MR imaging of the shoulder: Spectrum of abnormalities in 65 patients and correlation with arthrography and surgery

International Nuclear Information System (INIS)

Zlatkin, M.B.; Reicher, M.A.; Kellerhouse, L.E.; Resnick, D.; Sartoris, D.J.

1987-01-01

MR imaging has previously been used to demonstrate the appearance of the normal shoulder. In this investigation the authors employed MR imaging in 65 consecutive patients with shoulder pain. Subsequent arthrography was performed in 31 patients and surgery in 15. Clinical follow-up was obtained in 35 patients treated conservatively. MR imaging was highly accurate in depicting the spectrum of rotator cuff abnormalities associated with mechanical impingment, including both large and small rotator cuff tears as well as tendinitis. Abnormalities of the capsular mechanisms, osseous tumors, ostenonecrosis, and injuries to the supporting musculature were also well depicted. Considerable potential exists for MR imaging in evaluating shoulder joint disease

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

International Nuclear Information System (INIS)

Hu, Jin Guang; Lee, Jong Min; Ryeom, Hun Kyu

2005-01-01

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

Adhesive capsulitis of the shoulder: evaluation with MR arthrography

International Nuclear Information System (INIS)

Jung, Joon-Yong; Jee, Won-Hee; Chun, Ho Jong; Kim, Yang-Soo; Chung, Yang Guk; Kim, Jung-Man

2006-01-01

The purpose of this study was to determine the usefulness of magnetic resonance (MR) arthrography for diagnosing adhesive capsulitis. Shoulder MR images of 28 patients with (n=14) and without (n=14) adhesive capsulitis were retrospectively analyzed. MR images were assessed for capsule and synovium thickness as well as the width of the axillary recess on oblique coronal fat-suppressed T1-weighted images and T2-weighted images, respectively. On oblique sagittal fat-suppressed T1-weighted images, the width of the rotator interval and the presence of abnormal tissue in the interval were evaluated. Significant differences were found between the two groups in capsule and synovium thickness on both sides of the recess on oblique coronal T2-weighted images (P=0.000), whereas thickness on the humeral aspect showed no significant difference on oblique coronal fat-suppressed T1-weighted images (P=0.109). On oblique coronal T2-weighted images, a cut-off value of 3-mm thickness gave the highest diagnostic accuracy for adhesive capsulitis with sensitivity, specificity, and accuracy of 79% (11/14), 100% (14/14), and 89% (25/28) at the humeral side and 93% (13/14), 86% (12/14), and 89% (25/28) at the glenoid side, respectively. There were significant differences in rotator interval width, presence of abnormal tissue in the rotator interval, and axillary recess width between the two groups (P<0.05). Thickness of capsule and synovium of the axillary recess greater than 3 mm is a practical MR criterion for diagnosing adhesive capsulitis when measured on oblique coronal T2-weighted MR arthrography images without fat suppression. The presence of abnormal tissue in the rotator interval showed high sensitivity but rather low specificity. (orig.)

Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum

International Nuclear Information System (INIS)

Lee, Marc J.; Motamedi, Kambiz; Chow, Kira; Seeger, Leanne L.

2008-01-01

The purpose of this study was to determine the utility of fat-suppressed gradient-recalled echo (GRE) compared with conventional spin echo T1-weighted (T1W) sequences in direct shoulder MR arthrography for evaluating labral tears. Three musculoskeletal radiologists retrospectively reviewed MR arthrograms performed over a 12-month period for which surgical correlation was available. Of 180 serial arthrograms, 31 patients had surgery with a mean of 48 days following imaging. Paired coronal oblique and axial T1W or GRE sequences were analyzed by consensus for labral tear (coronal oblique two-dimensional multi-echo data image combination, 2D MEDIC; and axial three-dimensional double-echo steady-state, 3D DESS; Siemens MAGNETOM Sonata 1.5-T MR system). Interpretations were correlated with operative reports. Of 31 shoulders, 25 had labral tears at surgery. The GRE sequences depicted labral tears in 22, while T1W images depicted tears in 16 (sensitivity 88% versus 64%; p 0.7). Specificities were somewhat lower for GRE. Thin section GRE sequences are more sensitive than T1W for the detection of anterior and posterior labral tears. As the specificity of GRE was lower, it should be considered as an adjunctive imaging sequence that may improve depiction of labral tears, particularly smaller tears, in routine MR arthrography protocols. (orig.)

Usefulness of sono-guided needle puncture for MR arthrography of the shoulder

International Nuclear Information System (INIS)

Choi, Jae Woong; Hong, Suk Ju; Suh, San Il; Yong, Hwan Suk; Kim, Jung Hyuk; Park, Cheol Min; Suh, Won Hyuck; Kim, Myung Gyu

2000-01-01

To evaluate the usefulness of sono-guided needle puncture for MR arthrography of the shoulder to locate the path of access and to control the correct placement of the needle into the shoulder. Fifteen patients with suspicion of shoulder pathology were included in this study. Patients were laid in supine positions with the arm extended and slightly abducted, the palm of the hand facing upward. A sonographic unit with a high resolution transducer with 7.5 MHz linear array was used. Axial images in the anterior aspect of the shoulder were obtained to localize the coracoid process and the anteromedical portion of the humerus. Using an aseptic technique, a 21-guage needle was advanced into the shoulder joint under ultrasonographic guidance. When the needle made contract with the articular cartilage of the humeral head, the needle was tiled to position is point in the articular cavity. Solution of 0.1 ml gadopentetate dimeglumine in 25 ml of normal saline was prepared and 12-16 ml was injected into the joint cavity. The intra-articular position of the needle and the compete distension of the shoulder joint were again confirmed by sonography. The needle was accurately placed in 14 out of 15 patients without damage to neighboring structures. It took 10 to 15 minutes to complete the procedure in 14 patients. No side effects attributable to gadopentetate dimeglumine were found. Sono-guided needle puncture for the shoulder MR arthrography can be a substitutable method for fluoroscopic guidance, with easy access, advantages of lacking radiation hazard and eliminating the need for iodized contrast agents.

Ultrasound-guided intraarticular injection for MR arthrography of the shoulder

International Nuclear Information System (INIS)

Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K.

2010-01-01

Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

Postoperative MR arthography of the shoulder joint

International Nuclear Information System (INIS)

Rand, T.; Trattnig, S.; Breitenseher, M.; Freilinger, W.; Cochole, M.; Imhof, H.

1996-01-01

Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff. (orig.) [de

Indirect MR arthrography in the evaluation of tears of the glenoid labrum; Indirekte MR-Arthrographie in der Diagnostik von Laesionen des Labrum glenoidale

Energy Technology Data Exchange (ETDEWEB)

Sommer, T.; Vahlensieck, M.; Lutterbey, G.; Pauleit, D.; Kreft, B.; Keller, E.; Schild, H. [Radiologische Universitaetsklinik Bonn (Germany); Wallny, T. [Orthopaedische Universitaetsklinik Bonn (Germany); Steuer, K.; Golombek, V. [Klinik fuer Unfallchirurgie, Univ. Bonn (Germany)

1997-07-01

Purpose: It has been shown that intravenous administration of contrast media produces an MR arthrographic effect without the need for intraarticular injection. This is the first study evaluating this new technique of indirect MR arthrography in the diagnosis of glenoid labrum tears. Methods: 28 patients with clinically suspected labral injuries were prospectively investigated (1.5 Tesla, flexible surface coil). A plain MR examination of the shoulder (transverse and oblique-coronal orientation, T{sub 1}-weighted spin- [T{sub E}/T{sub R} 15/675], proton density- and T{sub 2}*-weighted gradient echo [T{sub E}/T{sub R}/Flip 14,32/600/30 ] sequences) and indirect MR arthrography (transverse and oblique-coronal orientation, fat-suppressed T{sub 1}-weighted spin-echo sequences [T{sub E}/T{sub R} 15/675], intravenous injection of gadopentetate dimeglumine [0.1 mmol/kg], followed by 10-15 min of joint movement) were performed. Results were confirmed by arthroscopy and/or open surgery. Results: Indirect MR arthrography significantly improved delineation of the glenoid labrum and hyaline cartilage (p<0.05). Sensitivity and specificity of indirect MR arthrography in the diagnosis of labral injuries were 90% and 89%, compared to 79% and 67% of the native MR examination. Conclusion: Indirect MR arthrography is a promising non-invasive technique in the evaluation of the glenoid labrum. (orig.) [Deutsch] Ziel: In frueheren Studien wurde gezeigt, dass die intravenoese Injektion gadoliniumhaltiger Kontrastmittel zur Signalintensitaetssteigerung im Gelenkkavum fuehrt. In dieser Studie wurde erstmals diese Technik der indirekten MR-Arthrographie am Schultergelenk in der Diagnostik von Labrumlaesionen evaluiert. Methode: 28 Patienten mit klinischem Verdacht auf eine Verletzung des Labrum glenoidale und/oder der Rotatorenmanschette wurden prospektiv nach folgendem Protokoll an einem 1,5-Tesla-System mit einer Oberflaechen-Ringspule untersucht: 1. Native MR-Standard-Untersuchung mit

Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum

Energy Technology Data Exchange (ETDEWEB)

Lee, Marc J.; Motamedi, Kambiz; Chow, Kira; Seeger, Leanne L. [David Geffen School of Medicine at UCLA, Department of Radiology, 200 UCLA Medical Plaza, Suite 165-59, Box 956952, Los Angeles, CA (United States)

2008-01-15

The purpose of this study was to determine the utility of fat-suppressed gradient-recalled echo (GRE) compared with conventional spin echo T1-weighted (T1W) sequences in direct shoulder MR arthrography for evaluating labral tears. Three musculoskeletal radiologists retrospectively reviewed MR arthrograms performed over a 12-month period for which surgical correlation was available. Of 180 serial arthrograms, 31 patients had surgery with a mean of 48 days following imaging. Paired coronal oblique and axial T1W or GRE sequences were analyzed by consensus for labral tear (coronal oblique two-dimensional multi-echo data image combination, 2D MEDIC; and axial three-dimensional double-echo steady-state, 3D DESS; Siemens MAGNETOM Sonata 1.5-T MR system). Interpretations were correlated with operative reports. Of 31 shoulders, 25 had labral tears at surgery. The GRE sequences depicted labral tears in 22, while T1W images depicted tears in 16 (sensitivity 88% versus 64%; p < 0.05). Subdividing the labrum, GRE was significantly more sensitive for the posterior labrum (75% versus 25%; p < 0.05) with a trend toward greater sensitivity at the anterior labrum (78% versus 56%; p = 0.157) but not significantly different for the superior labrum (50% versus 57%; p > 0.7). Specificities were somewhat lower for GRE. Thin section GRE sequences are more sensitive than T1W for the detection of anterior and posterior labral tears. As the specificity of GRE was lower, it should be considered as an adjunctive imaging sequence that may improve depiction of labral tears, particularly smaller tears, in routine MR arthrography protocols. (orig.)

Direct MR-arthrography of the shoulder with maximum capsular distension for surgical planning

International Nuclear Information System (INIS)

Drescher, R.; Rothenburg, T. von; Koester, O.; Schmid, G.; Ludwig, J.

2004-01-01

Purpose: To evaluate the effectiveness of direct MR arthrography of the glenohumeral joint with maximum distension of the joint capsule in patients with glenohumeral instability for preoperative diagnosis and for determining the method of surgical intervention. Materials and Methods: MR arthrography of the shoulder joint was performed on a 1.5 T system in 38 patients. All patients suffered from anterior or bidirectional instability. Using a fluoroscopically guided posterior approach, a 1% dilution of dimeglumine gadopentetate (5 mmol Gd-DTPA/l) was injected until full capsular stretching was achieved. MR imaging protocol included fat-saturated transversal, oblique-coronal and oblique-sagittal T1-weighted spin-echo, T1-weighted 3-D and transversal T2-weighted Flash-2D. Results: MR imaging revealed significant capsule distention in 22 patients and ventral capsule defects in 9 patients. Labral lesions were depicted in 25 patients, bicipital tendon lesions in 4 patients and partial ruptures of the rotator cuff in 3 patients. 15 of the 38 patients underwent surgery. Areas of pathologic laxity of the glenohumeral capsule were correctly described in all cases. In 12 of 15 patients, the best method of intervention could be determined prospectively. In 3 of 15 patients, the necessary operation was overestimated. Regarding labral ruptures, MRI had a sensitivity of 88%, a specificity of 86%, and a diagnostic accuracy of 87%. (orig.)

Postoperative MR arthography of the shoulder joint; MR-Arthographie des Schultergelenks im postoperativen Patientenkollektiv

Energy Technology Data Exchange (ETDEWEB)

Rand, T. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Trattnig, S. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Breitenseher, M. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Freilinger, W. [Orthopaedisches Krankenhaus Speising (Austria); Cochole, M. [Orthopaedische Abt., Allgemein Oeffentliches Krankenhaus Amstetten (Austria); Imhof, H. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria)

1996-12-01

Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff. (orig.) [Deutsch] In einer prospektiven Studie sollten die Einsatzmoeglichkeiten der MR-Arthrographie am operierten Schultergelenk erfasst werden. Ziel der Studie war einerseits eine gegenueber der konventionellen MR-Untersuchung verbesserten Diagnosestellung und andererseits die Erstellung von fuer die Rezidivdiagnostik relevanten Diagnosekriterien

MR arthrography of the ankle joint

International Nuclear Information System (INIS)

Trattnig, S.; Rand, T.; Breitenseher, M.; Ba-Ssalamah, A.; Schick, S.; Imhof, H.

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.) [de

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.)

Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography.

Science.gov (United States)

Gagliardi, J A; Chung, E M; Chandnani, V P; Kesling, K L; Christensen, K P; Null, R N; Radvany, M G; Hansen, M F

1994-09-01

Chondromalacia patellae is a condition characterized by softening, fraying, and ulceration of patellar articular cartilage. We compare the sensitivity, specificity, and accuracy of conventional MR imaging, MR arthrography, and CT arthrography in detecting and staging this abnormality. Twenty-seven patients with pain in the anterior part of the knee were prospectively examined with MR imaging, including T1-weighted (650/16), proton density-weighted (2000/20), T2-weighted (2000/80), and spoiled two-dimensional gradient-recalled acquisition in the steady state (SPGR/)/35 degrees (51/10) with fat saturation pulse sequences. All were also examined with T1-weighted MR imaging after intraarticular injection of dilute gadopentetate dimeglumine and with double-contrast CT arthrography. Each imaging technique was evaluated independently by two observers, who reached a consensus interpretation. The signal characteristics of cartilage on MR images and contour abnormalities noted with all imaging techniques were evaluated and graded according to a modification of the classification of Shahriaree. Twenty-six of the 54 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity, and accuracy of each imaging technique in the diagnosis of each stage of chondromalacia patellae were determined and compared by using the McNemar two-tailed analysis. Arthroscopy showed that 28 facets were normal. Grade 1 chondromalacia patellae was diagnosed only with MR and CT arthrography in two (29%) of seven facets. Intermediate (grade 2 or 3) chondromalacia patellae was detected in two (13%) of 15 facets with T1-weighted and SPGR MR imaging, in three (20%) of 15 facets with proton density-weighted MR imaging, in seven (47%) of 15 facets with T2-weighted MR imaging, in 11 (73%) of 15 facets with CT arthrography, and in 12 (80%) of 15 facets with MR arthrography. Grade 4 was detected in three (75%) of four facets with T1-, proton

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.

Multidetector spiral CT arthrography of the shoulder

International Nuclear Information System (INIS)

Lecouvet, Frederic E.; Simoni, Paolo; Koutaissoff, Sophie; Vande Berg, Bruno C.; Malghem, Jacques; Dubuc, Jean-Emile

2008-01-01

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

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

International Nuclear Information System (INIS)

Sahin, Guelden; Demirtas, Mehmet

2006-01-01

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

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.

MR-guided direct arthrography of the glenohumeral joint

International Nuclear Information System (INIS)

Soh, E.; Bearcroft, P.W.P.; Graves, M.J.; Black, R.; Lomas, D.J.

2008-01-01

Aim: To evaluate the feasibility of magnetic resonance (MR)-guided direct arthrography of the glenohumeral joint with a 1.5 T MR system, performing the entire procedure in a single MR examination. Materials and methods: MR-guided direct arthrography was performed on 11 patients. MR imaging guidance and interactive MR fluoroscopy, with in-room control and display system, were used for needle placement and contrast medium injection. The outcome measures were success or failure of joint puncture, the time taken for introduction of contrast medium, and the diagnostic quality of the subsequent MR arthrography images. Results: Contrast medium was successfully instilled into the joint and diagnostic quality MR arthrography images were obtained in all cases. The median time from initial placement of the skin marker to introduction of the contrast medium was 17 min (range 11-29 min). There were no immediate post-procedure complications. Conclusion: Accurate needle placement is feasible in a single MR examination on a commercial 1.5 T closed-bore MR system, using an in-room control and display system together with interactive fluoroscopic imaging, and this was used to provide direct MR arthrography in this study

Comparison between conventional MR arthrograhphy and abduction and external rotation MR arthrography in revealing tears of the antero-inferior glenoid labrum

International Nuclear Information System (INIS)

Choi, Jung Ah; Suh, Sang Il; Kim, Baek Hyun; Cha, Sang Hoon; Kim, Myung Gyu; Lee, Ki Yeol; Lee, Chang Hee

2001-01-01

To compare, in terms of their demonstration of tears of the anterior glenoid labrum, oblique axial MR arthrography obtained with the patient's shoulder in the abduction and external rotation (ABER) position, with conventional axial MR arthrography obtained with the patient's arm in the neutral position. MR arthrography of the shoulder, including additional oblique axial sequences with the patient in the ABER position, was performed in 30 patients with a clinical history of recurrent anterior shoulder dislocation. The degree of anterior glenoid labral tear or defect was evaluated in both the conventional axial and the ABER position by two radiologists. Decisions were reached by consensus, and a three-point scale was used: grade 1=normal; grade 2=probable tear, diagnosed when subtle increased signal intensity in the labrum was apparent; grade 3=definite tear/defect, when a contrast material-filled gap between the labrum and the glenoid rim or deficient labrum was present. The scores for each imaging sequence were averaged and to compare conventional axial and ABER position scans, Student's t test was performed. In 21 (70%) of 30 patients, the same degree of anterior instability was revealed by both imaging sequences. Eight (27%) had a lower grade in the axial position than in the ABER position, while one (3%) had a higher grade in the axial position. Three whose axial scan was grade 1 showed only equivocal evidence of tearing, but their ABER-position scan, in which a contrast material-filled gap between the labrum and the glenoid rim was present, was grade 3. The average grade was 2.5 (SD=0.73) for axial scans and 2.8 (SD=0.46) for the ABER position. The difference between axial and ABER-position scans was statistically significant (p<0.05). MR arthrography with the patient's shoulder in the ABER position is more efficient than conventional axial scanning in revealing the degree of tear or defect of the anterior glenoid labrum. When equivocal features are seen at

Comparison of shoulder positions at MR arthrography: change of labroligamentous complex shape and diagnosis of labral tears

International Nuclear Information System (INIS)

Kwak, Jin Young; Ha, Doo Hoe; Kim, Jeung Sook; Lee, Young Soo

2001-01-01

To compare the neutral, internal, and external rotation positions of the glenohumeral joint during magnetic resonance (MR) arthrography performed to assess changes in the shape of the labroligamentous complex (LLC) and in the labral tear. MR arthrography of the shoulder was retrospectively evaluated in 36 patients aged 14-66 (mean, 40) years. Fourteen cases were confirmed by arthroscopic surgery (7 SLAP lesions, 2 Bankart lesions, 1 both SLAP and Bankart lesions). Axial fat-suppressed T1-weighted spin-echo images were acquired with each shoulder in the neutral position, and with internal and external rotations. In each position, we measured the angle of rotation between the perpendicular line on the glenoid fossa and the long axis of the humeral head, analyzing the relationship between the rotational angle and changes in the shape of the LLC at each internal and external rotation, relative to the neutral position. In addition, labral tears in 14 arthroscopically confirmed joints were evaluated in each position. Mean angles of rotation relative to the neutral position were 44.1 and 45.3 degrees in internal and external rotation, respectively. Changes in the anterior LLC occurred in 25 and 24 cases of internal and external rotation, respectively. There was a significantly meaningful relationship between rotational angle and changes in the shape of the anterior LLC during external rotation, and when this changes was noticed, the rotational angle was wider (p<0.05). The posterior LLC changed in shape in 13 and 16 cases of internal and external rotation, respectively, but changes according to the angle of rotation were not statistically significant. In arthroscopically confirmed joints, diagnosis of the eight SLAP lesions at external rotation tended to become more accurate, but no statistically significant differences were noted (p=0.07). Two Bankart lesions were interpreted as a tear in all three positions, and one other such lesion was interpreted as a tear in the

