subchondral cyst formation on radiographs, these techniques can detect early cartilage or labral damage. A recently developed semiquantitative MRI-based scoring system for hip osteoarthritis includes evaluation of the labrum, and its application as a potential therapeutic monitoring tool is anticipated. The labrum shows pathological changes such as macroscopic hypertrophy and histological degeneration in hip osteoartbritis, but the pathological background is not well understood when evaluated by MRI. Kubo et al. compared radial MRI findings with histological changes of the labrum in ll hips with osteoarthritis using 1.5-T MRJ and found that fibrous separation and mucoid deposition occurred in the labrum with a ''diffuse high signal'' or ''obscure'' pattern. However, to the best of our knowledge, no studies have demonstrated a correlation between MRI fmdings and histological evidence of the severity of degeneration of the labrum. We hypothesized that radially reconstructed images of the acetabular labrum acquired by 3-T MRI can depict degenerative changes of the labrum. In this study, we sought to determine the correlation between MRI and histological findings of the

  17. Evaluation of Constant Thickness Cartilage Models vs. Patient Specific Cartilage Models for an Optimized Computer-Assisted Planning of Periacetabular Osteotomy.

    Directory of Open Access Journals (Sweden)

    Li Liu

    Full Text Available Modern computerized planning tools for periacetabular osteotomy (PAO use either morphology-based or biomechanics-based methods. The latter relies on estimation of peak contact pressures and contact areas using either patient specific or constant thickness cartilage models. We performed a finite element analysis investigating the optimal reorientation of the acetabulum in PAO surgery based on simulated joint contact pressures and contact areas using patient specific cartilage model. Furthermore we investigated the influences of using patient specific cartilage model or constant thickness cartilage model on the biomechanical simulation results. Ten specimens with hip dysplasia were used in this study. Image data were available from CT arthrography studies. Bone models were reconstructed. Mesh models for the patient specific cartilage were defined and subsequently loaded under previously reported boundary and loading conditions. Peak contact pressures and contact areas were estimated in the original position. Afterwards we used a validated preoperative planning software to change the acetabular inclination by an increment of 5° and measured the lateral center edge angle (LCE at each reorientation position. The position with the largest contact area and the lowest peak contact pressure was defined as the optimal position. In order to investigate the influence of using patient specific cartilage model or constant thickness cartilage model on the biomechanical simulation results, the same procedure was repeated with the same bone models but with a cartilage mesh of constant thickness. Comparison of the peak contact pressures and the contact areas between these two different cartilage models showed that good correlation between these two cartilage models for peak contact pressures (r = 0.634 ∈ [0.6, 0.8], p 0.8, p < 0.001. For both cartilage models, the largest contact areas and the lowest peak pressures were found at the same position. Our study is

  18. Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM

    Directory of Open Access Journals (Sweden)

    de Witte Pieter

    2011-12-01

    Full Text Available Abstract Background The Subacromial Impingement Syndrome (SIS is the most common diagnosed disorder of the shoulder in primary health care, but its aetiology is unclear. Conservative treatment regimes focus at reduction of subacromial inflammatory reactions or pathologic scapulohumeral motion patterns (intrinsic aetiology. Long-lasting symptoms are often treated with surgery, which is focused at enlarging the subacromial space by resection of the anterior part of the acromion (based on extrinsic aetiology. Despite that acromionplasty is in the top-10 of orthopaedic surgical procedures, there is no consensus on its indications and reported results are variable (successful in 48-90%. We hypothesize that the aetiology of SIS, i.e. an increase in subacromial pressure or decrease of subacromial space, is multi-factorial. SIS can be the consequence of pathologic scapulohumeral motion patterns leading to humerus cranialisation, anatomical variations of the scapula and the humerus (e.g. hooked acromion, a subacromial inflammatory reaction (e.g. due to overuse or micro-trauma, or adjoining pathology (e.g. osteoarthritis in the acromion-clavicular-joint with subacromial osteophytes. We believe patients should be treated according to their predominant etiological mechanism(s. Therefore, the objective of our study is to identify and discriminate etiological mechanisms occurring in SIS patients, in order to develop tailored diagnostic and therapeutic strategies. Methods In this cross-sectional descriptive study, applied clinical and experimental methods to identify intrinsic and extrinsic etiologic mechanisms comprise: MRI-arthrography (eligibility criteria, cuff status, 3D-segmented bony contours; 3D-motion tracking (scapulohumeral rhythm, arm range of motion, dynamic subacromial volume assessment by combining the 3D bony contours and 3D-kinematics; EMG (adductor co-activation and dynamometry instrumented shoulder radiographs during arm tasks (force and