Ultrasound-guided intraarticular injection for MR arthrography of the shoulder; Ultraschallgesteuerte intraartikulaere Kontrastmittelapplikation fuer die MR-Arthrografie der Schulter

Energy Technology Data Exchange (ETDEWEB)

Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany)

2010-03-15

Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

Ankle ligamints : comparison of MR arthrography with conventional MR imaging in amputated feet

International Nuclear Information System (INIS)

Yoo, Jae Sung; Lee, Sang Yong; Lee, Jeong Min; Han, Young Min; Chung, Kyung Ho; Kim, CHong Soo

2001-01-01

To compare magnetic resonance (MR) arthrography with conventional MR imaging in the evaluation of ankle ligaments. Eight freshly amputated human feet underwent conventional MR imaging and MR arthrography. For the former, 1.5-T magnets in the axial, coronal and sagittal planes were used, and T1-weighted sequences were obtained. Following the injection of 6-10 ml of diluted contrast media (Gd-DTPA 1:250), T1-weighted images were obtained in the same positions as conventional MR images. Paired conventional MR imaging and MR arthrography of each ankle ligament were rated on a five-point scale, and to reflect inter-group differences a Wilcoxon singed-rank test was used to compare the different measurements (p<0.05). In two ankles, MR images of the ligaments were correlated with ankle dissection. Anterior and posterior talofibular ligaments were more clearly revealed by MR arthrography than by conventional MR imaging, while calcaneofibular ligaments showed no difference between these two modalities. With regard to deltoid ligaments, visualization of the anterior and posterior tibiotalar ligament was much improved when contrast material was used to outline the ligament's articular aspect. Visualization of the posterior inferior tibiofibular ligament and inferior transverse ligament were also improved when the use of contrast material provided delineation of the articular side of the ligaments and separated them from adjacent bone. In addition, MR arthography was very useful for indentification of the posterior intermalleolar ligament, though its use did not enhance visualization of the calcaneofibular, tibiocalcaneal, spring or tibiospring ligaments. MR arthrography accurately revealed the anatomic details of ankle ligaments, and may therefore be more useful than conventional Mr imaging for evaluation of these structures

Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation

International Nuclear Information System (INIS)

Ferrari, Francesco S.; Governi, Simone; Burresi, Francesca; Vigni, Francesco; Stefani, Paolo

2002-01-01

The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then examined with MR arthrography. This technique involved free-hand injection of contrast medium into the shoulder joint. At surgery 20 incomplete and 24 complete tears were observed. Ultrasound offered good results for the large tears, but its sensitivity decreased proportionally with the size of the tears. Magnetic resonance arthrography correctly diagnosed 43 tears, whereas only one false-negative diagnosis of tendinosis was made for a partial tear on the bursal side. Since it improves the diagnosis of small tears, MR arthrography must be performed on all patients for whom surgical repair is necessary in order to restore normal functions. (orig.)

Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation

Energy Technology Data Exchange (ETDEWEB)

Ferrari, Francesco S.; Governi, Simone; Burresi, Francesca; Vigni, Francesco; Stefani, Paolo [Department of Radiologic and Orthopaedic-Rehabilitative Sciences, University Hospital Siena (Italy)

2002-05-01

The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then examined with MR arthrography. This technique involved free-hand injection of contrast medium into the shoulder joint. At surgery 20 incomplete and 24 complete tears were observed. Ultrasound offered good results for the large tears, but its sensitivity decreased proportionally with the size of the tears. Magnetic resonance arthrography correctly diagnosed 43 tears, whereas only one false-negative diagnosis of tendinosis was made for a partial tear on the bursal side. Since it improves the diagnosis of small tears, MR arthrography must be performed on all patients for whom surgical repair is necessary in order to restore normal functions. (orig.)

Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography

International Nuclear Information System (INIS)

Schmid, M.R.; Pfirrmann, C.W.A.; Hodler, J.; Zanetti, M.; Vienne, P.

2003-01-01

To compare MR arthrography and CT arthrography for the evaluation of cartilage lesions in the ankle joint.Design and patients Thirty-six consecutive patients with clinically suspected cartilage lesions were prospectively included in the study. A 1:1 mixture of diluted gadoteridol (4 mmol/l) and iopamidol (300 mg iodine/ml) was injected. The articular cartilages of the talus, tibia, and fibula were analyzed separately by two musculoskeletal radiologists. A review panel consisting of two musculoskeletal radiologists and an orthopedic surgeon represented the standard of reference. For reader 1 accuracy of MR arthrography in the talus/tibia/fibula (88%/88%/94%) was slightly inferior to CT arthrography (90%/94%/92%). For reader 2, the accuracy was 76%/78%/83% for MR arthrography, and 92%/93%/92% for CT arthrography, respectively. Interobserver agreement for MR arthrography was 79%/74%/89% (kappa 0.47/0.34/0.27), while interobserver agreement for CT arthrography was 89%/90%/89% (kappa 0.69/0.54/0.54). CT arthrography appears to be more reliable than MR arthrography for the detection of cartilage lesions in the ankle joint. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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.

Technical errors in MR arthrography

International Nuclear Information System (INIS)

Hodler, Juerg

2008-01-01

This article discusses potential technical problems of MR arthrography. It starts with contraindications, followed by problems relating to injection technique, contrast material and MR imaging technique. For some of the aspects discussed, there is only little published evidence. Therefore, the article is based on the personal experience of the author and on local standards of procedures. Such standards, as well as medico-legal considerations, may vary from country to country. Contraindications for MR arthrography include pre-existing infection, reflex sympathetic dystrophy and possibly bleeding disorders, avascular necrosis and known allergy to contrast media. Errors in injection technique may lead to extra-articular collection of contrast agent or to contrast agent leaking from the joint space, which may cause diagnostic difficulties. Incorrect concentrations of contrast material influence image quality and may also lead to non-diagnostic examinations. Errors relating to MR imaging include delays between injection and imaging and inadequate choice of sequences. Potential solutions to the various possible errors are presented. (orig.)

Technical errors in MR arthrography

Energy Technology Data Exchange (ETDEWEB)

Hodler, Juerg [Orthopaedic University Hospital of Balgrist, Radiology, Zurich (Switzerland)

2008-01-15

This article discusses potential technical problems of MR arthrography. It starts with contraindications, followed by problems relating to injection technique, contrast material and MR imaging technique. For some of the aspects discussed, there is only little published evidence. Therefore, the article is based on the personal experience of the author and on local standards of procedures. Such standards, as well as medico-legal considerations, may vary from country to country. Contraindications for MR arthrography include pre-existing infection, reflex sympathetic dystrophy and possibly bleeding disorders, avascular necrosis and known allergy to contrast media. Errors in injection technique may lead to extra-articular collection of contrast agent or to contrast agent leaking from the joint space, which may cause diagnostic difficulties. Incorrect concentrations of contrast material influence image quality and may also lead to non-diagnostic examinations. Errors relating to MR imaging include delays between injection and imaging and inadequate choice of sequences. Potential solutions to the various possible errors are presented. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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.

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

International Nuclear Information System (INIS)

Haller, Joerg; Bernt, Reinhard; Seeger, Thomas; Weissenbaeck, Alexander; Tuechler, Heinrich; Resnick, Donald

2006-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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.)

MR arthrography of the knee

International Nuclear Information System (INIS)

Kramer, J.; Engel, A. Jr.; Stiglbauer, R. Jr.; Prayer, L. Jr.; Hajek, P. Jr.; Imhof, H.

1991-01-01

This paper demonstrates the diagnostic value of MR arthrography in the assessment of cartilaginous lesions, including osteochondritis dissecans. One hundred thirty-two knees of 125 patients were examined with MR arthrography performed on a 1.5-T magnet with a knee resonator. T1-weighted spin-echo and T2*-weighted three-dimensional gradient-echo sequences were obtained after intraarticular administration of 40 mL of 2-mmol GD-DTPA solution. Seventy-five patients were also imaged without contrast agent. The description of the articular surface was classified into four types: I, normal cartilage surface and thickness; II, surface normal or slightly irregular; III, severe surface irregularities and cartilage defects; and IV, extensive cartilage defects, scar formation. MR findings were correlated with those of arthroscopy/arthrotomy (n = 75)

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

Energy Technology Data Exchange (ETDEWEB)

Magee, Thomas [NSI, Merritt Island, FL (United States); University of Central Florida School of Medicine, Orlando, FL (United States)

2014-08-15

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.)

Shoulder imaging with MR, US, arthography, and arthoscopy

International Nuclear Information System (INIS)

Drace, J.; Resendes, M.; Pyka, W.

1989-01-01

To date, the true efficacies of shoulder imaging modalities remain uncertain, as no prospective study controlling for significant selection bias has been reported. A minimum of 25 double-blind examinations now have definitive confirmation, not selected by the imaging modalities. 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 unsealing the envelope. Therefore, negative and positive cases were equivalently tested. To date, MR imaging and US remain equally sensitive (85%) for detection of rotator cuff tears, but the combination is more sensitive (90%), and both are more sensitive than arthrography. Arthrography increased specificity when MR imaging and US in combination appear useful for diagnosis of biceps tendinitis

Diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears at 3.0 T.

Science.gov (United States)

Lee, Ji Hyun; Yoon, Young Cheol; Jee, Sukkyung

2015-06-01

Indirect magnetic resonance (MR) arthrography is a non-invasive method for shoulder imaging. However, there are no studies that have examined the diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears in a large patient population. To assess the diagnostic performance of indirect fast spin-echo (FSE) MR arthrography for the diagnosis of rotator cuff tears at 3.0 T. A total of 149 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery were enrolled in this retrospective study. Two musculoskeletal radiologists evaluated images from each patient for the presence of supraspinatus-infraspinatus (SSP-ISP) or subscapularis (SSC) tendon tears. Using the arthroscopic findings as the reference standard, the overall diagnostic performance and detection rates for SSP-ISP and SSC tendon tears were calculated. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSP-ISP tendon tears were 94% and 95%, 89% and 85%, and 93% and 93%, respectively. The sensitivity of imaging for detection of SSP-ISP tendon tears by readers I and II were 100% and 100% for full-thickness tears and 84% and 86% for partial-thickness tears, respectively. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSC tendon tears were 80% and 76%, 89% and 93%, and 85% and 85%, respectively. Indirect MR arthrography is useful for the detection of SSP-ISP and SSC tendon tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Adhesive capsulitis of the shoulder: MR arthrography

International Nuclear Information System (INIS)

Kim, Hyun Jeong; Han, Tae Il; Lee, Kwang Won; Choi, Youn Seon; Kim, Dae Hong; Han, Hyun Young; Song, Mun Kab; Kwon, Soon Tae

2001-01-01

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

Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders

International Nuclear Information System (INIS)

Dinauer, Philip A.; Flemming, Donald J.; Murphy, Kevin P.; Doukas, William C.

2007-01-01

To prospectively compare the accuracy of noncontrast magnetic resonance imaging (MRI) with indirect MR arthrography (I-MRa) of unexercised shoulders for diagnosis of superior glenoid labral lesions. Institutional Review Board approval and patient informed consent were obtained for this prospective study. Superior labral findings on shoulder MRI and unexercised I-MRa studies of 104 patients were correlated with findings at arthroscopic shoulder surgery. Two musculoskeletal radiologists independently reviewed the two sets of MR images while blinded to arthroscopic results. For each radiologist, the McNemar test was used to detect statistically significant differences between techniques. The superior labrum was intact in 24 and abnormal in 80 subjects. For detection of superior labral lesions by each radiologist, I-MRa was more sensitive (84-91%) than MRI (66-85%), with statistically significant improvement in sensitivity for one reader (p = 0.003). However, I-MRa was less specific (58-71%) than MRI (75-83%). Overall, accuracy was slightly improved on I-MRa (78-86%) compared with MRI (70-83%), but this difference was not statistically significant for either reader. Compared with noncontrast MRI, I-MRa was more sensitive for diagnosis of superior glenoid labral lesions. However, the diagnostic value of I-MRa in shoulders remaining at rest is potentially limited by decreased specificity of the technique. (orig.)

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

International Nuclear Information System (INIS)

Spick, Claudio; Szolar, Dieter H.M.; Reittner, Pia; Preidler, Klaus W.; Tillich, Manfred

2014-01-01

lower a patient's pain intensity when applying intra-articular contrast media for MR arthrography of the shoulder. This could result in reduced costs and a reduced risk of adverse reactions, without an impact on patient comfort

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

lower a patient's pain intensity when applying intra-articular contrast media for MR arthrography of the shoulder. This could result in reduced costs and a reduced risk of adverse reactions, without an impact on patient comfort.

MR arthrography of the knee

International Nuclear Information System (INIS)

Kramer, J. Jr.; Engel, A. Jr.; Stiglbauer, R.; Prayer, L. Jr.; Hajek, P. Jr.; Imhof, H.

1991-01-01

This paper reports on MR imaging which has gained increasing importance as a diagnostic instrument in orthopedics. The key to joint diagnostics - the evaluation of hyaline articular cartilage - however, has not been touched sufficiently by this development. Fundamental studies were done and 140 patients were examined with MR imaging after intraarticular administration of contrast agent. Hyaline cartilage, cruciate ligaments, and menisci were assessed before and after injection of a 2-mmol/L Gd-DTPA solution, and the results were compared with those of arthroscopy/arthrotomy. MR arthrography provided superior image quality compared with plain MR imaging. This resulted in an improved delineation of intraarticular structures, especially of cartilage defects

All-in-One Magnetic Resonance Arthrography of the Shoulder in a Vertically Open Magnetic Resonance Unit

Energy Technology Data Exchange (ETDEWEB)

Vandevenne, J.E.; Vanhoenacker, F.; Beaulieu, C.F.; Bergman, A.; Butts Pauly, K.; Dillingham, M.F.; Lang, P.K. (Dept. of Radiology, Univ. Hospital Antwerp, Edegem-Antwerp (Belgium))

2008-10-15

Background: Magnetic resonance (MR) arthrography frequently involves joint injection under imaging guidance followed by MR imaging in static positions. Purpose: To evaluate if MR arthrography of the shoulder joint can be performed in a comprehensive fashion combining the MR-guided injection procedure, static MR imaging, and dynamic motion MR imaging in a single test. Material and Methods: Twenty-three shoulder joints were injected with Gd-DTPA2- under MR guidance. Static MR imaging was performed and included a three-point Dixon method to achieve water-selective images. Dynamic motion MR imaging with and without applying pressure to the upper arm was used to evaluate glenohumeral joint instability. In 10 cases, surgical correlation was available. Results: The all-in-one MR arthrography technique was successful in all patients, and took an average time of 65 min. All but one glenohumeral injection procedure were performed with a single needle pass, and no complications were observed. Out of eight labrum tears seen with static MR imaging, seven were confirmed at surgery. In 10 cases, dynamic motion MR imaging correlated well with the surgeon's intraoperative evaluation for presence and direction of instability. Conclusion: MR arthrography of the shoulder joint using a vertically open magnet can be performed as a single comprehensive test, including the injection and the static and dynamic motion MR imaging. Good diagnostic accuracy for intraarticular lesions and glenohumeral instability was found in a small sample.

Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder

International Nuclear Information System (INIS)

Jung, Jee Young; Yoon, Young Cheol; Yi, Sang-Kyu; Yoo, Jaechul; Choe, Bong-Keun

2009-01-01

To compare the diagnostic value of indirect magnetic resonance arthrography (I-MRA) with that of direct MR arthrography (D-MRA) for labral tears, rotator cuff tears, and long head of biceps tendon (LHBT) tears using a 3-T MR unit. Institutional review board approval was given; written informed consent was obtained from all patients. From November 2005 to June 2006, 19 patients (eight men and 11 women; mean age, 51 years) who had undergone both I-MRA and D-MRA underwent arthroscopic surgery. Both methods were performed in fat-saturated axial, coronal oblique, and sagittal oblique T1-weighted sequences, as well as axial and coronal oblique T2-weighted sequences. Two radiologists independently and retrospectively evaluated two sets of MRA for the diagnosis of superior and anterior labral tears, subscapularis tendon (SSC), and supraspinatus-infraspinatus tendon (SSP-ISP) tears, and LHBT tears. With the arthroscopic finding as a gold standard, we analyzed statistical differences of sensitivities and specificities between two sets of MRA and inter-observer agreement was evaluated using the kappa value. The sensitivity and specificity of I-MRA and D-MRA for reader 1 were 79/80% and 71/80%, respectively, for superior labral tears; 100/100% and 100/100%, respectively, for anterior labral tears; 64/75% and 64/100%, respectively, for SSC tears; 100/86% and 100/100%, respectively, for SSP-ISP tears; and 67/100% and 78/100%, respectively, for LHBT tears. Those of I-MRA and D-MRA for reader 2 were 86/80% and 71/100%, respectively, for superior labral tears; 100/83% and 100/100%, respectively, for anterior labral tears; 64/88% and 82/100%, respectively, for SSC tears; 92/86% and 100/100%, respectively, for SSP-ISP tears; and 78/90% and 89/100%, respectively, for LHBT tears. No significant differences were found between the methods. Inter-observer agreements were higher than moderate (κ > 0.41) with both methods. Based on a relatively small number of patients, no significant

Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder

Energy Technology Data Exchange (ETDEWEB)

Jung, Jee Young; Yoon, Young Cheol [Sungkyunkwan University, Department of Radiology, Samsung Medical Center, School of Medicine, Seoul (Korea); Yi, Sang-Kyu [Sungkyunkwan University, Department of Radiology, Samsung Medical Center, School of Medicine, Seoul (Korea); Sekye Radiologic Clinic, Daejeon (Korea); Yoo, Jaechul [Sungkyunkwan University, Department of Orthopedic Surgery, School of Medicine, Seoul (Korea); Choe, Bong-Keun [Kyung Hee University, Department of Preventive Medicine, School of Medicine, Seoul (Korea)

2009-07-15

To compare the diagnostic value of indirect magnetic resonance arthrography (I-MRA) with that of direct MR arthrography (D-MRA) for labral tears, rotator cuff tears, and long head of biceps tendon (LHBT) tears using a 3-T MR unit. Institutional review board approval was given; written informed consent was obtained from all patients. From November 2005 to June 2006, 19 patients (eight men and 11 women; mean age, 51 years) who had undergone both I-MRA and D-MRA underwent arthroscopic surgery. Both methods were performed in fat-saturated axial, coronal oblique, and sagittal oblique T1-weighted sequences, as well as axial and coronal oblique T2-weighted sequences. Two radiologists independently and retrospectively evaluated two sets of MRA for the diagnosis of superior and anterior labral tears, subscapularis tendon (SSC), and supraspinatus-infraspinatus tendon (SSP-ISP) tears, and LHBT tears. With the arthroscopic finding as a gold standard, we analyzed statistical differences of sensitivities and specificities between two sets of MRA and inter-observer agreement was evaluated using the kappa value. The sensitivity and specificity of I-MRA and D-MRA for reader 1 were 79/80% and 71/80%, respectively, for superior labral tears; 100/100% and 100/100%, respectively, for anterior labral tears; 64/75% and 64/100%, respectively, for SSC tears; 100/86% and 100/100%, respectively, for SSP-ISP tears; and 67/100% and 78/100%, respectively, for LHBT tears. Those of I-MRA and D-MRA for reader 2 were 86/80% and 71/100%, respectively, for superior labral tears; 100/83% and 100/100%, respectively, for anterior labral tears; 64/88% and 82/100%, respectively, for SSC tears; 92/86% and 100/100%, respectively, for SSP-ISP tears; and 78/90% and 89/100%, respectively, for LHBT tears. No significant differences were found between the methods. Inter-observer agreements were higher than moderate ({kappa} > 0.41) with both methods. Based on a relatively small number of patients, no significant

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?

International Nuclear Information System (INIS)

Schreinemachers, Saskia A.; Hulst, Victor P.M. van der; Woude, Henk-Jan van der; Willems, W.J.; Bipat, Shandra

2009-01-01

The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability. Institutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test. Weighted kappa values of ABER and conventional MR arthrography were 0.48-0.65 and 0.60-0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48-61% and 52-70%, respectively) and specificity (80-94% and 91-95%). Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears. (orig.)

Detection of partial-thickness supraspinatus tendon tears: is a single direct MR arthrography series in ABER position as accurate as conventional MR arthrography?

Energy Technology Data Exchange (ETDEWEB)

Schreinemachers, Saskia A. [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Onze Lieve Vrouwe Gasthuis, Amsterdam (Netherlands); Hulst, Victor P.M. van der; Woude, Henk-Jan van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Willems, W.J. [Onze Lieve Vrouwe Gasthuis, Orthopaedic Surgery, Amsterdam (Netherlands); Bipat, Shandra [University of Amsterdam (NL). Department of Radiology, Academic Medical Center (Netherlands)

2009-10-15

The purpose of this study was to retrospectively evaluate sensitivity and specificity of a single magnetic resonance (MR) arthrography series in abduction external rotation (ABER) position compared with conventional MR arthrography for detection of supraspinatus tendon tears, with arthroscopy as gold standard, and to assess interobserver variability. Institutional review board approval was obtained; informed consent was waived. MR arthrograms of 250 patients (170 men and 80 women; mean age, 36 years) were retrospectively and independently evaluated by three observers. Oblique coronal T1-weighted fat-suppressed images, proton density, and T2-weighted images and axial T1-weighted images and oblique sagittal T1-weighted fat-suppressed images were analyzed to detect supraspinatus tendon tears. Separately, a single T1-weighted fat-suppressed oblique axial series in ABER position was evaluated. Both protocols were scored randomly without knowledge of patients' clinical history and arthroscopy results. Tears were subclassified, based on articular surface integrity and extension (Lee classification). Interobserver agreement was assessed by kappa statistics for all patients. Ninety-two of 250 patients underwent arthroscopy; sensitivity and specificity of ABER and conventional MR arthrography were calculated and compared using paired McNemar test. Weighted kappa values of ABER and conventional MR arthrography were 0.48-0.65 and 0.60-0.67, respectively. According to arthroscopy, 69 of 92 patients had an intact cuff, and 23 patients had a cuff tear (16 partial thickness and seven full thickness). There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (48-61% and 52-70%, respectively) and specificity (80-94% and 91-95%). Sensitivity and specificity of a single T1-weighted series in ABER position and conventional MR arthrography are comparable for assessment of rotator cuff tears. (orig.)

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)

Choi, Dong Sik; Ryu, Kyung Nam; Kim, Ihn Sub; Rhee, Yong Girl

1998-01-01

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

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.

MR arthrography: Basics, technique, and first results

International Nuclear Information System (INIS)

Hajek, P.C.; Engel, A.; Kramer, J.; Imhof, H.

1988-01-01

Following evidence that intraarticular Gd-DTPA does not induce synovitis and is not stored in normal or chondropathic joint cartilage, the authors injected various concentrations of Gd-DTPA into 40 cadaveric and 40 in vivo knees. All in vivo knees underwent total prosthetic knee replacement, followed by a histologic workup. Results showed that MR arthrography greatly enhances the visibility of normal and pathologic structures and is a safe procedure. Moreover, MR arthrography seems to allow correct assessment and staging of various types of chondropathies

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

Energy Technology Data Exchange (ETDEWEB)

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.)

MR arthrographic findings in tenosynovitis of the long bicipital tendon of the shoulder

International Nuclear Information System (INIS)

Gueckel, C.; Nidecker, A.

1998-01-01

Purpose. To assess the MR arthrographic findings of bicipital tenosynovitis in correlation with arthroscopy. Design and patients. The shoulder MR arthrographies of 500 consecutive patients were retrospectively analyzed for signs of bicipital tenosynovitis and associated pathologies. Forty patients (8%) had MR evidence of bicipital tenosynovitis, but only 17 (3%) with arthroscopic confirmation were included in the study. The MR findings in these patients were compared with those of 10 patients with rotator cuff lesions but arthroscopically normal long biceps tendons. MR arthrography was performed with 10-15 ml of a 250 mmol/l gadoterate meglumine (Gd-DOTA) solution injected under fluoroscopic guidance, and transaxial, oblique coronal and sagittal MR sequences were obtained. Results. All 17 patients showed one or more abnormal findings: signal increase in the tendon with or without fusiform distension was seen in 12, surface irregularities in six, adhesions in 11 and noncommunicating effusions of the tendon sheath in six. Associated abnormalities of the rotator cuff were present in 16 while the seventeenth patient had glenohumeral synovitis without rotator cuff pathology. MR arthrograms correlated with arthroscopic findings in the joint but comparison was not possible in the intertubercular groove portion of the biceps tendon. None of the 10 patients with an arthroscopically normal biceps tendon showed any of the MR findings of bicipital tenosynovitis. Conclusion. Bicipital tenosynovitis is detectable by MR arthrography. In most cases it is an associated finding of rotator cuff abnormalities and likely to have a similar etiology. When lesions of the anterior rotator cuff are recognized, the biceps tendon should be scrutinized for inflammatory changes. (orig.)

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

Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta-analysis.

Science.gov (United States)

Lee, Sun Hwa; Yun, Seong Jong; Jin, Wook; Park, So Young; Park, Ji Seon; Ryu, Kyung Nam

2018-03-30

Although 3D-isotropic MR arthrography has been characterized as a substitute imaging tool for rotator cuff tear (RCT) and labral lesions, it has not been commonly used in clinical practice because of controversy related to image blurring and indistinctness of structural edges. To perform a comparison of the diagnostic performance of 3D-isotropic MR arthrography and 2D-conventional MR arthrography for diagnosis of RCT (solely RCT, full/partial-thickness supraspinatus [SST]-infraspinatus [IST] tear, or subscapularis [SSc] tear) and labral lesions. Meta-analysis. Patients with shoulder pain. 3D-isotropic and 2D-conventional MR arthrography at 3.0T or 1.5T. PubMed and EMBASE were searched following the PRISMA guidelines. Bivariate modeling and hierarchical summary receiver operating characteristic modeling were performed to compare the overall diagnostic performance of 3D-isotropic and 2D-conventional MR arthrography. Multiple-subgroup analyses were performed for diagnosing RCT, full/partial-thickness SST-IST tear, SSc tear, and labral lesions. Meta-regression analyses were performed according to subject, study, and MR arthrography characteristics including 3D-isotropic sequences (turbo spine echo [TSE] vs. gradient echo [GRE]). Eleven studies (825 patients) were included. Overall, 3D-isotropic MR arthrography had similar pooled sensitivity (0.90 [95% CI, 0.87-0.93]) (P = 0.95) and specificity (0.92 [95% CI, 0.87-0.95]) (P = 0.99), relative to 2D-conventional MR arthrography (sensitivity, 0.91 [95% CI, 0.86-0.94]); specificity, 0.92 [95% CI, 0.87-0.95]). Multiple-subgroup analyses showed that sensitivities (P = 0.13-0.91) and specificities (P = 0.26-0.99) on 3D-isotropic MR arthrography for diagnosing RCT, full/partial-thickness SST-IST tear, SSC tear, and labral lesions were not significantly different from 2D-conventional MR arthrography. On meta-regression analysis, 3D-TSE sequence demonstrated higher sensitivity (P 3D-GRE for RCT and labral

Diagnostic value of US, CT arthrography, and 0.5-T MR imaging of lesions of the biceps tendon

International Nuclear Information System (INIS)

Saez, F.; Elizagaray, E.; Pena, J.M.; Ferrero, A.; Azkuna, I.; Larrea, L.

1990-01-01

This paper evaluates the role of US, CT-arthrography, and MR imaging in lesions in the tendon of the long head of the biceps brachii and bicipital groove. One hundred fifty-four patients with painful shoulder were prospectively studied by means of US and axial CT-arthrography, and 45 of them were also examined with 0.5-T MR imaging. Fifty-three (34.4%) patients showed biceps tendon or bicipital groove abnormalities; including 34 bicipital groove bone spurs, 31 cases of tendinitis, eight intraarticular ruptures, four subluxations, and eight medial dislocations

Is a single direct MR arthrography series in ABER position as accurate in detecting anteroinferior labroligamentous lesions as conventional MR arthography?

Energy Technology Data Exchange (ETDEWEB)

Schreinemachers, Saskia A.; Hulst, Victor P.M. van der; Woude, Henk-Jan van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Amsterdam (Netherlands); Jaap Willems, W. [Onze Lieve Vrouwe Gasthuis, Orthopaedic Surgery, Amsterdam (Netherlands); Bipat, Shandra [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

2009-07-15

The purpose of this study is to retrospectively compare accuracy of single magnetic resonance (MR) arthrography series in Abduction External Rotation (ABER) with conventional MR arthrography for detection and characterisation of anteroinferior labroligamentous lesions, with arthroscopy as reference standard. Inter-observer variability of both protocols was determined. Institutional review board approval was obtained; informed consent was waived. MR arthrograms, including oblique axial fat suppressed T1-weighted images in ABER position and conventional imaging directions of 250 patients (170 men, 80 women; mean age, 36 years), were retrospectively and independently evaluated by three reviewers. Reviewers were blinded to clinical information and arthroscopic results. Labroligamentous lesions were registered in both ABER and MRa. The lesions were sub-classified (Bankart, Perthes, anterior labrum periosteal sleeve avulsion (ALPSA) or lesions not otherwise specified). Inter-observer agreement was assessed by Kappa statistics for all 250 patients. Ninety-two of 250 patients underwent arthroscopy. Sensitivity, specificity and accuracy of ABER versus conventional MR arthrography were calculated and compared using paired McNemar test. Kappa values of the ABER and conventional MR arthrography ranged from 0.44 to 0.56 and 0.44 to 0.62, respectively. According to arthroscopy, 45 of 92 patients had an intact anteroinferior labrum, and in 44 patients, a labroligamentous lesion (eight Bankart, seven Perthes, 29 ALPSA and three lesions not otherwise specified) was diagnosed. There were no statistically significant differences between ABER and conventional MR arthrography regarding sensitivity (85-89%, 89-96%), specificity (82-91%, 84-89%) and overall accuracy (50-62%, 53-63%). The results of a single MR arthrography series in ABER position are comparable with those of conventional MR arthrography for detecting anteroinferior labroligamentous lesions. (orig.)

Superior labrum anterior to posterior lesion type II with accompanied findings: assessment of shoulder MR arthrographic findings

International Nuclear Information System (INIS)

Choi, Sun Young; Chun, Kyung Ah; Kwon, Oh Soo; Kim, Ki Tae

2006-01-01

To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28%) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities (ρ < 0.001), glenohumeral osteoarthritis (ρ = 0.001), and acromioclavicular osteoarthritis (ρ < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions (ρ < 0.001). Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient influences

Superior labrum anterior to posterior lesion type II with accompanied findings: assessment of shoulder MR arthrographic findings

Energy Technology Data Exchange (ETDEWEB)

Choi, Sun Young; Chun, Kyung Ah; Kwon, Oh Soo; Kim, Ki Tae [The Catholic University of Korea, Uijeongbu St. Mary' s Hospital, Uijeongbu (Korea, Republic of)

2006-12-15

To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28%) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities ({rho} < 0.001), glenohumeral osteoarthritis ({rho} = 0.001), and acromioclavicular osteoarthritis ({rho} < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions ({rho} < 0.001). Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient

MR arthrographic findings in tenosynovitis of the long bicipital tendon of the shoulder

Energy Technology Data Exchange (ETDEWEB)

Gueckel, C. [Department of Radiology, University Hospital of Basel, Petersgraben 4, CH-4031 Basel (Switzerland); Nidecker, A. [MRI Institut Rebgasse, Untere Rebgasse 18, CH-4058 Basel (Switzerland)

1998-01-01

Purpose. To assess the MR arthrographic findings of bicipital tenosynovitis in correlation with arthroscopy. Design and patients. The shoulder MR arthrographies of 500 consecutive patients were retrospectively analyzed for signs of bicipital tenosynovitis and associated pathologies. Forty patients (8%) had MR evidence of bicipital tenosynovitis, but only 17 (3%) with arthroscopic confirmation were included in the study. The MR findings in these patients were compared with those of 10 patients with rotator cuff lesions but arthroscopically normal long biceps tendons. MR arthrography was performed with 10-15 ml of a 250 mmol/l gadoterate meglumine (Gd-DOTA) solution injected under fluoroscopic guidance, and transaxial, oblique coronal and sagittal MR sequences were obtained. Results. All 17 patients showed one or more abnormal findings: signal increase in the tendon with or without fusiform distension was seen in 12, surface irregularities in six, adhesions in 11 and noncommunicating effusions of the tendon sheath in six. Associated abnormalities of the rotator cuff were present in 16 while the seventeenth patient had glenohumeral synovitis without rotator cuff pathology. MR arthrograms correlated with arthroscopic findings in the joint but comparison was not possible in the intertubercular groove portion of the biceps tendon. None of the 10 patients with an arthroscopically normal biceps tendon showed any of the MR findings of bicipital tenosynovitis. Conclusion. Bicipital tenosynovitis is detectable by MR arthrography. In most cases it is an associated finding of rotator cuff abnormalities and likely to have a similar etiology. When lesions of the anterior rotator cuff are recognized, the biceps tendon should be scrutinized for inflammatory changes. (orig.) With 4 figs., 4 tabs., 22 refs.

Feasibility of ultrasound-guided intraarticular contrast injection for MR arthrography

International Nuclear Information System (INIS)

Baek, Soo Jin; Lee, Jong Min; Kang, Duck Sick

2005-01-01

To assess the feasibility of ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography. Between June 2002 and October 2004, 132 patients (29 female, 103 male: mean age, 33.6 years) underwent ultrasound-guided intraarticular contrast media injection (40 ml saline + 10 ml 2% lidocaine + 0.2 ml gadopentetate dimeglumine + 0.4 ml epinephrine) for MR arthrography. The patients were classified into four groups, viz. the no leakage group, the minor leakage with successful intraarticular injection group, the major leakage with unsuccessful intraarticular injection group, and the injection failure group. The 'no leakage' and 'minor leakage' groups were considered to be technical successes, while the 'major leakage' and 'injection failure' groups were regarded as technical failures. The technical success rate of ultrasound-guided intraarticular contrast injection using the posterior approach for MR Arthrography was 99.2% (131/132 patients) and one patients 0.7% (1/132 patients) was included in the 'major leakage' group. Ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography was feasible with a high success rate

[Technique and value of direct MR arthrography applying articular distraction].

Science.gov (United States)

Becce, Fabio; Wettstein, Michael; Guntern, Daniel; Mouhsine, Elyazid; Palhais, Nuno; Theumann, Nicolas

2010-02-24

Direct MR arthrography has a better diagnostic accuracy than MR imaging alone. However, contrast material is not always homogeneously distributed in the articular space. Lesions of cartilage surfaces or intra-articular soft tissues can thus be misdiagnosed. Concomitant application of axial traction during MR arthrography leads to articular distraction. This enables better distribution of contrast material in the joint and better delineation of intra-articular structures. Therefore, this technique improves detection of cartilage lesions. Moreover, the axial stress applied on articular structures may reveal lesions invisible on MR images without traction. Based on our clinical experience, we believe that this relatively unknown technique is promising and should be further developed.

Triple correlation in temporomandibular joint dysfunction: MR imaging with arthrography, arthroscopy, and open surgery

International Nuclear Information System (INIS)

Rao, V.M.; Farole, A.; Karasick, D.

1988-01-01

Triple correlation of MR imaging with arthrography, arthroscopy, and open surgery was performed in 24 patients (34 temporomandibular joints) with ages ranging from 17 to 66 years. MR imaging showed disk position and morphologic features accurately in 30 joints (88%). It was false negative in one joint and false positive in three joints (9%). Degenerative changes were accurately detected with MR imaging, arthrography, and arthroscopy. Adhesions were diagnosed with arthrography in eight joints, arthroscopy in 14, and MR imaging in none. Disk perforations seen at open surgery were not detected with MR imaging. In conclusion, there is an overlap of information presented by various modalities. MR imaging is better than arthrography detecting disk morphologic features and displacement. Arthrography may add information by showing meniscal dynamics. Arthroscopy entails direct observation of superior joint space only and can detect adhesions and perforations better, but it may alter disk position and dynamics. In the more difficult cases, triple correlation may be needed, as modalities can be complementary

Evaluation of the triangular fibrocartilage complex tears by arthrography and MR imaging

Energy Technology Data Exchange (ETDEWEB)

Sakai, Makoto; Shibata, Yasushi [Hokkaido Kin-i-kyou Central Hospital, Sapporo (Japan); Takahata, Naoji

1995-08-01

Arthroscopic or open surgical findings in 21 wrists with chronic ulnar painful lesion were compared both with arthrography and magnetic resonance (MR) imaging results to evaluate the accuracy of the two diagnostic procedures in the detection of triangular fibrocartilage complex (TFCC) lesions. Arthrography investigations were performed for the 20 wrists but one that had allergy for iodine and MR imagings were performed for the recent 12 wrists. Arthrography and magnetic resonance (MR) imaging were almost equally useful for the detection of the TFCC injury and their injury sites. (author).

Virtual MR arthroscopy of the shoulder: image gallery with arthroscopic correlation of major pathologies in shoulder instability.

Science.gov (United States)

Stecco, A; Volpe, D; Volpe, N; Fornara, P; Castagna, A; Carriero, A

2008-12-01

The purpose of this study was to compare virtual MR arthroscopic reconstructions with arthroscopic images in patients affected by shoulder joint instability. MR arthrography (MR-AR) of the shoulder is now a well-assessed technique, based on the injection of a contrast medium solution, which fills the articular space and finds its way between the rotator cuff (RC) and the glenohumeral ligaments. In patients with glenolabral pathology, we used an additional sequence that provided virtual arthroscopy (VA) post-processed views, which completed the MR evaluation of shoulder pathology. We enrolled 36 patients, from whom MR arthrographic sequence data (SE T1w and GRE T1 FAT SAT) were obtained using a GE 0.5 T Signa--before any surgical or arthroscopic planned treatment; the protocol included a supplemental 3D, spoiled GE T1w positioned in the coronal plane. Dedicated software loaded on a work-station was used to elaborate VAs. Two radiologists evaluated, on a semiquantitative scale, the visibility of the principal anatomic structures, and then, in consensus, the pathology emerging from the VA images. These images were reconstructed in all patients, except one. The visualization of all anatomical structures was acceptable. VA and MR arthrographic images were fairly concordant with intraoperative findings. Although in our pilot study the VA findings did not change the surgical planning, the results showed concordance with the surgical or arthroscopic images.

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

International Nuclear Information System (INIS)

Nakanishi, Katsunuki; Masatomi, Takashi; Ochi, Takahiro; Ishida, Takeshi; Hori, Shinichi; Ikezoe, Junpei; Nakamura, Hironobu

1996-01-01

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

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.

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

International Nuclear Information System (INIS)

Lee, Ji Hyun; Yoon, Young Cheol; Kwon, Jong Won; Yoo, Jae Chul; Cha, Jang Kyu; Jee, Suk Kyoung

2014-01-01

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.

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

Energy Technology Data Exchange (ETDEWEB)

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

Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation

International Nuclear Information System (INIS)

Kang, Chang Ho; Kim, Sam Soo; Kim, Jung Hyuk; Chung, Kyoo Byung; Kim, Yun Hwan; Oh, Yu-Whan; Jeong, Woong-Kyo; Kim, Baek Hyun

2009-01-01

The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small ( 3 cm). The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears. (orig.)