  19. Interposition Porcine Acellular Dermal Matrix Xenograft Successful Alternative in Treatment for Massive Rotator Cuff

    Science.gov (United States)

    Neumann, Julie; Zgonis, Miltiadis H.; Reay, Kathleen Dolores; Mayer, Stephanie W.; Boggess, Blake; Toth, Alison P.

    2016-01-01

    Objectives: Despite advances in the surgical techniques of rotator cuff repair (RCR), the management of massive rotator cuff tears in shoulders without glenohumeral arthritis poses a difficult problem for surgeons. Failure of massive rotator cuff repairs range from 20-90% at one to two years postoperatively using arthrography, ultrasound, or magnetic resonance imaging. Additionally, there are inconsistent outcomes reported with debridement alone of massive rotator cuff tears as well as limitations seen with other current methods of operative intervention including arthroplasty and tendon transfers. The purpose of this prospective, comparative study was to determine if the repair of massive rotator cuff tears using an interposition porcine acellular dermal matrix xenograft improves subjective function, pain, range of motion, and strength at greater than two years follow-up. To our knowledge, this is the largest prospective series reporting outcomes of using porcine acellular dermal matrix xenograft as an interposition graft. Methods: Thirty-seven patients (37 shoulders) with an average age of 66 years (range 51-80 years) were prospectively followed for 33 months (range 23-48) following massive RCR using porcine acellular dermal matrix interposition xenograft. Subjective outcomes were measured using the Visual Analog Scale (VAS) pain score (0-10, 0 = no pain), Modified American Shoulder and Elbow Score (M-ASES), and Short-Form12 (SF-12) scores. Preoperative and postoperative objective outcome measures included active range of motion and supraspinatus and infraspinatus manual muscle strength. Postoperative outcome measures included quantitative muscle strength using a dynamometer and static and dynamic ultrasonography to assess the integrity of the repair. Results: Average VAS pain score decreased from 4.5 to 1.1 (Pacellular dermal matrix xenografts, patients had significant improvement in pain, range of motion, strength and reported good subjective function based on

  20. Humeral head cysts and rotator cuff tears: an MR arthrographic study

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Martin [Southmead Hospital, Department of Radiology, Westbury-on-Trym, Bristol (United Kingdom); Lambert, Robert G.W.; Jhangri, Gian S.; Grace, Michael; Zelaso, Jay; Wong, Ben; Dhillon, Sukhvinder S. [University of Alberta Hospital, Department of Radiology and Diagnostic Imaging, Edmonton (Canada)

    2006-12-15

    Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age. Shoulder MR arthrograms were reviewed in 120 consecutive patients - 83 males (mean age 38.0, range 19-59 years) and 37 females (mean age 41.2, range 15-59 years). Patients were referred for investigation of a variety of conditions, and instability was suspected in only a minority of cases. MR was performed before and after direct arthrography with 0.01% solution of gadolinium. Cysts were defined as well-demarcated circular/ovoid foci in two planes that demonstrated high signal on pre-arthrographic T2W sequences. Location, size and numbers of cysts and post-arthrographic enhancement were documented, along with the location of rotator cuff tears, if present. Cysts in the tuberosities of the humerus were identified in 84 patients (70%), and were seen seven times more frequently in the posterior aspect of the greater tuberosity than anteriorly. Most cysts (94%) demonstrated communication with the joint post-arthrogram. Rotator cuff tears were present in 36 patients, and 79% of all tears occurred in supraspinatus tendon. There was no significant difference in the occurrence of cysts between patients older or younger than age 40 or between genders, but rotator cuff tears were seen significantly more often in the older age group (p<0.01). Tuberosity cysts and rotator cuff tears did not appear to be related (p=0.55). However, whilst this lack of association was quite obvious posteriorly (p=0.84), the trend in the anterior aspect of the greater tuberosity is not as clear (p=0.14). Humeral cysts are most often located in the posterior aspect of the greater tuberosity, communicate with the joint space and, in this location, are not related to aging or rotator cuff tear. (orig.)

  1. 髋关节撞击综合征影像表现的初步探讨%Preliminary study of image findings of femoroacetabular impingement

    Institute of Scientific and Technical Information of China (English)

    过哲; 张晶; 洪楠; 程晓光

    2010-01-01

    Objective To assess the image findings of femoroacetabular impingement (FAI).Methods Image findings of 9 patients with surgically proved femoroacetabular impingement were retrospectively reviewed for characteristic image findings of FAL All 9 patients underwent X-ray examinations and MRI of affected hip, and 1 patient underwent MR arthrography (MRA) additionally. Results X-ray examinations of all 9 patients showed bump at femoral head-neck junction or overcoverage of the acetabula.MRI showed various degrees of injury of anterosuperior labrum in all 9 patients. The injuries were stage Ⅰ A in2 cases, stage Ⅰ B in3, stage ⅡA in2, and stage ⅡB in 2. MRA of the case showed tears of anterosuperior labrum, with contrast media entering into the teared labrum. There were sclerosis and cystic degeneration of subchondral bone of femoral head in 2 cases, and these findings were confirmed as cartilage delamination by surgery. Conclusions MRI can display the injures of labrum and articular cartilage, which is helpful to the early diagnosis of FAI.%目的 探讨髋关节撞击综合征(FAI)的影像表现.方法 回顾性分析经手术证实的9例FAI患者的影像资料,9例患者均行髋关节正侧位X线检查及患髋MR检查,其中1例还接受了患髋关节MR关节造影检查,探讨其影像特征性改变.结果 9例患者X线表现均出现股骨头颈交界处骨性突起或髋臼过度覆盖.MR检查显示9例患者均出现不同程度的髋臼盂唇损伤,均出现在前上盂唇,ⅠA期损伤2例,ⅠB期损伤3例,ⅡA期损伤2例,ⅡB期损伤2例;1例患髋关节MR造影检查显示髋臼前上盂唇内线样裂隙,可见对比剂进入裂隙.2例的股骨头负重区软骨下骨内出现硬化囊变区,手术证实相应部位出现直径2 cm大小的软骨剥脱.结论 MRI可以显示FAI患者髋臼盂唇及关节软骨损伤,有助于早期诊断FAI.

  2. Treatment of temporomandibular joint disc perforation with injection of hyaluronic acid or disc repair%颞下颌关节盘穿孔两种治疗方法的疗效分析

    Institute of Scientific and Technical Information of China (English)

    陆金标; 龙星; 邓末宏; 程勇; 李波

    2014-01-01

    Objective To assess the efficacy of injection of sodium hyaluronate in the treatment of patients with disc perforation by using cone-beam computed tomography (CBCT) and temporomandibular joint (TMJ) function.Methods Twenty-eight patients (38 joints) with disc perforation observed through arthrography who received injection of sodium hyaluronate and other 20 patients (29 joints) who received disc repair were included in this study.Pain (visual analog scale,scores 0 to 100),maximal mouth opening,modified Helkimo's clinical dysfunction index and TMJ examinations with CBCT were obtained before and 3,9 months after treatment.Results A statistically significant increase (P<0.05) in TMJ clinical outcome was observed at each follow-up.The maximal mouth opening (MMO) increased 5.89 mm and 7.64 mm at 3 and 9 months follow-up in the hyaluronic acid (HA) group,and the MMO increased 2.75 mm and 6.10 mm at 3 and 9 months follow-up in the operation group.Osseous remodeling occurred in 66% (25 of 38 joints) of patients after HA injection and 55%(16 of 29 joints) of patients appeared bone remodeling after disc repair.Conclusions Both injection of hyaluronic acid and disc repair are effective for treatment of temporomandibular joint disc perforation.%目的 分析透明质酸(hyaluronic acid,HA)关节腔注射及关节盘修补术两种方法治疗颞下颌关节盘穿孔的效果.方法 随访分别采用透明质酸注射治疗的28例(38侧,HA组)及关节盘修补术治疗的20例(29侧,手术组)颞下颌关节盘穿孔患者,比较治疗前及治疗后3、9个月时最大开口度、疼痛及髁突骨质变化.结果 两组患者治疗后3及9个月开口度均较治疗前显著增大,HA组开口度增大平均5.89、7.64 mm;手术组增大2.75、6.10 mm,同时疼痛缓解,临床症状减轻,差异均有统计学意义(P<0.05).髁突有骨质修复性改建:HA组66%(25/38),手术组55%(16/29).结论 透明质酸注射及关节盘修补术均能有效缓解关节盘穿孔患者的临床症状.