Supraspinatus tendon tears: comparison of 3D US and MR arthrography with surgical correlation

Energy Technology Data Exchange (ETDEWEB)

Kang, Chang Ho [Kangwon National University Hospital, Department of Radiology, Kangwon-do (Korea); Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea); Kim, Sam Soo [Kangwon National University Hospital, Department of Radiology, Kangwon-do (Korea); Kim, Jung Hyuk; Chung, Kyoo Byung; Kim, Yun Hwan; Oh, Yu-Whan [Korea University Anam Hospital, Korea University College of Medicine, Department of Radiology, Seoul (Korea); Jeong, Woong-Kyo [Korea University Anam Hospital, Korea University College of Medicine, Orthopaedic Surgery, Seoul (Korea); Kim, Baek Hyun [Korea University Ansan Hospital, Korea University College of Medicine, Department of Radiology, Ansan City (Korea)

2009-11-15

The objective of the study was to compare the diagnostic reliability of 3D US with MR arthrography in diagnosing supraspinatus tendon tears, with arthroscopic findings used as the standard. In a prospective study 50 patients who later underwent arthroscopic surgery of the rotator cuff were examined pre-operatively by 3D US with MR arthrography. The presence or absence of a full- or partial-thickness supraspinatus tendon tear and the tear size as demonstrated by each imaging and arthroscopy was recorded. The tear size was divided into three grades: small (<1 cm), medium (1-3 cm), and large (>3 cm). The arthroscopic diagnosis was a full-thickness tear in 40 patients, partial-thickness tears in 5, and intact supraspinatus tendon in 5. 3D US correctly diagnosed 35 out of 40 full-thickness tears and MR arthrography 39 out of 40 full-thickness tears. Regarding partial-thickness tears, 3D US underestimated 2 cases as no tear and overestimated 1 case as a full-thickness tear. MR arthrography underestimated 1 case as a partial-thickness tear and overestimated 2 cases as full-thickness and partial-thickness tears respectively. 3D US and MR arthrography yield a sensitivity for full-thickness tears of 87.5% and 97.5% with specificity of 90.0% and 90.0%. Based on the grading system, 3D US measurements correctly predicted the tear size of 23 (65.7%) of the 35 full-thickness tears and MR arthrography 30 (75.0%) of the 39 full-thickness tears. Three-dimensional ultrasound seems to be a promising imaging modality comparable to MR arthrography for the assessment of the supraspinatus tendon tears. (orig.)

Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences

Energy Technology Data Exchange (ETDEWEB)

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

2012-11-15

To assess the diagnostic performance of shoulder MR arthrography with 3D isotropic fat-suppressed (FS) turbo spin-echo sequence (TSE-SPACE) for supraspinatus tendon tears in comparison with 2D conventional sequences at 3.0 T. The study was HIPAA-compliant and approved by the institutional review board with a waiver of informed consent. Eighty-seven arthroscopically confirmed patients who underwent 3.0 T shoulder MR arthrography with 2D sequences and 3D TSE-SPACE were included in a consecutive fashion from March 2009 to February 2010. Two reviewers independently analyzed 2D sequences and 3D TSE-SPACE. Sensitivity, specificity, accuracy, and interobserver agreement ({kappa}) were compared between 2D sequences and 3D TSE-SPACE for full-thickness and partial-thickness supraspinatus tendon tears together and for partial-thickness supraspinatus tendon tears alone. There were 33 full-thickness tears and 28 partial-thickness tears of supraspinatus tendons. For full-thickness and partial-thickness supraspinatus tendon tears together, the mean sensitivity, specificity, and accuracy of both readers were 96, 92, and 94% on 2D sequences and 91, 84, and 89% on 3D TSE-SPACE. For partial-thickness supraspinatus tendon tears alone, the mean sensitivity, specificity, and accuracy were 95, 92, and 94% on 2D sequences and 84, 85, and 84% on 3D TSE-SPACE. There was no statistical difference between 2D sequences and 3D TSE-SPACE. Interobserver agreements were almost perfect on 2D conventional sequences and substantial on 3D TSE-SPACE. Compared with 2D conventional sequences, MR arthrography using 3D TSE-SPACE was comparable for diagnosing supraspinatus tendon tears despite limitations in detecting small partial-thickness tears and in discriminating between full-thickness and deep partial-thickness tears. (orig.)

Supraspinatus tendon tears at 3.0 T shoulder MR arthrography: diagnosis with 3D isotropic turbo spin-echo SPACE sequence versus 2D conventional sequences

International Nuclear Information System (INIS)

Jung, Joon-Yong; Jee, Won-Hee; Park, Michael Y.; Lee, So-Yeon; Kim, Yang-Soo

2012-01-01

To assess the diagnostic performance of shoulder MR arthrography with 3D isotropic fat-suppressed (FS) turbo spin-echo sequence (TSE-SPACE) for supraspinatus tendon tears in comparison with 2D conventional sequences at 3.0 T. The study was HIPAA-compliant and approved by the institutional review board with a waiver of informed consent. Eighty-seven arthroscopically confirmed patients who underwent 3.0 T shoulder MR arthrography with 2D sequences and 3D TSE-SPACE were included in a consecutive fashion from March 2009 to February 2010. Two reviewers independently analyzed 2D sequences and 3D TSE-SPACE. Sensitivity, specificity, accuracy, and interobserver agreement (κ) were compared between 2D sequences and 3D TSE-SPACE for full-thickness and partial-thickness supraspinatus tendon tears together and for partial-thickness supraspinatus tendon tears alone. There were 33 full-thickness tears and 28 partial-thickness tears of supraspinatus tendons. For full-thickness and partial-thickness supraspinatus tendon tears together, the mean sensitivity, specificity, and accuracy of both readers were 96, 92, and 94% on 2D sequences and 91, 84, and 89% on 3D TSE-SPACE. For partial-thickness supraspinatus tendon tears alone, the mean sensitivity, specificity, and accuracy were 95, 92, and 94% on 2D sequences and 84, 85, and 84% on 3D TSE-SPACE. There was no statistical difference between 2D sequences and 3D TSE-SPACE. Interobserver agreements were almost perfect on 2D conventional sequences and substantial on 3D TSE-SPACE. Compared with 2D conventional sequences, MR arthrography using 3D TSE-SPACE was comparable for diagnosing supraspinatus tendon tears despite limitations in detecting small partial-thickness tears and in discriminating between full-thickness and deep partial-thickness tears. (orig.)

MR imaging of the shoulder

International Nuclear Information System (INIS)

Heuck, A.; Appel, M.; Kaiser, E.; Luttke, G.; Lukas, P.

1990-01-01

This paper evaluates the occurrence, frequency, and significance of increased signal intensity (SI) in the rotator cuff (RC) of normal volunteers suggestive of pathologic findings such as partial tears and tendinitis. Shoulders of 30 volunteers without evidence of prior shoulder disease or trauma were studied. MR imaging at 1.5 T included T1-weighted, proton-density, and T2-weighted spin-echo (SE) and T2*-weighted gradient-echo sequences in axial, oblique coronal, and sagittal planes. Shoulders of 30 cadavers were dissected and studied for correlation with MR findings, five of them after MR examination

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

Science.gov (United States)

Pahwa, Shivani; Srivastava, Deep N; Sharma, Raju; Gamanagatti, Shivanand; Kotwal, Prakash P; Sharma, Vijay

2014-01-01

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. PMID:25114389

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.

Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach

International Nuclear Information System (INIS)

Yoo, Koun J.; Ha, Doo Hoe; Lee, Sang Min

2011-01-01

To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance(MR) arthrography. Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedure-related pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test. There was no significant difference in VAS scores between the anterior and posterior groups (1.77 ± 1.10 vs. 1.80 ± 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 ± 0.8 cm and 1.8 ± 0.3 cm vs. 6.6 ± 0.9 cm and 2.8 ± 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003). The posterior approach will be useful in shoulder MR arthrography with a suspected anterior pathology, a postoperative follow-up study or obese patient.

Diagnosis of SLAP lesions with Grashey-view arthrography

International Nuclear Information System (INIS)

Lee, J.H. Edmund; Van Raalte, Vanessa; Malian, Vartan

2003-01-01

To examine the accuracy of Grashey views obtained during shoulder arthrography in the diagnosis of clinically relevant superior labrum anterior-posterior (SLAP) lesions. Grashey views obtained during diagnostic arthrography (conventional and MR) were used to examine the superior labrum. Twenty-eight of 118 shoulder arthrograms obtained during a 27-month period fulfilled study criteria and were correlated for accuracy using arthroscopically confirmed grade 2-4 SLAP lesions as the standard of reference. Arthrograms were graded using the consensus method. Prevalence, sensitivity, specificity, and accuracy were 21%, 50%, 86%, and 79%. The appearance of the superior labrum on the Grashey view was compared subjectively with MR arthrography. Sources of errors were analyzed. Grashey views obtained during shoulder arthrography can diagnose clinically relevant SLAP lesions with moderately high specificity, moderate accuracy, and limited sensitivity. Findings on the Grashey view closely resemble those seen on coronal oblique MR arthrography. Grashey views should be considered in patients undergoing shoulder arthrography. (orig.)

Diagnosis of SLAP lesions with Grashey-view arthrography

Energy Technology Data Exchange (ETDEWEB)

Lee, J.H. Edmund [Radiological Associates of Sacramento Medical Group, Inc., 1500 Expo Parkway, Sacramento, CA 95815 (United States); Department of Diagnostic Radiology, UC Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817 (United States); Van Raalte, Vanessa; Malian, Vartan [Department of Diagnostic Radiology, UC Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA 95817 (United States)

2003-07-01

To examine the accuracy of Grashey views obtained during shoulder arthrography in the diagnosis of clinically relevant superior labrum anterior-posterior (SLAP) lesions. Grashey views obtained during diagnostic arthrography (conventional and MR) were used to examine the superior labrum. Twenty-eight of 118 shoulder arthrograms obtained during a 27-month period fulfilled study criteria and were correlated for accuracy using arthroscopically confirmed grade 2-4 SLAP lesions as the standard of reference. Arthrograms were graded using the consensus method. Prevalence, sensitivity, specificity, and accuracy were 21%, 50%, 86%, and 79%. The appearance of the superior labrum on the Grashey view was compared subjectively with MR arthrography. Sources of errors were analyzed. Grashey views obtained during shoulder arthrography can diagnose clinically relevant SLAP lesions with moderately high specificity, moderate accuracy, and limited sensitivity. Findings on the Grashey view closely resemble those seen on coronal oblique MR arthrography. Grashey views should be considered in patients undergoing shoulder arthrography. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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.)

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

International Nuclear Information System (INIS)

Holzapfel, Konstantin; Waldt, Simone; Bruegel, Melanie; Rummeny, Ernst J.; Woertler, Klaus; Paul, Jochen; Imhoff, Andreas B.; Heinrich, Petra

2010-01-01

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 κ 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 (κ = 0.82) for detection and substantial (κ = 0.63) for classification of SLAP lesions. For each reader intraobserver agreement was excellent for detection (κ = 0.93, κ = 0.97, κ = 0.97) and classification (κ = 0.94, κ = 0.84, κ = 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.)

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

Articular cartilage and labral lesions of the glenohumeral joint: diagnostic performance of 3D water-excitation true FISP MR arthrography

Energy Technology Data Exchange (ETDEWEB)

Dietrich, Tobias Johannes [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Kantonsspital Muensterlingen, Department of Radiology, PO Box 8596, Muensterlingen (Switzerland); Zanetti, Marco; Saupe, Nadja; Pfirrmann, Christian W.A.; Hodler, Juerg [Orthopedic University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Fucentese, Sandro F. [Hospital Balgrist, Department of Orthopedic Surgery, Orthopedic University, Zurich (Switzerland)

2010-05-15

To evaluate the diagnostic performance of MR arthrography in the detection of articular cartilage and labral lesions of the glenohumeral joint using a transverse 3D water-excitation true fast imaging with steady-state precession (FISP) sequence. Seventy-five shoulders were included retrospectively. Shoulder arthroscopy was performed within 6 months of MR arthrography. MR images were evaluated separately by two radiologists. They were blinded to clinical and arthroscopic information. Arthroscopy served as the reference standard. For the detection of humeral cartilage lesions, sensitivities and specificities were 86% (12/14)/89% (50/56) for observer 1 and 93%/86% for observer 2) for the transverse true FISP sequence and 64%/86% (50%/82% for observer 2) for the coronal intermediate-weighted spin-echo images. The corresponding values for the glenoidal cartilage were 60% (6/10)/88% (51/58) (80%/76% for observer 2) and 70%/86% (60%/74% for observer 2) respectively. For the detection of abnormalities of the anterior labrum (only assessed on true FISP images) the values were 94% (15/16)/84% (36/43) (88%/79% for observer 2). The corresponding values for the posterior labrum were 67% (8/12)/77% (36/47) (observer 2: 25%/74%). The kappa values for the grading of the humeral and glenoidal cartilage lesions were 0.81 and 0.55 for true FISP images compared with 0.49 and 0.43 for intermediate-weighted fast spin-echo images. Kappa values for true FISP evaluation of the anterior and posterior part of the labrum were 0.81 and 0.70. Transverse 3D true FISP MR arthrography images are useful for the difficult diagnosis of glenohumeral cartilage lesions and suitable for detecting labral abnormalities. (orig.)

Articular cartilage defect detectability in human knees with MR-arthrography

International Nuclear Information System (INIS)

Engel, A.; Kramer, J.; Stiglbauer, R.; Hajek, P.C.; Imhof, H.

1993-01-01

One hundred and thirteen knee joints were examined, of which 48 showed damage of the hyaline cartilage in one or more locations. For the evaluation of the magnetic resonance (MR) arthrographic images we used the macroscopic staging according to Outerbridge, the defect staging according to Bauer, as well as a new MR-arthrographic staging. The results of the evaluation were compared with the surgical findings in 61 knee joints. This revealed a sensitivity of 86 %, a specificity of 100 % and accuracy of 90 %. All lesions that could not be classified on MR-arthrography were of stage-I chondromalacia. (orig.)

Articular cartilage defect detectability in human knees with MR-arthrography

Energy Technology Data Exchange (ETDEWEB)

Engel, A. [Orthopaedic Clinic, Univ. of Vienna (Austria); Kramer, J. [MR-Inst., Univ. of Vienna (Austria); Stiglbauer, R. [MR-Inst., Univ. of Vienna (Austria); Hajek, P.C. [MR-Inst., Univ. of Vienna (Austria); Imhof, H. [MR-Inst., Univ. of Vienna (Austria)

1993-04-01

One hundred and thirteen knee joints were examined, of which 48 showed damage of the hyaline cartilage in one or more locations. For the evaluation of the magnetic resonance (MR) arthrographic images we used the macroscopic staging according to Outerbridge, the defect staging according to Bauer, as well as a new MR-arthrographic staging. The results of the evaluation were compared with the surgical findings in 61 knee joints. This revealed a sensitivity of 86 %, a specificity of 100 % and accuracy of 90 %. All lesions that could not be classified on MR-arthrography were of stage-I chondromalacia. (orig.)

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.)

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

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

International Nuclear Information System (INIS)

Cerezal, Luis; Fernandez-Hernando, Moises; Perez Carro, Luis; Llorca, Javier; Llopis, Eva; Montero, Juan Antonio; Canga, Ana

2015-01-01

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

Optimization of the Contrast Mixture Ratio for Simultaneous Direct MR and CT Arthrography: an in Vitro Study

International Nuclear Information System (INIS)

Choi, Ja Young; Hong, Sung Hwan; Kim, Na Ra; Jun, Woo Sun; Moon, Sung Gyu; Kang, Heung Sik; Lee, Joon Woo; Choi, Jung Ah

2008-01-01

This study was designed to determine the optimal mixture ratio of gadolinium and iodinated contrast agent for simultaneous direct MR arthrography and CT arthrography. An in vitro study was performed utilizing mixtures of gadolinium at six different concentrations (0.625, 1.25, 2.5, 5.0, 10 and 20 mmol/L) and iodinated contrast agent at seven different concentrations (0, 12.5, 25, 37.5, 50, 75 and 92-99.9%). These mixtures were placed in tissue culture plates, and were then imaged with CT and MR (with T1-weighted sequences, proton-density sequences and T2-weighted sequences). CT numbers and signal intensities were measured. Pearson's correlation coefficients were used to assess the correlations between the gadolinium/iodinated contrast agent mixtures and the CT numbers/MR signal intensities. Scatter diagrams were plotted for all gadolinium/iodinated contrast agent combinations and two radiologists in consensus identified the mixtures that yielded the optimal CT numbers and MR signal intensities. The CT numbers showed significant correlation with iodinated contrast concentrations (r = 0.976, p < 0.001), whereas the signal intensities as measured on MR images showed a significant correlation with both gadolinium and iodinated contrast agent concentrations (r = -484 to -0.719, p < 0.001). A review of the CT and MR images, graphs, and scatter diagram of 42 combinations of the contrast agent showed that a concentration of 1.25 mmol/L gadolinium and 25% iodinated contrast agent was the best combination for simultaneous CT and MR imaging. A mixture of 1.25 mmol/L gadolinium and 25% iodinated contrast agent was found to be optimal for simultaneous direct MR arthrography and CT arthrography

MR imaging of rotator cuff tears

International Nuclear Information System (INIS)

Kumagai, Hideo

1992-01-01

A total of 115 patients with clinical symptoms and signs suggesting rotator cuff tears underwent MR imaging with a 1.5-Tesla system. The body coil was used as the receiver coil in 24 patients and a single 10 cm surface coil in 91. Arthrography or MR imaging with intra-articular Gd-DTPA (MR arthrography) was performed in 95 of the 115. T2-weighted images with the body coil showed high signal intensity lesions in rotator cuffs in only seven of the 10 patients who had tears demonstrated by arthrography or MR arthrography. On the other hand, T2-weighted images with the surface coil demonstrated high signal intensity lesions in cuffs in all 27 patients who were diagnosed to have tears by arthrography or MR arthrography. In 12 patietns, T2-wighted images with the surface coil showed high signal intensity lesions in cuffs, while arthrography and MR arthrography did not show tears. Surgery was performed in four of the 12 patients and partial tears were confirmed. A single 10 cm surface coil, 3 mm slice thickness and 2.5 second repetition time seem to account for the fine visualization of cuff tears by the T2-weighted images. These results suggest that T2-weighted images obtained with the surface coil are superior to arthrography and MR arthrography. (author)

Non-contrast MR imaging of the glenohumeral joint. Part I. Normal anatomy

International Nuclear Information System (INIS)

Rafii, Mahvash

2004-01-01

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved. (orig.)

Non-contrast MR imaging of the glenohumeral joint. Part I. Normal anatomy

Energy Technology Data Exchange (ETDEWEB)

Rafii, Mahvash [NYU School of Medicine, NYU Medical Center, Department of Radiology, New York (United States)

2004-10-01

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved. (orig.)

MR imaging in sports-related glenohumeral instability

International Nuclear Information System (INIS)

Woertler, Klaus; Waldt, Simone

2006-01-01

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.)

Direct MR Arthrography of the wrist in comparison with Arthroscopy: A prospective study on 125 patients

International Nuclear Information System (INIS)

Schmitt, R.; Christopoulos, G.; Coblenz, G.; Froehner, S.; Meier, R.; Lanz, U.; Krimmer, H.

2003-01-01

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

Can symptomatic acromioclavicular joints be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging?

Science.gov (United States)

Choo, Hye Jung; Lee, Sun Joo; Kim, Jung Han; Cha, Seong Sook; Park, Young Mi; Park, Ji Sung; Lee, Jun Woo; Oh, Minkyung

2013-04-01

To evaluate retrospectively whether symptomatic acromioclavicular joints can be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging. This study included 146 patients who underwent physical examination of acromioclavicular joints and 3-T MR imaging of the shoulder. Among them, 67 patients showing positive results on physical examination were assigned to the symptomatic group, whereas 79 showing negative results were assigned to the asymptomatic group. The following MR findings were compared between the symptomatic and asymptomatic groups: presence of osteophytes, articular surface irregularity, subchondral cysts, acromioclavicular joint fluid, subacromial fluid, subacromial bony spurs, joint capsular distension, bone edema, intraarticular enhancement, periarticular enhancement, superior and inferior joint capsular distension degree, and joint capsular thickness. The patients were subsequently divided into groups based on age (younger, older) and the method of MR arthrography (direct MR arthrography, indirect MR arthrography), and all the MR findings in each subgroup were reanalyzed. The meaningful cutoff value of each significant continuous variable was calculated using receiver operating characteristic analysis. The degree of superior capsular distension was the only significant MR finding of symptomatic acromioclavicular joints and its meaningful cutoff value was 2.1mm. After subgroup analyses, this variable was significant in the older age group and indirect MR arthrography group. On 3-T MR imaging, the degree of superior joint capsular distension might be a predictable MR finding in the diagnosis of symptomatic acromioclavicular joints. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Open MR imaging of the unstable shoulder in the apprehension test position: description and evaluation of an alternative MR examination position

International Nuclear Information System (INIS)

Wintzell, G.; Larsson, S.; Larsson, H.; Zyto, K.