  3. Does the experience level of the radiologist, assessment in consensus, or the addition of the abduction and external rotation view improve the diagnostic reproducibility and accuracy of MRA of the shoulder?

    International Nuclear Information System (INIS)

    Aim: To prospectively evaluate the influence of observer experience, consensus assessment, and abduction and external rotation (ABER) view on the diagnostic performance of magnetic resonance arthrography (MRA) in patients with traumatic anterior-shoulder instability (TASI). Materials and methods: Fifty-eight MRA examinations (of which 51 had additional ABER views) were assessed by six radiologists (R1–R6) and three teams (T1–T3) with different experience levels, using a seven-lesion standardized scoring form. Forty-five out of 58 MRA examination findings were surgically confirmed. Kappa coefficients, sensitivity, specificity, and differences in percent agreement or correct diagnosis (p-value, McNemar's test) were calculated per lesion and overall per seven lesion types to assess diagnostic reproducibility and accuracy. Results: Overall kappa ranged from poor (k = 0.17) to moderate (k = 0.53), sensitivity from 30.6–63.5%, and specificity from 73.6–89.9%. Overall, the most experienced radiologists (R1–R2) and teams (T2–T3) agreed significantly more than the lesser experienced radiologists (R3–R4: p = 0.014, R5–R6; p = 0.018) and teams (T2–T3: p = 0.007). The most experienced radiologist (R1, R2, R3) and teams (T1, T2) were also consistently more accurate than the lesser experienced radiologists (R4, R5, R6) and team (T3). Significant differences were found between R1–R4 (p = 0.012), R3–R4 (p = 0.03), and T2–T3 (p = 0.014). The overall performance of consensus assessment was systematically higher than individual assessment. Significant differences were established between T1–T2 and radiologists R3–R4 (p<0.001, p = 0.001) and between T2 and R3 (p<0.001/p = 0.001) or R4 (p = 0.050). No overall significant differences were found between the radiologists' assessments with and without ABER. Conclusion: The addition of ABER does not significantly improve overall diagnostic performance. The radiologist

  4. Cross-Sectional Area of the Rotator Cuff Muscles in MRI - Is there Evidence for a Biomechanical Balanced Shoulder?

    Directory of Open Access Journals (Sweden)

    Samy Bouaicha

    correlation of the craniocaudal force couple (supraspinatus/deltoid that ranged from r = 0.565-0.698 (p<0.0001. Inter-reader agreement (ranged from 0.841 to 0.997, p = 0.0007 and intra-reader agreement were excellent (ranged from 0.863 to 0.999, p = 0.0006.The significant correlation of the CSA of the RCM that form the transverse (subscapularis/infraspinatus-teres minor and craniocaudal (supraspinatus/deltoid force couple measured by MR-arthrography supports the biomechanical concept of a dynamically balanced shoulder in patients with an intact rotator cuff.

  5. Early outcome of hip arthroscopy for acetabular labrale tears%髋臼盂唇损伤的关节镜手术

    Institute of Scientific and Technical Information of China (English)

    王卫国; 李子荣; 岳德波; 张念非; 洪闻

    2010-01-01

    Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and

  6. MRI与MR关节造影诊断腕三角纤维软骨撕裂准确性的Meta分析%MRI and MRA in Detecting Wrist Triangular Fibrocartilage Tear:A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    孟祥虹; 王植; 万业达