1999-01-01

The aim of this study was to describe and evaluate an alternative MR assessment procedure for analysis of unstable shoulders. Twelve patients with unilateral recurrent anterior shoulder dislocation had both shoulders examined. Magnetic resonance imaging was performed with an open-MR system in the apprehension position with the shoulder in 90 of abduction and maximum tolerable external rotation. Contrast enhancement was achieved with intravenous gadolinium. Correlations were made to the findings at operation. In 10 of 12 unstable shoulders the inferior glenohumeral ligament labral complex (IGHLLC) was detached from the glenoid as seen on MR and later verified during surgery. In one shoulder MR was unable to show a capsulolabral detachment that was verified at surgery, whereas in one shoulder both MR and surgical assessment revealed no soft tissue detachment (accuracy 92 %). A Hill-Sachs lesion was visualized and verified in all unstable shoulders, whereas the stable controls revealed normal IGHLLC and no Hill-Sachs lesion. Open-MRI evaluation of the shoulder in the apprehension test position may become a useful tool for the evaluation of anterior shoulder instability. (orig.)

Non-contrast MR imaging of the glenohumeral joint. Part II. Glenohumeral instability and labrum tears

International Nuclear Information System (INIS)

Rafii, Mahvash

2004-01-01

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved. (orig.)

Non-contrast MR imaging of the glenohumeral joint. Part II. Glenohumeral instability and labrum tears

Energy Technology Data Exchange (ETDEWEB)

Rafii, Mahvash [NYU School of Medicine, NYU Medical Center, Department of Radiology, New York (United States)

2004-11-01

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved. (orig.)

MR appearance of cartilage defects of the knee: preliminary results of a spiral CT arthrography-guided analysis

International Nuclear Information System (INIS)

Berg, B.C. vande; Lecouvet, F.E.; Maldague, B.; Malghem, J.

2004-01-01

The aim of this study was to determine signal intensity patterns of cartilage defects at MR imaging. The MR imaging (3-mm-thick fat-suppressed intermediate-weighted fast spin-echo images) was obtained in 31 knees (21 male and 10 female patients; mean age 45.5 years) blindly selected from a series of 252 consecutive knees investigated by dual-detector spiral CT arthrography. Two radiologists determined in consensus the MR signal intensity of the cartilage areas where cartilage defects had been demonstrated on the corresponding reformatted CT arthrographic images. There were 83 cartilage defects at spiral CT arthrography. In 52 (63%) lesion areas, the MR signal intensity was higher than that of adjacent normal cartilage with signal intensity equivalent to (n=31) or lower than (n=21) that of articular fluid. The MR signal intensity was equivalent to that of adjacent normal cartilage in 17 (20%) lesion areas and lower than that of adjacent cartilage in 8 (10%) lesion areas. In 6 (7%) lesion areas, mixed low and high signal intensity was observed. The MR signal intensity of cartilage defects demonstrated on spiral CT arthrographic images varies from low to high on fat-suppressed intermediate-weighted fast spin-echo MR images obtained with our equipment and MR parameters. (orig.)

Double oblique MR images of the shoulder. Comparison with conventional images

International Nuclear Information System (INIS)

Sasaki, Taisuke; Saito, Yoko; Yodono, Hiraku; Miura, Hiroyuki; Shinohara, Atsushi; Abe, Shuichiro

1998-01-01

Because the scapula is not only slanted on transverse sections but also inclines on sagittal sections, we now perform shoulder MR imaging using double oblique images (DOI), which are planes perpendicular or parallel to the long axis of the scapula obtained with oblique sagittal scout imaging. The purpose of this study was to evaluate the usefulness of double oblique shoulder MR imaging. MR images of shoulders with operatively or arthroscopically proven lesions (20 cases) that had been examined on both conventional images (CI) and DOI were retrospectively reviewed. DOI were compared with CI not only in terms of diagnostic performance but also in their ability to identify the details of shoulder anatomy. All MR studies were done with a shoulder coil on a high-field (1.5 T) unit. Although the accuracy of DOI in diagnosing shoulder disorders such as rotator cuff tear and labrum injury was not as good as that of CI, DOI were better for identifying or discriminating muscles and tendons of the rotator cuff, labralbicipital junction and anterior band of the inferior gleno-humeral ligament, and for recognizing the correct position of the glenoid labrum. MR double oblique imaging of the shoulder provides more detailed information about shoulder anatomy and disorders than conventional imaging. (author)

Paralabral cysts in the hip joint: findings at MR arthrography

International Nuclear Information System (INIS)

Magerkurth, Olaf; Jacobson, Jon A.; Girish, Gandikota; Kalume Brigido, Monica; Fessell, David; Bedi, Asheesh

2012-01-01

The purpose of this research was to retrospectively characterize paralabral cysts of the hip as seen at MR arthrography. After Institutional Review Board approval, 704 patients who had MR arthrography were identified over a 3-year period and 40 patients were identified as having a cyst or fluid collection at the hip by MR report. MR images from these 40 patients were retrospectively reviewed by three radiologists where 18 were found to have a paralabral cyst, which were characterized as follows: location, configuration, contrast filling, size of the cyst, extent, direction, and whether associated osseous changes were present. In addition, the acetabular labrum was assessed for tears and, if present, the location and pattern were characterized. Paralabral cysts were located anterosuperiorly in 56%, anteriorly in 22%, posterosuperiorly in 17%, and anteroinferiorly in 6% of cases. The vast majority (94%) were multilocular and filled with intra-articular contrast medium. The average dimensions were 8 x 7 x 11 mm. The paralabral cyst demonstrated extracapsular extension in 72% of cases, with 39% located between the ilium and gluteus minimus, and 22% between the ilium and iliopsoas. Remodeling of the ilium adjacent to the cyst was observed in 50% of these cases. A labral tear was at the base of the labrum adjacent to the cyst in 78% of cases, while the tear was isolated to the body of the labrum in 22%. Tears were most commonly anterosuperior (55%) or anterior (28%) in location. Our results show that paralabral cysts of the hip are most commonly located anterosuperiorly, are multilocular, fill with intra-articular contrast medium, have average dimensions up to 11 mm, and often extend extracapsularly between muscle and bone where they may remodel the adjacent ilium. (orig.)

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

International Nuclear Information System (INIS)

Dyck, P. van; Gielen, J.L.; Parizel, P.M.

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 guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (κ) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (κ = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (κ = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the basis of

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

Energy Technology Data Exchange (ETDEWEB)

Dyck, P. van; Gielen, J.L.; Parizel, P.M. (Dept. of Radiology, Univ. Hospital Antwerp and Univ. of Antwerp, Antwerp (Belgium)) (and others)

2009-11-15

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 guidance for joint injection is not required. Purpose: To assess the diagnostic performance of indirect MR arthrography in the diagnosis of full- and partial-thickness supraspinatus tears in a symptomatic population. Material and Methods: Two radiologists with different levels of experience independently and retrospectively interpreted indirect MR (1.5T) arthrograms of the shoulder obtained in 67 symptomatic patients who underwent subsequent arthroscopy. On MR, the supraspinatus tendon was evaluated for full- or partial-thickness tear. With arthroscopy as the standard of reference, sensitivity, specificity, and diagnostic accuracy of indirect MR arthrography in the detection of full- and partial-thickness tears of the supraspinatus tendon was calculated. Kappa (kappa) statistics were used for the assessment of the agreement between arthroscopic and imaging findings and for the assessment of interobserver agreement. Results: For full-thickness tears of the supraspinatus tendon, sensitivities, specificities, and accuracies exceeded 90% for both observers, with excellent interobserver agreement (kappa = 0.910). For partial-thickness tears, sensitivities (38-50%) and accuracies (76-78%) were poor for both reviewers, and interobserver agreement was moderate (kappa = 0.491). Discrepancies between MR diagnosis and arthroscopy were predominantly observed with small partial-thickness tears. Conclusion: Indirect MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears. However, the diagnosis of partial-thickness tears with indirect MR arthrography remains faulty, because exact demarcation of degenerative change and partial rupture is difficult. On the

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

Energy Technology Data Exchange (ETDEWEB)

Chun, Kyung Ah; Kim, Min Sung; Kim, Young Joo [Catholic University of Korea Uijeongbu St.Mary' s Hospital, Uijeongbu (Korea, Republic of)

2010-10-15

To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articularsided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal- sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and

Comparisons of the Various Partial-Thickness Rotator Cuff Tears on MR Arthrography and Arthroscopic Correlation

International Nuclear Information System (INIS)

Chun, Kyung Ah; Kim, Min Sung; Kim, Young Joo

2010-01-01

To assess the diagnostic performance of MR arthrography in the diagnosis of the various types of partial-thickness rotator cuff tears by comparing the MR imaging findings with the arthroscopic findings. The series of MR arthrography studies included 202 patients consisting of 100 patients with partial-thickness rotator cuff tears proved by arthroscopy and a control group of 102 patients with arthroscopically intact rotator cuffs, which were reviewed in random order. At arthroscopy, 54 articularsided, 26 bursal-sided, 20 both articular- and bursal-sided partial-thickness tears were diagnosed. The MR arthrographies were analyzed by two radiologists for articular-sided tears, bursal-sided tears, and both articular- and bursal-sided tears of the rotator cuff. The sensitivity and specificity of each type of partial-thickness tears were determined. Kappa statistics was calculated to determine the interand intra-observer agreement of the diagnosis of partial-thickness rotator cuff tears. The sensitivity and specificity of the various types of rotator cuff tears were 85% and 90%, respectively for articular-sided tears, 62% and 95% for bursal- sided tears, as well as 45% and 99% for both articular- and bursal-sided tears. False-negative assessments were primarily observed in the diagnosis of bursal-sided tears. Conversely, both articular- and bursal-sided tears were overestimated as full-thickness tears. Inter-observer agreement was excellent for the diagnosis of articular-sided tears (k = 0.70), moderate (k = 0.59) for bursal-sided tears, and fair (k = 0.34) for both articular- and bursal-sided tears, respectively. Intra-observer agreement for the interpretation of articular- and bursal-sided tears was excellent and good, respectively, whereas intra-observer agreement for both articular- and bursal-sided tears was moderate. MR arthrography is a useful diagnostic tool for partial-thickness rotator cuff tears, but has limitations in that it has low sensitivity in bursal- and

Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

International Nuclear Information System (INIS)

Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K.; Imhoff, A.B.

2007-01-01

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

Energy Technology Data Exchange (ETDEWEB)

Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K. [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Imhoff, A.B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Munich (Germany)

2007-02-15

We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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

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

International Nuclear Information System (INIS)

Lee, Guen Young; Kim, Baek Hyun; Park, Jong Woong

2011-01-01

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

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

Denervation syndromes of the shoulder girdle: MR imaging with electrophysiologic correlation

International Nuclear Information System (INIS)

Bredella, M.A.; Wischer, T.K.; Stork, A.; Genant, H.K.; Tirman, P.F.J.; Fritz, R.C.

1999-01-01

Objective. To investigate the use of MR imaging in the characterization of denervated muscle of the shoulder correlated with electrophysiologic studies.Design and patients. We studied with MR imaging five patients who presented with shoulder weakness and pain and who underwent electrophysiologic studies. On MR imaging the distribution of muscle edema and fatty infiltration was recorded, as was the presence of masses impinging on a regional nerve.Results. Acute/subacute denervation was best seen on T2-weighted fast spin-echo images with fat saturation, showing increased SI related to neurogenic edema. Chronic denervation was best seen on T1-weighted spin-echo images, demonstrating loss of muscle bulk and diffuse areas of increased signal intensity within the muscle. Three patients showed MR imaging and electrophysiologic findings of Parsonage Turner syndrome. One patient demonstrated an arteriovenous malformation within the spinoglenoid notch, impinging on the suprascapular nerve with associated atrophy of the infraspinatus muscle. The fifth patient demonstrated fatty atrophy of the teres minor muscle caused by compression by a cyst of the axillary nerve and electrophysiologic findings of an incomplete axillary nerve block.Conclusion. MR imaging is useful in detecting and characterizing denervation atrophy and neurogenic edema in shoulder muscles. MR imaging can provide additional information to electrophysiologic studies by estimating the age (acute/chronic) and identifying morphologic causes for shoulder pain and atrophy. (orig.)

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.)

Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging

International Nuclear Information System (INIS)

Daenen, B.R.; Ferrara, M.A.; Marcelis, S.; Dondelinger, R.F.

1998-01-01

The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions. (orig.)

Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging

Energy Technology Data Exchange (ETDEWEB)

Daenen, B.R.; Ferrara, M.A.; Marcelis, S.; Dondelinger, R.F. [Department of Medical Imaging, University Hospital Sart-Tilman, Liege (Belgium)

1998-07-01

The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions. (orig.) With 4 figs., 3 tabs., 21 refs.

Wrist Traction During MR Arthrography Improves Detection of Triangular Fibrocartilage Complex and Intrinsic Ligament Tears and Visibility of Articular Cartilage.

Science.gov (United States)

Lee, Ryan K L; Griffith, James F; Ng, Alex W H; Nung, Ryan C H; Yeung, David K W

2016-01-01

The purpose of this study was to assess the effects of traction during MR arthrography of the wrist on joint space widening, cartilage visibility, and detection of tears of the triangular fibrocartilage complex (TFCC) and intrinsic ligaments. A prospective study included 40 wrists in 39 patients (25 men, 14 women; mean age, 35 years). MR arthrography was performed with a 3-T MRI system with and without axial traction. Two radiologists independently measured wrist and carpal joint space widths and semiquantitatively graded articular cartilage visibility. Using conventional arthrography as the reference standard and working in consensus, they assessed for the presence of tears of the TFCC, lunotriquetral ligament (LTL), and scapholunate ligament (SLL). Visibility of a tear before traction was compared with visibility after traction. With traction, all joint spaces in the wrist and carpus were significantly widened (change, 0.15-1.01 mm; all p < 0.006). Subjective cartilage visibility of all joint spaces improved after traction (all p ≤ 0.048) except for that of the radioscaphoid space, which was well visualized even before traction. Conventional arthrography depicted 24 TFCC tears, seven LTL tears, and three SLL tears. The accuracy of tear detection improved after traction for the TFCC (98% after traction vs 83% before traction), the LTL (100% vs 88%), and the SLL (100% vs 95%). Tear visibility improved after traction for 54% of TFCC tears, 71% of LTL tears, and 66% of SLL tears. Wrist MR arthrography with axial traction significantly improved the visibility of articular cartilage and the detection and visibility of tears of the TFCC and intrinsic ligaments. The results favor more widespread use of traction during MR arthrography of the wrist.

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.

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

International Nuclear Information System (INIS)

Guermazi, Ali; Jomaah, Nabil; Hayashi, Daichi; Jarraya, Mohamed; Silva, Jose Roberto; Niu, Jingbo; Almusa, Emad; Landreau, Philippe

2014-01-01

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

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

International Nuclear Information System (INIS)

Schaeffeler, Christoph; Mueller, Dirk; Rummeny, Ernst J.; Woertler, Klaus; Kirchhoff, Chlodwig; Wolf, Petra

2011-01-01

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.)

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.)

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

International Nuclear Information System (INIS)

Amin, Mohammed Farghally; Youssef, Ahmed Omar

2012-01-01

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

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.

Indirect MR-arthrography in osteochondral autograft and crushed bone graft with a collagen membrane-Correlation with histology

Energy Technology Data Exchange (ETDEWEB)

Streitparth, F. [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany)], E-mail: florian.streitparth@charite.de; Schoettle, P.; Schell, H. [Center for Musculoskeletal Surgery, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany); Lehmkuhl, L.; Madej, T.; Wieners, G. [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany); Duda, G.N. [Center for Musculoskeletal Surgery, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany); Schroeder, R.J. [Klinik fuer Strahlenheilkunde, Charite, Campus Virchow-Klinikum, Humboldt-University, Berlin (Germany)

2009-04-15

Objective: To analyze the spectrum of findings in indirect MR-arthrography following osteochondral autograft transfer system (OATS) and crushed bone graft using a magnetic resonance imaging (MRI) scoring and grading system in relation to histology as the standard of reference. Materials and methods: Iatrogenic lesions were set at ovine condylar facets (n = 6/group), treated with OATS or crushed bone graft. 1.5 T MRI was performed 6 months after surgery using PD-weighted (w fat saturated (fs) fast spin echo (FSE), T1-w 2D, and 3D fs gradient echo (GE) sequences 30 min. after i.v. Gd-DTPA administration and passive joint exercise. The repair tissue was evaluated by two independent radiologists. The MR findings were compared to histology. Results: In all cases, MRI and histologic grading correlated well and showed significant superior repair in OATS at 6 months (p < 0.05), reproducing the original articular contour and a good subchondral restoration. FsT1-w3DGE proved most appropriate identifying characteristic post-operative findings: the OATS group demonstrated bone marrow edema at the donor site and the graft/host interface showed significant enhancement in indirect MR-arthrography, indicating fibrocartilage. After crushed bone graft, we found an irregular structure and significant contrast uptake, consistent with remnants of bone grafts surrounded by inflammatory tissue. Conclusion: Indirect MR-arthrography is an accurate, non-invasive monitoring tool following OATS and crushed bone graft as the MRI scoring and grading system allows a reliable evaluation of normal and pathological osteochondral repair with a high histologic correlation.

Frequency of glenoid chondral lesions on MR arthrography in patients with anterior shoulder instability

International Nuclear Information System (INIS)

O’Brien, J.; Grebenyuk, J.; Leith, J.; Forster, B.B.

2012-01-01

Purpose: To describe the frequency of glenoid chondral abnormalities in relation to Hill Sachs (HS) lesions in MR arthrograms of patients with anterior shoulder instability versus controls. Such glenoid lesions can directly impact surgical decision-making and approach, and potentially negatively impact outcome if missed. Materials and methods: Retrospective analysis of direct MR shoulder arthrograms in 165 subjects, (101 with anterior instability/64 controls) was performed independently by 2 blinded musculoskeletal radiologists. Outcome measures were the presence of a HS, anterior labral pathology and glenoid chondral injury. Kappa statistic, Pearson Chi-square and Mann–Whitney analysis were employed for analysis. Results: Inter-observer variability for the presence of HS, labral and chondral lesions was 0.964, 0.965 and 0.858 respectively, with intra-observer variability of 1.0, 0.985 and 0.861 for the principle reader. 58% of patients and 8% of controls had HS (p < 0.001). 72% of patients and 25% of controls had anterior labral injury (p < 0.001). 36% of instability patients and 10% controls had glenoid chondral lesions (p < 0.001). 46% of anterior instability patients with HS defects had chondral injury as opposed to 21% of patients without HS defects (p = 0.009). Depth of the HS lesion did not increase the likelihood of a glenoid chondral lesion (p = 0.7335). Conclusion: In the clinical anterior instability cohort, we demonstrated a statistically significant higher number of HS and glenoid chondral lesions than in controls. In anterior instability patients, the presence of a HS lesion confers a statistically significant greater likelihood of having a glenoid chondral lesion when compared to patients with instability and no HS.

Frequency of glenoid chondral lesions on MR arthrography in patients with anterior shoulder instability

Energy Technology Data Exchange (ETDEWEB)

O' Brien, J., E-mail: juliemobrien@gmail.com [Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5 (Canada); Grebenyuk, J., E-mail: julia.grebenyuk@utoronto.ca [Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5 (Canada); Leith, J., E-mail: jleith@shaw.ca [Department of Orthopaedic Surgery, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5 (Canada); Forster, B.B., E-mail: Bruce.Forster@vch.ca [Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5 (Canada)

2012-11-15

Purpose: To describe the frequency of glenoid chondral abnormalities in relation to Hill Sachs (HS) lesions in MR arthrograms of patients with anterior shoulder instability versus controls. Such glenoid lesions can directly impact surgical decision-making and approach, and potentially negatively impact outcome if missed. Materials and methods: Retrospective analysis of direct MR shoulder arthrograms in 165 subjects, (101 with anterior instability/64 controls) was performed independently by 2 blinded musculoskeletal radiologists. Outcome measures were the presence of a HS, anterior labral pathology and glenoid chondral injury. Kappa statistic, Pearson Chi-square and Mann-Whitney analysis were employed for analysis. Results: Inter-observer variability for the presence of HS, labral and chondral lesions was 0.964, 0.965 and 0.858 respectively, with intra-observer variability of 1.0, 0.985 and 0.861 for the principle reader. 58% of patients and 8% of controls had HS (p < 0.001). 72% of patients and 25% of controls had anterior labral injury (p < 0.001). 36% of instability patients and 10% controls had glenoid chondral lesions (p < 0.001). 46% of anterior instability patients with HS defects had chondral injury as opposed to 21% of patients without HS defects (p = 0.009). Depth of the HS lesion did not increase the likelihood of a glenoid chondral lesion (p = 0.7335). Conclusion: In the clinical anterior instability cohort, we demonstrated a statistically significant higher number of HS and glenoid chondral lesions than in controls. In anterior instability patients, the presence of a HS lesion confers a statistically significant greater likelihood of having a glenoid chondral lesion when compared to patients with instability and no HS.

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.

Intrinsic carpal ligaments on MR and multidetector CT arthrography: comparison of axial and axial oblique planes

Energy Technology Data Exchange (ETDEWEB)

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

2017-03-15

To compare axial and oblique axial planes on MR arthrography (MRA) and multidetector CT arthrography (CTA) to evaluate dorsal and volar parts of scapholunate (SLIL) and lunotriquetral interosseous (LTIL) ligaments. Nine cadaveric wrists of five male subjects were studied. The visibility of dorsal and volar parts of the SLIL and LTIL was graded semi-quantitatively (good, intermediate, poor) on MRA and CTA. The presence of a ligament tear was determined on arthrosocopy and sensitivity, specificity and accuracy of tear detection were calculated. Oblique axial imaging was particularly useful for delineating dorsal and volar parts of the LTIL on MRA with overall 'good' visibility increased from 11 % to 78 %. The accuracy of MRA and CTA in revealing SLIL and LTIL tear was higher using the oblique axial plane. The overall accuracy for detecting SLIL tear on CTA improved from 94 % to 100 % and from 89 % to 94 % on MRA; the overall accuracy of detecting LTIL tear on CTA improved from 89 % to 100 % and from 72 % to 89 % on MRA Oblique axial imaging during CT and MR arthrography improves detection of tears in the dorsal and volar parts of both SLIL and LTIL. (orig.)

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

Multimodality imaging of the postoperative shoulder

Energy Technology Data Exchange (ETDEWEB)

Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany)

2007-12-15

Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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.)

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

International Nuclear Information System (INIS)

Tadros, Anthony S.; Huang, Brady K.; Wymore, Lucas; Hoenecke, Heinz; Fronek, Jan; Chang, Eric Y.

2015-01-01

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.)

Indirect MR arthrography of the wrist in the diagnosis of TFCC-lesions

International Nuclear Information System (INIS)

Herold, T.; Lenhart, M.; Held, P.; Feuerbach, S.; Link, J.; Babel, M.; Ruf, S.

2001-01-01

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.) [de

The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

Energy Technology Data Exchange (ETDEWEB)

Ogul, Hayri, E-mail: drhogul@gmail.com [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Guzel, Yunus [Department of Orthopaedics and Traumatology, Medical Faculty, Ordu University, Ordu (Turkey); Pirimoglu, Berhan [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Tuncer, Kutsi [Department of Orthopedic, Medical Faculty, Ataturk University, Erzurum (Turkey); Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey)

2016-10-15

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

International Nuclear Information System (INIS)

Ogul, Hayri; Guzel, Yunus; Pirimoglu, Berhan; Tuncer, Kutsi; Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit

2016-01-01

Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

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

International Nuclear Information System (INIS)

Carroll, K.W.; Helms, C.A.

2002-01-01

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.)

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

International Nuclear Information System (INIS)

Bencardino, Jenny T.; La Rocca Vieira, Renata; Kassarjian, Ara; Schwartz, Richard; Mellado, Jose M.; Kocher, Mininder

2011-01-01

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.)

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

International Nuclear Information System (INIS)

Tuite, Michael J.; Petersen, Brian D.; Wise, Steven M.; Fine, Jason P.; Kaplan, Lee D.; Orwin, John F.

2007-01-01

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.)

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

Energy Technology Data Exchange (ETDEWEB)

Tuite, Michael J; Petersen, Brian D; Wise, Steven M [University of Wisconsin Hospital and Clinics, Department of Radiology, Madison, WI (United States); Fine, Jason P [University of Wisconsin Hospital and Clinics, Department of Biostatistics, Madison, WI (United States); Kaplan, Lee D; Orwin, John F [University of Wisconsin Hospital and Clinics, Department of Orthopedic Surgery, Madison, WI (United States)

2007-06-15

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.)

MR arthrography: pharmacology, efficacy and safety in clinical trials

International Nuclear Information System (INIS)

Schulte-Altedorneburg, G.; Gebhard, M.; Wohlgemuth, W.A.; Fischer, W.; Zentner, J.; Bohndorf, K.; Wegener, R.; Balzer, T.

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 the same

How often do surgeons intervene on shoulder labral lesions detected at MR examination? A retrospective review of MR examinations correlated with arthroscopy

Science.gov (United States)

2014-01-01

Objective: We report the prevalence of surgical intervention on shoulder labral lesions detected at MR examinations and how surgeons describe labral tears seen at MR examinations in their arthroscopy reports. Methods: A retrospective review of 100 consecutive patients aged 50 years or younger who had shoulder labral tears on MR and went on to have surgery performed. It was determined whether surgical intervention was performed on the MR lesions. Results: Of these 100 patients, 72 had superior labral anterior to posterior (SLAP) tears, 38 had posterior labral tears and 28 had anterior labral tears on MR examination. All 100 patients went on to arthroscopy. All lesions described on MRI were described on arthroscopy. Of the 72 SLAP tears, 64 were described as fraying on arthroscopy with 51 debrided. The remaining eight SLAP tears were tacked surgically. Of the 38 posterior labral tears, 36 were described as fraying on arthroscopy with 29 debrided and 2 had surgical tacking performed. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. There were four SLAP tears, two anterior labral tears and three posterior labral tears seen on arthroscopy but not seen on MR examination. Conclusion: In this series, a high percentage of SLAP tears and posterior labral tears described on MR examination did not have surgical tacking. Most anterior labral tears had surgical tacking. Based on the above, our surgeons request we describe superior and posterior labral lesions as fraying and/or tearing, unless we can see a displaced tear. Most anterior labral lesions are treated with surgical tacking. Advances in knowledge: MRI allows for sensitive detection of labral tears. The tears often are not clinically significant. PMID:24712320

Comparison between evaluations of the glenoid concavity by double oblique axial MR arthrography and clinical results in arthroscopic bankart repair

International Nuclear Information System (INIS)

Maeda, Shugo; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Toh, Satoshi; Sasaki, Taisuke

2011-01-01

The purpose of this study was to compare the findings obtained in the glenoid concavity by double oblique axial MR arthrography (DOA-MRA) and the clinical outcome after arthroscopic Bankart repair. The results in 57 shoulders of 50 patients who underwent arthroscopic Bankart repair were reviewed. The pre and postoperative lesions in the inferior glenohumeral ligament labrum complex (IGHLLC) were classified into 5 morphological types based on the DOA-MRA findings prominent (P), split (S), flat (F), detached (D), and capsular tear (C). The height and slope of the anterior labrum from the glenoid fossa were measured on the DOA-MRA images. The Japan Shoulder Society Shoulder Instability Score (JSS-SIS) system was used to evaluate the affected shoulder of all of the patients after surgery. There were no significant differences between the JSS-SISs of the shoulders in the P group, F group, and S+D group (recurrent Bankart lesion) 6 months postoperatively. There were significant increases in the slope and height of all of the shoulders as a whole between the preoperative period and 3 months postoperatively, but there were no statistically significant differences in the slope or height between 3 months and 6 months postoperatively. The initial capsulolabral buttress property was maintained at 6 months after arthroscopic Bankart repair, and there was no correlation between the morphology of the IGHLLC and the JSS-SISs. (author)

Shoulder distention arthrography as a treatment modality

International Nuclear Information System (INIS)

Kang, Heung Sik; Park, Chan Sup; Kim, Jin Ho; Kim, Sang Bum

1987-01-01

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

Indirect wrist MR arthrography: the effects of passive motion versus active exercise

Energy Technology Data Exchange (ETDEWEB)

Schweitzer, M.E.; Natale, P.; Winalski, C.S.; Culp, R. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States)

2000-01-01

Purpose. In the wrist, to determine whether passive motion or active exercise yields a better indirect MR arthrographic effect following intravenous gadolinium administration.Design and patients. Twenty-six consecutive patients were studied by indirect wrist MR arthrography. In half active exercise and in half passive motion was performed. Four regions of interest were studied including the distal radioulnar joint, the radiocarpal joint, the midcarpal joint, and the triangular fibrocartilage. Ranges and means of signal intensity were calculated. Surgical follow-up was performed in 22 patients.Results. The joint fluid intensity was greatest in the distal radioulnar joint. Fluid signal intensity was greater and more consistent in the passive motion group although the results did not achieve statistical significance. Imaging accuracy appeared similar in the two groups and was excellent for the triangular fibrocartilage (100%) and scapholunate ligaments (96%).Conclusion. Active exercise and passive motion yield similar degrees of wrist arthrographic effect, but the effect of passive motion is somewhat more consistent. Preliminary data show good accuracy for internal derangements. (orig.)

Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation

Energy Technology Data Exchange (ETDEWEB)

Omoumi, Patrick [Cliniques Universitaires St Luc - Universite Catholique de Louvain, Department of Radiology, Brussels (Belgium); Lausanne University Hospital, Department of Radiology, Lausanne (Switzerland); Rubini, Alexandra; Berg, Bruno C. vande; Lecouvet, Frederic E. [Cliniques Universitaires St Luc - Universite Catholique de Louvain, Department of Radiology, Brussels (Belgium); Dubuc, Jean-Emile [Cliniques Universitaires St Luc - Universite Catholique de Louvain, Department of Orthopedic Surgery, Brussels (Belgium)

2015-04-01

To compare the diagnostic performance of multi-detector CT arthrography (CTA) and 1.5-T MR arthrography (MRA) in detecting hyaline cartilage lesions of the shoulder, with arthroscopic correlation. CTA and MRA prospectively obtained in 56 consecutive patients following the same arthrographic procedure were independently evaluated for glenohumeral cartilage lesions (modified Outerbridge grade ≥2 and grade 4) by two musculoskeletal radiologists. The cartilage surface was divided in 18 anatomical areas. Arthroscopy was taken as the reference standard. Diagnostic performance of CTA and MRA was compared using ROC analysis. Interobserver and intraobserver agreement was determined by κ statistics. Sensitivity and specificity of CTA varied from 46.4 to 82.4 % and from 89.0 to 95.9 % respectively; sensitivity and specificity of MRA varied from 31.9 to 66.2 % and from 91.1 to 97.5 % respectively. Diagnostic performance of CTA was statistically significantly better than MRA for both readers (all p ≤ 0.04). Interobserver agreement for the evaluation of cartilage lesions was substantial with CTA (κ = 0.63) and moderate with MRA (κ = 0.54). Intraobserver agreement was almost perfect with both CTA (κ = 0.94-0.95) and MRA (κ = 0.83-0.87). The diagnostic performance of CTA and MRA for the detection of glenohumeral cartilage lesions is moderate, although statistically significantly better with CTA. (orig.)

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

International Nuclear Information System (INIS)

Schmaranzer, Florian; Klauser, Andrea; Henninger, Benjamin; Kogler, Michael; Schmaranzer, Ehrenfried; Forstner, Thomas; Reichkendler, Markus

2015-01-01

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.)

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

Energy Technology Data Exchange (ETDEWEB)

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.)

3D-MR vs. 3D-CT of the shoulder in patients with glenohumeral instability

Energy Technology Data Exchange (ETDEWEB)

Stillwater, Laurence; Koenig, James; Maycher, Bruce; Davidson, Michael [University of Manitoba, Winnipeg (Canada)

2017-03-15

To determine whether 3D-MR osseous reformats of the shoulder are equivalent to 3D-CT osseous reformats in patients with glenohumeral instability. Patients with glenohumeral instability, who were to be imaged with both CT and MRI, were prospectively selected. CT and MR were performed within 24 h of one another on 12 shoulders. Each MR study included an axial 3D isotropic VIBE sequence. The image data from the isotropic VIBE sequence were post-processed using subtraction and 3D software. CT data were post-processed using 3D software. The following measurements were obtained for both 3D-CT and 3D-MR post-processed images: height and width of the humeral head and glenoid, Hill-Sachs size and percent humeral head loss (if present), size of glenoid bone loss and percent glenoid bone loss (if present). Paired t-tests and two one-sided tests for equivalence were used to assess the differences between imaging modalities and equivalence. The measurement differences from the 3D-CT and 3D-MR post-processed images were not statistically significant. The measurement differences for humeral height, glenoid height and glenoid width were borderline statistically significant; however, using any adjustment for multiple comparisons, this failed to be significant. Using an equivalence margin of 1 mm for measurements and 1.5% for percent bone loss, the 3D-MR and 3D-CT post-processed images were equivalent. Three-dimensional-MR osseous models of the shoulder using a 3D isotropic VIBE sequence were equivalent to 3D-CT osseous models, and the differences between modalities were not statistically significant. (orig.)

Arthrography of the equine shoulder joint

International Nuclear Information System (INIS)

Nixon, A.J.; Spencer, C.P.

1990-01-01

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

Diagnostic Accuracy and Inter-Observer Agreement of Shoulder Magnetic Resonance Arthrography in the Detection of Labral Lesion and Assessment of Lesion Location

Energy Technology Data Exchange (ETDEWEB)

Hwang, Ji Young; Song, Sook Yun; Choi, Jin Ha; Shin, Sang Jin [School of Medicine, Ewha Womans University, Mokdong Hospital, Seoul (Korea, Republic of)

2012-11-15

To evaluate the diagnostic accuracy and inter-observer agreement of magnetic resonance (MR) arthrography in the detection of labral lesions by location and to describe useful MR imaging findings of labral tears. Sixty-eight patients who underwent both pre-operative MR arthrography and arthroscopy were included. The location of the labrum was classified into anterior (2-6 o'clock), superior (12-2 o'clock), and posterior (6-12 o'clock). Sensitivity, specificity, accuracy, and inter-observer agreement of MR arthrography for the diagnosis of labral lesions by location were calculated. Frequency of MR imaging findings such as detachment, high signal intensity cleft, contour change, absence, and signal change of the labrum by location were analyzed. 35 anterior, 44 superior and 15 posterior labral lesions were detected by arthroscopy. The corresponding sensitivities were 91.4%, 79.5%, and 40.0%, specificities were 90.9%, 20.8%, and 86.8%, accuracies were 91.2%, 58.8%, and 76.5%, and kappa values were 0.823, 0.252, and 0.394, for anterior, superior, posterior lesions, respectively. The most common MR imaging findings were detachment in 60.0% of anterior labrums, high signal intensity cleft in 52.3% of superior labrums, and normal in 60.0% of posterior labrums. Diagnostic accuracy and inter-observer agreement of MR arthrography in the diagnosis of labral lesions are high in anterior labrums and low in superior or posterior labrums. The useful MR imaging findings of labral tears were different according to labral location.

Magnetic resonance imaging of the shoulder

International Nuclear Information System (INIS)

Ilieva, E.

2015-01-01

Full text: Magnetic resonance imaging (MRI) is an excellent non-invasive imaging tool that can complement the physical examination in the evaluation of traumatic and non-traumatic injuries of the shoulder. The superb soft tissue contrast and multiplanar capabilities of MRI make it a preferred modality to provide a global assessment of the soft tissue and osseous structures of the shoulder. Learning objectives: to review briefly the anatomy of the shoulder and the specificity of sequences and planes for MRI; to demonstrate the characteristic MR findings of some of the most common shoulder disorders; to indicate how MR arthrography (MRA) of the shoulder can add extra value to the diagnostic process; to outline a systematic approach to the interpretation of the shoulder MR examination. Choosing the most suitable sequences and planes as well as the thorough knowledge of the anatomic structures assist the correct diagnosis of the pathologic disorders of the shoulder which is of great importance for the precise treatment management, surgical versus conservative, as well as for the appropriate surgical approach, open versus arthroscopic

Magnetic resonance imaging (MR) of the shoulder

International Nuclear Information System (INIS)

Heuck, A.; Appel, M.; Lehner, K.; Luttke, G.; Technische Univ. Muenchen; Muenchen Univ.

1990-01-01

In order to test the criteria for abnormalities of the shoulder as seen on MR, 30 normal shoulders were examined. The examination included T 1 , proton and T 2 -weighted SE sequences and T 2 * -weighted FE sequences, using transverse, oblique coronary and oblique sagittal planes. In 57% there was increased signal intensity in the tendon of the rotator cuff; this might have been interpreted as a rupture of the cuff or tendinitis. Anatomical examination suggests that the finding is due to a normal layer between the long head of the biceps and the tendon joint complex. The anterior glenoid labrum could not be clearly delineated in 57% and the posterior labrum in 5%. In two cases there was a superior, postero-lateral defect in the head of the humerus. The currently accepted criteria for the MRT diagnosis of shoulder abnormalities need to be critically re-evaluated. (orig.) [de

Comparison of Plain MRI and MR Arthrography in the Evaluation of Lateral Ligamentous Injury of the Ankle Joint

Directory of Open Access Journals (Sweden)

Mei-Chun Chou

2006-01-01

Conclusion: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.

MR imaging of chondramalacia patella

International Nuclear Information System (INIS)

Yulish, B.S.; Montanez, J.; Mulopulos, G.P.; Goodfellow, D.; Dollinger, B.; Bryan, P.J.; Modic, M.T.

1986-01-01

Because of its inherent soft-tissue contrast, MR imaging can distinguish hyaline articular cartilage, fibrocartilage, and cortical and medullary bone, and thus seems a method ideally suited to examine the posterior patellar hyaline articular cartilage. The authors studied the knees of people with suspected chondromalacia patella using MR imagine and compared our findings to normal knees and, where available, results of surgery. They find that we can distinguish swollen cartilage, irregular cartilage, absent cartilage, and bony patellar defects. Joint fluid and meniscal injuries could also be identified. MR imaging is a useful method for evaluation of chondromalacia patella and may reduce the need for arthroscopy and arthrography for diagnosis

[Shoulder injuries in overhead sports].

Science.gov (United States)

Wörtler, K

2010-05-01

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.

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

Diagnostic performance of MR arthrography with anterior trans-subscapularis versus posterior injection approach for subscapularis tendon tears at 3.0 T

Energy Technology Data Exchange (ETDEWEB)

Jung, Joon-Yong; Jee, Won-Hee [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology, Seoul (Korea, Republic of); Chun, Chang-Woo [Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology, Uijeongbu-si, Gyeonggi-do (Korea, Republic of); Kim, Yang-Soo [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Department of Orthopedic Surgery, Seoul (Korea, Republic of)

2017-03-15

To compare the diagnostic performance of shoulder magnetic resonance arthrography (MRA) with the anterior trans-subscapularis versus posterior injection approach to diagnose subscapularis tendon (SCT) tears. One hundred and sixty-seven arthroscopically confirmed patients (84 anterior and 83 posterior approaches) were included. Two readers retrospectively scored SCT tears. Proportions of correctly graded tears between MR arthrography and arthroscopy were calculated. Retrospective error analysis was performed. The sensitivity and specificity were 80 % (24/30) and 72 % (39/54) by reader 1, 73 % (22/30) and 76 % (41/54) by reader 2 in the anterior approach, and 86 % (30/35) and 79 % (38/48) by reader 1, 80 % (28/35) and 88 % (42/48) by reader 2 in the posterior approach, respectively. There were no significant differences in sensitivity and specificity between the two groups. Proportions of correctly graded tears of both readers were 48 % and 36 % in the anterior approach, and 70 % and 68 % in the posterior approach, respectively. The intratendinous collection of contrast material was not statistically significantly different between anterior (n = 8) and posterior (n = 3) approach group. For the MRA diagnosis of SCT tears, there was no significant difference between the anterior trans-subscapularis and the posterior approach. (orig.)