    2015-01-01

    目的:正确诊断腕三角纤维软骨(TFC)有无撕裂及评价撕裂程度对合理治疗至关重要,目前多采用 MRI 进行诊断。本文采用 Meta 分析评价 MRI 和 MR 关节造影(MRA)对 TFC 撕裂的诊断价值。资料与方法检索万方、维普数据库及CNKI 等中文数据库,Cochrane 图书馆、Medline、Embase 及 PubMed 等英文数据库,搜集符合纳入标准的文献,提取文献的一般信息,使用诊断试验准确性研究质量工具进行文献质量评价。检验文献的异质性,计算 MRI 及 MRA 诊断 TFC 撕裂的汇总敏感度、特异度,并绘制汇总受试者工作特征曲线。结果共获取符合纳入标准的文献15篇,其中中文2篇,英文13篇,各研究间存在异质性。MRI 诊断 TFC 撕裂的汇总加权敏感度、特异度分别为0.66(95% CI 0.61~0.71)、0.75(95% CI 0.69~0.81),而 MRA 诊断 TFC 撕裂的汇总加权敏感度、特异度分别为0.80(95% CI 0.73~0.87)、0.86(95% CI 0.74~0.93)。MRI 诊断 TFC 撕裂的汇总受试者工作特征曲线下面积、Q*指数分别为0.8566、0.7875,而 MRA 诊断 TFC 撕裂的汇总受试者工作特征曲线下面积、Q*指数分别为0.9123、0.8446。结论 MRA 诊断 TFC 撕裂的准确性高于MRI,常规 MRI 诊断 TFC 撕裂不明确时,可考虑采用 MRA 进一步检查。%Purpose Accurate diagnosis of triangular fibrocartilage (TFC) tear is very important for treatment. MRI is most used for diagnosing TFC tear. This paper aims to evaluate MRI and MR arthrography (MRA) for diagnosing TFC tear by meta-analysis. Materials and Methods The articles were searched in the databases such as Wanfang, VIP, CNKI, Cochrane Library, Medline, Embase and PubMed. The QUADAS items were used to evaluate the quality of the included studies. Heterogeneity of the included articles was tested. The pooled weighted sensitivity and specificity of MRI and MRA in diagnosing TFC tear were calculated, and the

  7. The preliminary comparative study between MRI and arthroscopy manifestation for rotator cuff injury%肩袖损伤MR I与关节镜下表现对比的初步研究

    Institute of Scientific and Technical Information of China (English)

    刘佳超; 陈建海; 黄伟; 王天兵; 姜保国

    2013-01-01

    目的:通过比较肩关节术前 MRI检查与关节镜下肩袖所见的异同,了解 MRI 对肩袖损伤诊断的准确性,并进一步明确肩袖损伤关节镜治疗的适应证。方法回顾性分析2007年7月至2010年12月北京大学人民医院创伤骨科行关节镜检查或治疗患者的59例肩部疾病患者,将MRI表现与关节镜所见进行对照分析。结果59例患者中,术前 MRI 检查明确诊断肩袖损伤36例,经关节镜证实肩袖撕裂35例,肩袖组织关节镜下结果完整,未见明显撕裂者1例;术前 MRI 检查未发现肩袖撕裂而关节镜下见撕裂7例,MRI检查与关节镜均未见肩袖撕裂者16例。MRI 对肩袖损伤诊断的敏感度为88.3%,特异度为94.1%,阳性预测值97.2%,阴性预测值69.6%。结论 MRI 是诊断肩袖损伤的有效辅助检查,但仍存在一定程度的漏诊,关节镜检查是诊断肩袖损伤最为可靠的辅助检查手段。%Objective Rotator cuff, a sleeve-like structure composed of supraspinatus, infraspinatus muscle,teres minor and subscapularis,is the major anatomical structure to maintain shoulder stability.Rotator cuff pathologies are frequently encountered in patients with pain at the shoulder.The rotator cuff can be visualized with different imaging techniques such as ultrasonography (US),arthrography,arthroscopy,computed tomography (CT)and magnetic resonance imaging (MRI).MRI had quickly become the favored method for preoperative diagnosis of the rotator cuff inj ury,with high soft tissue resolution ratio,sensitivity and accuracy.It is clinically significant to correctly understand the MRI manifestation of patients with the painful shoulder.We retrospectively analyzed the MRI examination and arthroscopy findings of 5 9 rotator cuff inj uries treated in one hospital.Methods (1)Subjects:From July 2007 to December 2010,a total of 59 patients (25 males and 34 females,aged from 24 to 83 years old,mean age 54.33 years),who underwent arthroscopic surgery for

  8. 关节镜下经肌腱修补治疗关节侧肩袖部分损伤%Arthroscopic treatment of articular side partial tear of supraspinatus tendon by the trans-tendon approach

    Institute of Scientific and Technical Information of China (English)

    汪滋民; 李全; 王一; 沈锋; 许国星; 宋爽

    2014-01-01

    Background Partial rotator cuff tears result in pain and disfunction in patients.An previous study,the researchers measured the supraspinatus tendon of 1 7 corpses and came to a conclusion that the average thickness of the supraspinatus tendon was 1 2 mm.Divides the rotator cuff tears into partial articular tears,partial bursa tears and intra-tendon tears according to the inj ury sites. Based on the thickness of inj ured rotator cuff measured during the operation,the tears are divided into 3 degrees:Degree I (≤3 mm),Degree Ⅱ (3-6 mm)and Degree Ⅲ (≥ 6 mm),and the injured thickness of the Degree Ⅲ is more than 50%.Waibl et al put forward the concept of partial articular surface tendon avulsions(PASTA)and the trans-tendon approach to repair the inj ury.The PASTA has a high morbidity.Modi et al reviewed 100 cases who were all over 35 years old.They recieved an arthroscopic surgery for rotator cuff lesions.Waibl then found 62 cases had PASTA.Yamanaka et al followed 40 PASTA patients using arthrography,the average follow-up was 412 days.They found that the PASTA had a tendency to expand (53%)and to progress to full-thickness tears (28%).Take this into account,most scholars tend to endorse the decision that tears over degree Ⅲ must be repaired.The methods include the conventional repair after the conversion of the full-thickness tear and the direct repair of the tears using the tendon approach.Compared with the former,the tendon repair can save the residual normal rotator cuff tissue,and the length-tension balance after rotator cuff repair is simmilar to normal anatomy.Up to now,China is still lack of treatment reports for such reported inj uries.From March 2008 to July 2010,we had 12 cases of patients with PASTA who recieved the arthroscopic trans-tendon repair using the method improved by Lo.All patients were followed up for 1 2 months or more,and the results are as follows.Methods I.General Information:There are 1 2 cases in the group, including 5 males,7

  9. 关节镜下经肌腱修补治疗关节侧肩袖部分损伤%Arthroscopic treatment of articular side partial tear of supraspinatus tendon by the trans-tendon approach

    Institute of Scientific and Technical Information of China (English)

    汪滋民; 李全; 王一; 沈锋; 许国星; 宋爽

    2014-01-01

    .The PASTA has a high morbidity.Modi et al reviewed 100 cases who were all over 35 years old.They recieved an arthroscopic surgery for rotator cuff lesions.Waibl then found 62 cases had PASTA.Yamanaka et al followed 40 PASTA patients using arthrography,the average follow-up was 412 days.They found that the PASTA had a tendency to expand (53%)and to progress to full-thickness tears (28%).Take this into account,most scholars tend to endorse the decision that tears over degree Ⅲ must be repaired.The methods include the conventional repair after the conversion of the full-thickness tear and the direct repair of the tears using the tendon approach.Compared with the former,the tendon repair can save the residual normal rotator cuff tissue,and the length-tension balance after rotator cuff repair is simmilar to normal anatomy.Up to now,China is still lack of treatment reports for such reported inj uries.From March 2008 to July 2010,we had 12 cases of patients with PASTA who recieved the arthroscopic trans-tendon repair using the method improved by Lo.All patients were followed up for 1 2 months or more,and the results are as follows.Methods I.General Information:There are 1 2 cases in the group, including 5 males,7 females,whose ages are from 29 to 72 years old with the average age of 52.9± 13.3 years old.9 lesions were on the right shoulder,3 on the left shoulder,and nine on the dominant shoulder.6 patients had a history of trauma on their shoulders,of which 3 patients hit their shoulders on the ground and 3 hit their hands on the ground.All patients have a pain of the inj ured shoulder, night pain and most had a problem of shoulder mobility.The patients received the preoperative functional exercise,physical therapy,non-steroidal anti-inflammatory drug therapy and local steroid injection for 1 to 17 months (average 6 months).Physical examination was as follows:11 cases had front shoulder lateral tenderness,9 cases had positive Neer impingement signs,9 cases had positive Hawkins