Diagnostic performance of MR arthrography with anterior trans-subscapularis versus posterior injection approach for subscapularis tendon tears at 3.0 T

International Nuclear Information System (INIS)

Jung, Joon-Yong; Jee, Won-Hee; Chun, Chang-Woo; Kim, Yang-Soo

2017-01-01

To compare the diagnostic performance of shoulder magnetic resonance arthrography (MRA) with the anterior trans-subscapularis versus posterior injection approach to diagnose subscapularis tendon (SCT) tears. One hundred and sixty-seven arthroscopically confirmed patients (84 anterior and 83 posterior approaches) were included. Two readers retrospectively scored SCT tears. Proportions of correctly graded tears between MR arthrography and arthroscopy were calculated. Retrospective error analysis was performed. The sensitivity and specificity were 80 % (24/30) and 72 % (39/54) by reader 1, 73 % (22/30) and 76 % (41/54) by reader 2 in the anterior approach, and 86 % (30/35) and 79 % (38/48) by reader 1, 80 % (28/35) and 88 % (42/48) by reader 2 in the posterior approach, respectively. There were no significant differences in sensitivity and specificity between the two groups. Proportions of correctly graded tears of both readers were 48 % and 36 % in the anterior approach, and 70 % and 68 % in the posterior approach, respectively. The intratendinous collection of contrast material was not statistically significantly different between anterior (n = 8) and posterior (n = 3) approach group. For the MRA diagnosis of SCT tears, there was no significant difference between the anterior trans-subscapularis and the posterior approach. (orig.)

Optimization of T2-weighted imaging for shoulder magnetic resonance arthrography by synthetic magnetic resonance imaging.

Science.gov (United States)

Lee, Seung Hyun; Lee, Young Han; Hahn, Seok; Yang, Jaemoon; Song, Ho-Taek; Suh, Jin-Suck

2017-01-01

Background Synthetic magnetic resonance imaging (MRI) allows reformatting of various synthetic images by adjustment of scanning parameters such as repetition time (TR) and echo time (TE). Optimized MR images can be reformatted from T1, T2, and proton density (PD) values to achieve maximum tissue contrast between joint fluid and adjacent soft tissue. Purpose To demonstrate the method for optimization of TR and TE by synthetic MRI and to validate the optimized images by comparison with conventional shoulder MR arthrography (MRA) images. Material and Methods Thirty-seven shoulder MRA images acquired by synthetic MRI were retrospectively evaluated for PD, T1, and T2 values at the joint fluid and glenoid labrum. Differences in signal intensity between the fluid and labrum were observed between TR of 500-6000 ms and TE of 80-300 ms in T2-weighted (T2W) images. Conventional T2W and synthetic images were analyzed for diagnostic agreement of supraspinatus tendon abnormalities (kappa statistics) and image quality scores (one-way analysis of variance with post-hoc analysis). Results Optimized mean values of TR and TE were 2724.7 ± 1634.7 and 80.1 ± 0.4, respectively. Diagnostic agreement for supraspinatus tendon abnormalities between conventional and synthetic MR images was excellent (κ = 0.882). The mean image quality score of the joint space in optimized synthetic images was significantly higher compared with those in conventional and synthetic images (2.861 ± 0.351 vs. 2.556 ± 0.607 vs. 2.750 ± 0.439; P optimized TR and TE for shoulder MRA enables optimization of soft-tissue contrast.

Shoulder injuries in overhead sports

International Nuclear Information System (INIS)

Woertler, K.

2010-01-01

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.) [de

MR imaging in shoulder trauma. Value of STIR images

International Nuclear Information System (INIS)

Rand, T.; Trattnig, S.; Haller, J.; Imhof, H.; Nguyen, N.K.

1998-01-01

Purpose: To determine the adequacy of MR standard protocols by analyzing conventional T1- and T2-weighted SE sequences, and to evaluate the usefulness of additional fat-suppressed (STIR) images in shoulder trauma. Material and Methods: Paracoronal T1-weighted, T2-weighted SE, and STIR images were obtained on a 0.5 T superconductive system in 25 patients with shoulder trauma. In a separate evaluation of T1/T2 images and a combined evaluation of T1/T2 SE- and STIR images, we compared the number of patients with evidence of Hill-Sachs lesions, bone bruises, and/or rotator-cuff lesions. Results: Compared to the combined evaluation of T1/T2 and STIR images, the separate evaluation of T1/T2 SE images revealed identical results for rotator-cuff lesions and Hill-Sachs lesions, but different results for the bone bruises in the area of the major tubercle. Conclusion: Occult fractures of the major tubercle, indicated by areas of bone bruising, might be missed with MR using conventional SE images. We recommend the use of additional paracoronal fat-suppressed sequences in patients with clinically suspected lesions and equivocal findings on plain radiographs and on standard SE sequences. (orig.)

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.

Postprocedural pain in shoulder arthrography: differences between using preservative-free normal saline and normal saline with benzyl alcohol as an intraarticular contrast diluent.

Science.gov (United States)

Storey, Troy F; Gilbride, George; Clifford, Kelly

2014-11-01

The purpose of this study was to prospectively evaluate the effect of benzyl alcohol, a common preservative in normal saline, on postprocedural pain after intraarticular injection for direct shoulder MR arthrography. From April 2011 through January 2013, 138 patients underwent direct shoulder MR arthrography. Using the Wong-Baker Faces Pain Scale, patients were asked to report their shoulder pain level immediately before and immediately after the procedure and then were contacted by telephone 6, 24, and 48 hours after the procedure. Fourteen patients did not receive the prescribed amount of contrast agent for diagnostic reasons or did not complete follow-up. Sixty-two patients received an intraarticular solution including preservative-free normal saline (control group) and 62 patients received an intraarticular solution including normal saline with 0.9% benzyl alcohol as a contrast diluent (test group). Patients were randomized as to which intraarticular diluent they received. Fluoroscopic and MR images were reviewed for extracapsular contrast agent administration or extravasation, full-thickness rotator cuff tears, and adhesive capsulitis. The effect of preservative versus control on pain level was estimated with multiple regression, which included time after procedure as the covariate and accounted for repeated measures over patients. Pain scale scores were significantly (p = 0.0382) higher (0.79 units; 95% CI, 0.034-1.154) with benzyl alcohol preservative compared with control (saline). In both study arms, the pain scale scores decreased slightly after the procedure, increased by roughly 1 unit over baseline for the test group and 0.3 unit over baseline for the control group by 6 hours after the procedure, were 0.50 unit over baseline for the test group and 0.12 unit over baseline for the control group at 24 hours, then fell to be slightly greater than baseline at 48 hours with benzyl alcohol and slightly less than baseline without benzyl alcohol. These trends

Detection of rotator cuff lesions with indirect MR angiography

International Nuclear Information System (INIS)

Rudolph, J.; Lorenz, M.; Schroeder, R.; Felix, R.

2000-01-01

Purpose: To determine the value of indirect MR arthrography in lesions of the rotator cuff, prospectively versus arthroscopy. Methods: 63 patients with suspected shoulder pathology were examined: Oblique-coronary and axial T 1 w sequences, axial FLASH-2 D sequences, furthermore oblique-coronary T 2 - and PD-weighted sequences were taken. After intravenous administration of 0.1 mmol Gd-DTPA/kilogram body weight and active motion of the shoulder T 1 w sequences were repeated. Signal intensities (SI) inside the tendon were quantitatively measured by the ROI technique (region-of-interest) and the percentual contrast-enhancement CE was calculated. In 32 patients the results were confirmed by surgical follow-up. Results: The mean SI measured in the supraspinous tendon were higher in lesions (degeneration, impingement, partial and total rupture), before as well as after contrast medium, compared to intact findings (p [de

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.

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

Science.gov (United States)

Cerny, Milena; Marlois, Romain; Theumann, Nicolas; Bollmann, Christof; Wehrli, Laurent; Richarme, Delphine; Meuli, Reto; Becce, Fabio

2013-10-01

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. 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. With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1mm, 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 = 0mm, 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). 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. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

A Simple Technique for Shoulder Arthrography

Energy Technology Data Exchange (ETDEWEB)

Berna-Serna, J.D.; Redondo, M.V.; Martinez, F.; Reus, M.; Alonso, J.; Parrilla, A.; Campos, P.A. [Virgen de la Arrixaca Univ. Hospital, El Palmar, Murcia (Spain). Dept. of Radiology

2006-09-15

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.

Diagnosis of shoulder impingement syndrome

International Nuclear Information System (INIS)

Hodler, J.

1996-01-01

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.) [de

MR imaging appearance of discoid menisci of the knee

International Nuclear Information System (INIS)

Silverman, J.; Mink, J.H.; Deutsch, A.L.

1988-01-01

Although discoid menisci of the knee have been recognized with magnetic resonance (MR) imaging, there are no MR criteria for their diagnosis. In this paper the authors define a discord meniscus as three or more 5-mm-thick interleaved sagittal sections that demonstrate continuity of the meniscus between the anterior and posterior horns. High-resolution coronal images allow more graphic depiction of the abnormally wide meniscus. They present a total of 29 cases imaged with MR. In approximately one-third of their cases, the measurable height difference between the discoid meniscus and the adjacent meniscus was at least 2 mm. Surgical correlation revealed only two discrepancies between MR imaging and arthrography

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

International Nuclear Information System (INIS)

Ramirez Ruiz, Francisco Alejandro; Baranski Kaniak, Beatriz Cristina; Trudell, Debra; Resnick, Donald L.; Haghighi, Parviz

2012-01-01

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.)

MR imaging of subscapularis tendon injury in the setting of anterior shoulder dislocation

Energy Technology Data Exchange (ETDEWEB)

Gyftopoulos, Soterios; Carpenter, Elizabeth; Kazam, Jonathan; Babb, James; Bencardino, Jenny [NYU Hospital for Joint Diseases, New York, NY (United States)

2012-11-15

To evaluate the degree and location patterns of subscapularis tendon injury in patients with prior anterior shoulder dislocation (ASD). Forty-five consecutive MR shoulder examinations in patients with a history of ASD and 20 consecutive MR examinations in patients without prior dislocation were reviewed. Two readers assessed for the presence and location of tendinosis and tearing in the subscapularis tendon, which was divided into three segments: superior, middle, and inferior. The readers also documented the presence of anterior labral tears, osseous Bankart defects and Hill-Sachs lesions. Fisher's exact tests were performed to analyze the different types of pathology and their locations. Subscapularis tendinosis, and partial thickness and full thickness tears were more common in patients with a history of ASD. Tendinosis was found in 60-64.4% of the dislocation patients compared with 40% of the non-dislocation group. When stratified by location, the middle and inferior thirds were the most commonly affected with statistical significance (p < 0.05) found in tearing of the inferior third. Anterior labral tears, osseous Bankart defects, and Hill-Sachs lesions were more common in the dislocation group with statistically significant associations with tendinosis in the middle and inferior thirds and tearing of the middle third (p < 0.05). Our study suggests an association between middle and inferior subscapularis tendon pathology and prior anterior shoulder dislocation. Based on our results, careful MR assessment of the subscapularis tendon by the radiologist is indicated in the setting of ASD as injury of this structure can be symptomatic and may be amenable to treatment. (orig.)

MR imaging of subscapularis tendon injury in the setting of anterior shoulder dislocation

International Nuclear Information System (INIS)

Gyftopoulos, Soterios; Carpenter, Elizabeth; Kazam, Jonathan; Babb, James; Bencardino, Jenny

2012-01-01

To evaluate the degree and location patterns of subscapularis tendon injury in patients with prior anterior shoulder dislocation (ASD). Forty-five consecutive MR shoulder examinations in patients with a history of ASD and 20 consecutive MR examinations in patients without prior dislocation were reviewed. Two readers assessed for the presence and location of tendinosis and tearing in the subscapularis tendon, which was divided into three segments: superior, middle, and inferior. The readers also documented the presence of anterior labral tears, osseous Bankart defects and Hill-Sachs lesions. Fisher's exact tests were performed to analyze the different types of pathology and their locations. Subscapularis tendinosis, and partial thickness and full thickness tears were more common in patients with a history of ASD. Tendinosis was found in 60-64.4% of the dislocation patients compared with 40% of the non-dislocation group. When stratified by location, the middle and inferior thirds were the most commonly affected with statistical significance (p < 0.05) found in tearing of the inferior third. Anterior labral tears, osseous Bankart defects, and Hill-Sachs lesions were more common in the dislocation group with statistically significant associations with tendinosis in the middle and inferior thirds and tearing of the middle third (p < 0.05). Our study suggests an association between middle and inferior subscapularis tendon pathology and prior anterior shoulder dislocation. Based on our results, careful MR assessment of the subscapularis tendon by the radiologist is indicated in the setting of ASD as injury of this structure can be symptomatic and may be amenable to treatment. (orig.)

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

Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder

Energy Technology Data Exchange (ETDEWEB)

Tshering Vogel, Dechen W.; Anderson, Suzanne E. [University Hospital of Bern, Department of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Steinbach, Lynne S. [University of California San Francisco, Department of Radiology, San Francisco, California (United States); Hertel, Ralph [University Hospital of Bern, Department of Orthopedics, Plastic and Hand Surgery, Bern (Switzerland); Bernhard, Juerg [Burgerspital, Department of Rheumatology, Solothurn (Switzerland); Stauffer, Edouard [University Hospital of Bern, Department of Pathology, Bern (Switzerland)

2005-05-01

(1) To analyse the imaging appearances of nine patients with acromioclavicular joint cysts presenting as shoulder masses for tumor staging with operative, histopathological and joint aspiration findings. Retrospective review of imaging and correlation with clinical, operative and surgical notes. Images were reviewed by two musculoskeletal radiologists by consensus. Nine patients who presented clinically with a shoulder mass were evaluated by radiographs (n=9), ultrasound (n=1), conventional arthrography (n=3), MRI (n=6; with direct MR arthrography n=2, indirect MR arthrography n=4). All patients had a focal mass superior to the AC joint, with a size ranging from 1.5 cm to 6 cm and a mean of 3.27 cm. Correlation was available with surgery (n=7), histopathology (n=2) and cyst aspiration (n=2). Two patients were managed conservatively. Geyser sign was positive in all three arthrograms. All MRIs revealed extensive rotator cuff tears with a column of fluid extending from the glenohumeral joint through the rotator cuff tear into the acromioclavicular joint and acromioclavicular cyst. Chondrocalcinosis was seen in the acromioclavicular joint cyst (n=2) and in the glenohumeral joint (n=1). Aspirate in two patients contained calcium pyrophosphate dihydrate crystals. (orig.)

Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder

International Nuclear Information System (INIS)

Tshering Vogel, Dechen W.; Anderson, Suzanne E.; Steinbach, Lynne S.; Hertel, Ralph; Bernhard, Juerg; Stauffer, Edouard

2005-01-01

(1) To analyse the imaging appearances of nine patients with acromioclavicular joint cysts presenting as shoulder masses for tumor staging with operative, histopathological and joint aspiration findings. Retrospective review of imaging and correlation with clinical, operative and surgical notes. Images were reviewed by two musculoskeletal radiologists by consensus. Nine patients who presented clinically with a shoulder mass were evaluated by radiographs (n=9), ultrasound (n=1), conventional arthrography (n=3), MRI (n=6; with direct MR arthrography n=2, indirect MR arthrography n=4). All patients had a focal mass superior to the AC joint, with a size ranging from 1.5 cm to 6 cm and a mean of 3.27 cm. Correlation was available with surgery (n=7), histopathology (n=2) and cyst aspiration (n=2). Two patients were managed conservatively. Geyser sign was positive in all three arthrograms. All MRIs revealed extensive rotator cuff tears with a column of fluid extending from the glenohumeral joint through the rotator cuff tear into the acromioclavicular joint and acromioclavicular cyst. Chondrocalcinosis was seen in the acromioclavicular joint cyst (n=2) and in the glenohumeral joint (n=1). Aspirate in two patients contained calcium pyrophosphate dihydrate crystals. (orig.)

MR arthrography gadolinium versus standard MR imaging in rotator cuff pathology

International Nuclear Information System (INIS)

Hodler, J.; Brahme, S.K.; Karzel, R.; Cervilla, V.; Snyder, S.; Schweitzer, M.; Flannigan, B.; Resnick, D.

1990-01-01

This paper compares the accuracy of MR imaging with and without intraarticular gadolinium in the diagnosis of rotator cuff pathology, using arthroscopy as the gold standard. The authors examined 36 patients, first with T2-weighted sequences and then with T1-weighted sequences after the injection of 15-20 mL of diluted gadolinium. The images were read blindly by three radiologists experienced in musculoskeletal MR imaging. The results were compared with those of arthroscopy. In 16 of 19 arthroscopically intact rotator cuffs, both sequences demonstrated no evidence of rotator cuff tear. The remaining three cases were interpreted as partial or full-thickness tears. Of 12 partial tears, T1-weighted images with intraarticular gadolinium demonstrated a partial tear in five, degeneration in four, a full thickness tear in two, and a normal rotator cuff in one

Indications for CT and MR arthrography. Recommendations of the Musculoskeletal Workgroup of the DRG; Indikationen der MR- und CT-Arthrografie. Empfehlungen der AG Muskuloskelettale Radiologie der DRG

Energy Technology Data Exchange (ETDEWEB)

Fischer, W. [Hessingpark Clinic, Radiologengemeinschaft Augsburg (Germany); Bohndorf, K.; Zentner, J. [Zentralklinikum Augsburg (Germany). Klinik fuer Diagnostische Radiologie und Neuroradiologie; Kreitner, K.F. [Universitaetsklinikum Mainz (Germany). Klinik und Poliklinik fuer Radiologie; Schmitt, R. [Herz- und Gefaessklinik GmbH, Bad Neustadt an der Saale (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Woertler, K. [Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Roentgendiagnostik

2009-05-15

The ongoing discussion about CT and MR arthrography is at least in part due to the lack of definite guidelines. The intention of the musculoskeletal workgroup of the DRG (Deutsche Roentgengesellschaft) was the establishment of recommendations for general guidance. After review of the recent literature, the indications for arthrographic examinations were discussed during a consensus meeting. Since the published data are insufficient and partially contradictory, no precise statements could be extracted from the literature. Therefore, the proposed recommendations are mainly based on expert opinions. In this review the main statements of the published literature are summarized and the recommendations of the musculoskeletal workgroup of the DRG are presented. (orig.)

The significance of preoperative shoulder arthrography in painful arc patients

International Nuclear Information System (INIS)

Myllylae, V.; Jalovaara, P.; Pyhtinen, J.; Oulu Univ.

1984-01-01

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.) [de

Tumoral calcium pyrophosphate dihydrate deposition disease with bone destruction in the shoulder. CT an MR findings in two cases

International Nuclear Information System (INIS)

Mizutani, H.; Ohba, S.; Sasaki, S.; Ando, K.; Mizutani, M.; Matsushita, Y.; Ohtsuka, T.; Terazawa, T.; Ijima, S.

1998-01-01

We report on specific CT and MR features in two cases of tumoral calcium pyrophosphate dihydrate deposition disease in the shoulder with unusually large tumors. CT revealed features that were specific to the disease. MR was useful for detecting the extent of the mass and for obtaining information on adjacent soft-tissue and bone-marrow changes. (orig.)

Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: Accuracy, and inter- and intra-observer agreements

Energy Technology Data Exchange (ETDEWEB)

Jung, Joon-Yong; Jee, Won-Hee; Chun, Ho Jong; Ahn, Myeong Im (Dept. of Radiology, Seoul St. Mary' s Hospital, School of Medicine, Catholic Univ. of Korea, Seoul (Korea)), e-mail: whjee@catholic.ac.kr; Kim, Yang-Soo (Dept. of Orthopedic Surgery, Seoul St. Mary' s Hospital, School of Medicine, Catholic Univ. of Korea, Seoul (Korea))

2010-03-15

Background: Partial-thickness tear of the rotator cuff is a common cause of shoulder pain. Magnetic resonance (MR) arthrography has been described as a useful measure to diagnose rotator cuff abnormalities. Purpose: To determine the reliability and accuracy of MR arthrography with abduction and external rotation (ABER) view for the diagnosis of partial-thickness tears of the rotator cuff. Material and Methods: Among patients who underwent MR arthrographies, 22 patients (12 men, 10 women; mean age 45 years) who had either partial-thickness tear or normal tendon on arthroscopy were included. MR images were independently scored by two observers for partial-thickness tears of the rotator cuff. Interobserver and intraobserver agreements for detection of partial-thickness tears of the rotator cuff were calculated by using kappa coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate Z-score test. Differences in sensitivity and specificity for interpretations based on different imaging series were tested for significance using the McNemar statistic. Results: Sensitivity, specificity, and accuracy of each reader on MR imaging without ABER view were 83%, 90%, and 86%, and 83%, 80%, and 82%, respectively, whereas on overall interpretation including ABER view, the sensitivity, specificity, and accuracy of each reader were 92%, 70%, and 82%, and 92%, 80%, and 86%, respectively. Including ABER view, interobserver agreement for partial-thickness tear increased from kappa=0.55 to kappa=0.68. Likewise, intraobserver agreements increased from kappa=0.79 and 0.53 to kappa=0.81 and 0.70 for each reader, respectively. The areas under the ROC curves for each reader were 0.96 and 0.90, which were not significantly different. Conclusion: Including ABER view in routine sequences of MR arthrography increases the sensitivity, and inter- and intraobserver agreements for detecting partial-thickness tear of rotator cuff

Magnetic resonance arthrography including ABER view in diagnosing partial-thickness tears of the rotator cuff: Accuracy, and inter- and intra-observer agreements

International Nuclear Information System (INIS)

Jung, Joon-Yong; Jee, Won-Hee; Chun, Ho Jong; Ahn, Myeong Im; Kim, Yang-Soo

2010-01-01

Background: Partial-thickness tear of the rotator cuff is a common cause of shoulder pain. Magnetic resonance (MR) arthrography has been described as a useful measure to diagnose rotator cuff abnormalities. Purpose: To determine the reliability and accuracy of MR arthrography with abduction and external rotation (ABER) view for the diagnosis of partial-thickness tears of the rotator cuff. Material and Methods: Among patients who underwent MR arthrographies, 22 patients (12 men, 10 women; mean age 45 years) who had either partial-thickness tear or normal tendon on arthroscopy were included. MR images were independently scored by two observers for partial-thickness tears of the rotator cuff. Interobserver and intraobserver agreements for detection of partial-thickness tears of the rotator cuff were calculated by using κ coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were assessed with a univariate Z-score test. Differences in sensitivity and specificity for interpretations based on different imaging series were tested for significance using the McNemar statistic. Results: Sensitivity, specificity, and accuracy of each reader on MR imaging without ABER view were 83%, 90%, and 86%, and 83%, 80%, and 82%, respectively, whereas on overall interpretation including ABER view, the sensitivity, specificity, and accuracy of each reader were 92%, 70%, and 82%, and 92%, 80%, and 86%, respectively. Including ABER view, interobserver agreement for partial-thickness tear increased from κ=0.55 to κ=0.68. Likewise, intraobserver agreements increased from κ=0.79 and 0.53 to κ=0.81 and 0.70 for each reader, respectively. The areas under the ROC curves for each reader were 0.96 and 0.90, which were not significantly different. Conclusion: Including ABER view in routine sequences of MR arthrography increases the sensitivity, and inter- and intraobserver agreements for detecting partial-thickness tear of rotator cuff tendon

The Usefulness of Dynamic Cine-Arthrography for Wrist Instability as Correlated with Arthroscopic Palmer Classification

Energy Technology Data Exchange (ETDEWEB)

Kim TaeYeon; Lee, Guen Young; Kim, Baek Hyun; Park, Jong Woong; Seo, Bo Kyoung; Cha, Sang Hoon [Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of)

2011-05-15

To introduce dynamic cine-arthrography and compare it with MR arthrography in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears, based on arthroscopic findings. A total of thirty-eight wrists of 38 patients who had undergone both dynamic cine-arthrography and MR arthrography were enrolled. Dynamic cinearthrography was performed after puncture of the radiocarpal joint by slow injection of contrast under continuous fluoroscopic guidance during passive wrist exercise. We obtained 1.5- or 3-T MR arthrography with fat-suppressed T1-weighted coronal and axial images. We evaluated scapholunate and lunotriquetral ligaments and triangular fibrocartilage complex tears according to the Palmer classification system. Based on the arthroscopic findings, we compared the diagnostic values between the two examinations using Kappa values. The overall sensitivity and specificity of diagnosis of intrinsic ligament tears was similar between dynamic cine-arthrography and MR arthrography (scapholunate ligament: sensitivity 66.7% vs. 80%, specificity 100% vs. 95.7%, lunotriquetral ligament: sensitivity 75.0% vs. 75.0%, specificity 94.1% vs. 91.2%). For triangular fibrocartilage complex tears, all diagnostic values were the same (sensitivity 96.4%, specificity 100%). The inter-examination agreement was substantial to perfect (kappa value 1.000). Dynamic cine-arthrography is valuable in the diagnosis of intrinsic ligament and triangular fibrocartilage complex tears compared to MR arthrography.

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

International Nuclear Information System (INIS)

Robinson, G.; Chung, T.; Finlay, K.; Friedman, L.

2006-01-01

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

Role of MR imaging in chronic wrist pain

Energy Technology Data Exchange (ETDEWEB)

Zanetti, Marco; Saupe, Nadja [University Hospital Balgrist, Department of Radiology, Zurich (Switzerland); Nagy, Ladislav [University Hospital Balgrist, Department of Orthopedic Surgery, Zurich (Switzerland)

2007-04-15

Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienboeck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain. (orig.)

Role of MR imaging in chronic wrist pain

International Nuclear Information System (INIS)

Zanetti, Marco; Saupe, Nadja; Nagy, Ladislav

2007-01-01

Magnetic resonance (MR) imaging for chronic wrist pain is challenging. Correct assessment of the triangular fibrocartilage, hyaline cartilage, ligaments, and tendons has become mandatory for comprehensive decision making in wrist surgery. The MR technique, potential and limits of MR imaging in patients with chronic wrist pain will be discussed. MR arthrography with injection of gadolinium-containing contrast material into the distal radioulnar joint is suggested for evaluation of the triangular fibrocartilage. The clinically meaningful ulnar-sided peripheral tears are otherwise hard to diagnose. The diagnostic performance of MR imaging for interosseous ligament tears varies considerably. The sensitivity for scapholunate ligament tears is consistently better than for lunotriquetral ligament tears. Gadolinium-enhanced MR imaging is considered to be the best technique for detecting established avascularity of bone, but the assessment of the MR results remains challenging. Most cases of ulnar impaction syndrome have characteristic focal signal intensity changes in the ulnar aspect of the lunate. Avascular necrosis of the lunate (Kienboeck's disease) is characterized by signal changes starting in the proximal radial aspect of the lunate. MR imaging is extremely sensitive for occult fractures. Questions arise if occult posttraumatic bone lesions seen on MR images only necessarily require the same treatment as fractures evident on plain films or computed tomography (CT) images. MR imaging and ultrasound are equally effective for detecting occult carpal ganglia. Carpe bossu (carpal boss) is a bony protuberance of a carpometacarpal joint II and III which may be associated with pain. (orig.)

MR alterations of the rotator cuff and anterior gienold labrum

International Nuclear Information System (INIS)

Kjellin, I.; Ho, C.; Haghighi, P.; Kerr, R.; Trudell, D.; Cervilla, V.; Resnick, D.

1990-01-01

This paper determines the histopathologic causes of alterations in signal and morphology in the tendinous rotator cuff and glenoid labrum on shoulder MR images. MR imaging was performed in 13 cadaveric shoulders. Coronal oblique imaging of the rotator cuff was performed with spin-echo sequences (TR 2,000; TE 25/80). The labrum was examined with transaxial spin-echo, fat-suppression (HYBRID), and MPGR sequences. The shoulders then were frozen and sectioned at 3-mm intervals in the plane of interest. Areas corresponding to sites of MR alterations were examined histologically

Virtual MR arthroscopy of the wrist joint: a new intraarticular perspective

International Nuclear Information System (INIS)

Sahin, Guelden; Dogan, Basak Erguvan; Demirtas, Mehmet

2004-01-01

The aim of this study is to investigate whether virtual MR arthroscopy could be used to visualize the internal architecture of the radiocarpal compartment of the wrist joint in comparison to surgical arthroscopy. Diluted paramagnetic contrast material was injected into the radiocarpal compartment prior to MR examination in all patients. A fat-suppressed T1-weighted three-dimensional fast spoiled gradient echo sequence was acquired in addition to our standard MR imaging protocol in each patient. Three-dimensional data sets were then transferred to an independent workstation and were postprocessed using navigator software to generate surface rendered virtual MR arthroscopic images. Nineteen patients referred for chronic ulnar-sided wrist pain were evaluated with conventional MR arthrography prospectively. Virtual MR arthroscopic images demonstrating the triangular fibrocartilage complex (TFCC) in an intraarticular perspective were achieved in 12 out of 19 patients. Our preliminary investigation suggests that although it has several limitations, virtual MR arthroscopy shows promise in visualizing the TFCC from an intraarticular perspective. (orig.)

MR imaging in the diagnosis of impingement syndrome

International Nuclear Information System (INIS)

Seeger, L.L.; Gold, R.H.; Bassett, L.W.; Ellman, H.

1986-01-01

The impingement syndrome is entrapment of the supraspinatus tendon by either the acromion, or a subacromial or acromioclavicular spur. Arthrography is normal during stages I (tendon inflammation) and II (fibrosis). The lack of objective findings often delays diagnosis until stage III (ischemic rotator cuff tear) is present. The purpose was to determine if MR imaging is useful in diagnosing this condition. T1-weighted surface coil scans were obtained on eight patients using a 0.3-T MR system. An axial scout allowed oblique alignment for imaging the osseous-soft tissue relationship and the supraspinatus tendon. MR is capable of displaying the specific pathologic anatomy of this disorder. Impinging spurs can be seen, and the adjacent tendon shows inferior displacement and abnormal signal intensity

Rotator cuff ruptures of the shoulder joint, sonography - arthrography

International Nuclear Information System (INIS)

Triebel, H.J.; Wening, V.; Witte, G.; Hamburg Univ.

1986-01-01

47 patients suspected of rutpure of the rotator cuff were sonographed and arthrographed. Rupture of the rotator cuff was diagnosed in 12 cases, both diagnostic methods yielding the same result. In 29 patients sonography and arthrography did not reveal any abnormal findings. Six ruptures evident in sonography were not confirmed by arthrography and were considered false positive. Direct pointers towards rupture of the cuff would be: echoless defects, cuff cannot be visualised fully or in part and irregularities of movement during dynamic examination. Echoless 'cystic' areas in the periarticular soft parts must be considered an indirect pointer. Echorich focal findings in the echopoor cuff represent a differential diagnostic problem and we cannot give a final assessment as yet. Shoulder sonography is justified as a screening method in suspicion of rotator cuff rupture before initiating arthrography. If sonography reveals no abnormal findings, shoulder arthrography need not be performed. (orig.) [de

Arthrography

Medline Plus

Full Text Available ... the joint and appears on the MR images. As in conventional direct arthrography, the contrast material outlines the structures within the joint, such as cartilage, ligaments and bones, and allows them to ...

Arthrography

Medline Plus

Full Text Available ... have MR or CT arthrography and have claustrophobia (fear of enclosed spaces) or anxiety, you may want ... physician and technologist if they may be pregnant. Children younger than 13 may need to be sedated ...

Arthrography

Medline Plus

Full Text Available ... and possibly hear gurgling when the joint is moved. If your arthrography exam involves MR imaging: It is normal for the area of your body being imaged to feel slightly warm, but if it ...

Pseudodynamic MR imaging of temporomandibular joint disorders

International Nuclear Information System (INIS)

Nakasato, Tatsuhiko; Ehara, Shigeru

1992-01-01

Magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) has now been established as a procedure of choice in the evaluation of TMJ disorders. In this study, we evaluated the dynamics of TMJ motion on MR imaging, which resembles arthrography. Sixty-eight TMJs in 38 symptomatic patients and one healthy volunteer were examined using pseudodynamic images with gradient echo sequences using a 0.5 Tesla MR unit and 8 cm circular planar surface coil. For depiction of each compartment of the meniscus, the optimum sequence was 200/15/2 (TR/TE/excitations) with 50 deg or 60 deg flip angle in gradient refocused acquisition in steady-state (GRASS) sequences. Three contiguous slices on sagittal MR images were routinely obtained at 14-18 different phases of the opening cycle and displayed in closed-loop cine fashion. Internal derangement was observed in 57% of 68 joints. The most common type was anterior meniscal displacement without reduction. Sideway and rotational displacements, observed in 10% each, were noted on both sagittal multislice images and axial reference images. As a pseudodynamic MR technique, jaw movement specifically designed to check bite procedure to adjust splints is useful for detecting the exact time of meniscal redisplacement on the second click. After conservative therapy for arthrosis, pseudodynamic MR provided information on changes in the meniscus and condylar relationship. Pseudodynamic MR with multiple phases is suitable for evaluating subtle motion abnormality of the meniscus and for post-therapeutic monitoring. (author)

Pseudodynamic MR imaging of temporomandibular joint disorders

Energy Technology Data Exchange (ETDEWEB)

Nakasato, Tatsuhiko; Ehara, Shigeru (Iwate Medical Coll., Morioka (Japan). School of Medicine)

1992-09-01

Magnetic resonance (MR) imaging of the temporomandibular joint (TMJ) has now been established as a procedure of choice in the evaluation of TMJ disorders. In this study, we evaluated the dynamics of TMJ motion on MR imaging, which resembles arthrography. Sixty-eight TMJs in 38 symptomatic patients and one healthy volunteer were examined using pseudodynamic images with gradient echo sequences using a 0.5 Tesla MR unit and 8 cm circular planar surface coil. For depiction of each compartment of the meniscus, the optimum sequence was 200/15/2 (TR/TE/excitations) with 50 deg or 60 deg flip angle in gradient refocused acquisition in steady-state (GRASS) sequences. Three contiguous slices on sagittal MR images were routinely obtained at 14-18 different phases of the opening cycle and displayed in closed-loop cine fashion. Internal derangement was observed in 57% of 68 joints. The most common type was anterior meniscal displacement without reduction. Sideway and rotational displacements, observed in 10% each, were noted on both sagittal multislice images and axial reference images. As a pseudodynamic MR technique, jaw movement specifically designed to check bite procedure to adjust splints is useful for detecting the exact time of meniscal redisplacement on the second click. After conservative therapy for arthrosis, pseudodynamic MR provided information on changes in the meniscus and condylar relationship. Pseudodynamic MR with multiple phases is suitable for evaluating subtle motion abnormality of the meniscus and for post-therapeutic monitoring. (author).

MR imaging of hyaline cartilage in chondromalacia patellae and osteochondrosis dissecans: A comparison with CT-arthrography and arthroscopy

International Nuclear Information System (INIS)

Lehner, K.; Heuck, A.; Lukas, P.; Rodammer, G.; Allgayer, B.; Pasquay, E.

1987-01-01

Superior to spin-echo sequences, the articular hyaline cartilage was imaged with fast-field-echo sequences (FFE, Gyroscan 0.5-T, Philips) with an excitation pulse angle of 40 0 to 60 0 . Chondromalaceous lesions could be demonstrated in 30 patients with chondropathia patellae with the same sensitivity compared with CT arthrography. In a further 50 patients with osteochondrosis dissecans, discontinuities of the cartilage could be predicted using the deeply invading articular fluid as an indicator. The sensitivity of MR imaging, as controlled by arthroscopy, was very high in that respect. Separate from the nonhemorrhagic articular fluid, the cartilaginous defects could be imaged directly by variation of the FFE parameters

Intra-articular ganglion cysts of the knee: clinical and MR imaging features

International Nuclear Information System (INIS)

Kim, M.G.; Cho, W.H.; Kim, B.H.; Choi, J.A.; Lee, N.J.; Chung, K.B.; Choi, Y.S.; Cho, S.B.; Lim, H.C.

2001-01-01

The purpose of this study was to present clinical and MR imaging features of intra-articular ganglion cysts of the knee. Retrospective review of 1685 consecutive medical records and MR examinations of the knee performed at three imaging centers allowed identification of 20 patients (13 men and 7 women; mean age 35 years), in whom evidence of intra-articular ganglion cyst was seen. Of the 20 ganglion cysts, 5 were found in the infrapatellar fat pad, 10 arose from the posterior cruciate ligament, and 5 from the anterior cruciate ligament. Three of five patients with ganglion cyst in the infrapatellar fat pad had a palpable mass. In 7 of 15 patients with ganglion cyst in the intercondylar notch, exacerbation of pain occurred in a squatting position. On four MR arthrographies, ganglion cysts were an intra-articular round, lobulated, low signal intensity lesion. Five cases of fat-suppressed contrast-enhanced T1-weighted SE images demonstrated peripheral thin rim enhancement. The clinical presentation of intra-articular ganglion cyst is varied according to its intra-articular location. The MR appearance of intra-articular ganglion cyst is characteristic and usually associated with the cruciate ligament or the infrapatellar fat pad. Magnetic resonance arthrography has no definite advantage over conventional MR in the evaluation of the lesion. For intra-articular ganglion cyst in the infrapatellar fat pad, fat-suppressed contrast-enhanced MR imaging could be useful, because a thin, rim-enhancing feature of intra-articular ganglion cyst allows it to be distinguished from synovial hemangioma and synovial sarcoma. (orig.)

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

International Nuclear Information System (INIS)

Ojala, Risto; Klemola, Rauli; Karppinen, Jaro; Sequeiros, Roberto Blanco; Tervonen, Osmo

2001-01-01

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

The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT

International Nuclear Information System (INIS)

Markenstein, Jeroen E.; Jaspars, Kjell C.C.J.; Hulst, Victor P.M. van der; Willems, W.J.

2014-01-01

The purpose of this study is to investigate if magnetic resonance imaging with intra-articular contrast (MR-arthro) is as reliable as three-dimensionally reconstructed computed tomography imaging (3D-CT) in quantifying the glenoid bone loss in patients with anterior shoulder instability. Thirty-five patients were included. Sagittal MR-arthro and 3D-CT images of the glenoid surface were obtained pre-operatively. Two observers measured these images twice with OsiriX software in a randomized and blinded way. The intraclass correlations (ICC) of the intra- and inter-observer reliability within one method and an additional Bland-Altman plot for calculating agreement between the two methods were obtained. The joint estimates of the intra-observer reliability, taking into account the data from both observer A and B, for 3D-CT and MR-arthro were good to excellent. The intra-observer reliability was 0.938 (95 % CI: 0.879, 0.968) for 3D-CT and 0.799 (95 % CI: 0.639, 0.837) for MR-arthro. The inter-observer reliability between the two observers within one method (3D-CT or MR-arthro) was moderate to good. 3D-CT: 0.724 (95 % CI: 0.236, 0.886) and MR-arthro: 0.534 (95 % CI: 0.128, 0.762). Comparing both the 3D-CT and MR-arthro method, a Bland-Altman plot showed satisfying differences with the majority of outcomes (89 %) within 1 SD. Good to excellent intra- and moderate to good inter-observer correlations and a satisfying Bland-Altman plot when compared to 3D-CT show tendencies that MR-arthro is reliable and valid for measuring bony defects of the glenoid. (orig.)

The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT

Energy Technology Data Exchange (ETDEWEB)

Markenstein, Jeroen E. [Onze Lieve Vrouwe Gasthuis, Department of Orthopedic Surgery, Postbox 95500, Amsterdam (Netherlands); Jaspars, Kjell C.C.J. [Van Weel-Bethesda Ziekenhuis, Department of Orthopedic Surgery, Dirksland (Netherlands); Hulst, Victor P.M. van der [Onze Lieve Vrouwe Gasthuis, Department of Radiology, Postbox 95500, Amsterdam (Netherlands); Willems, W.J. [Delairesse Kliniek, Department of Orthopedic Surgery, Amsterdam (Netherlands)

2014-04-15

The purpose of this study is to investigate if magnetic resonance imaging with intra-articular contrast (MR-arthro) is as reliable as three-dimensionally reconstructed computed tomography imaging (3D-CT) in quantifying the glenoid bone loss in patients with anterior shoulder instability. Thirty-five patients were included. Sagittal MR-arthro and 3D-CT images of the glenoid surface were obtained pre-operatively. Two observers measured these images twice with OsiriX software in a randomized and blinded way. The intraclass correlations (ICC) of the intra- and inter-observer reliability within one method and an additional Bland-Altman plot for calculating agreement between the two methods were obtained. The joint estimates of the intra-observer reliability, taking into account the data from both observer A and B, for 3D-CT and MR-arthro were good to excellent. The intra-observer reliability was 0.938 (95 % CI: 0.879, 0.968) for 3D-CT and 0.799 (95 % CI: 0.639, 0.837) for MR-arthro. The inter-observer reliability between the two observers within one method (3D-CT or MR-arthro) was moderate to good. 3D-CT: 0.724 (95 % CI: 0.236, 0.886) and MR-arthro: 0.534 (95 % CI: 0.128, 0.762). Comparing both the 3D-CT and MR-arthro method, a Bland-Altman plot showed satisfying differences with the majority of outcomes (89 %) within 1 SD. Good to excellent intra- and moderate to good inter-observer correlations and a satisfying Bland-Altman plot when compared to 3D-CT show tendencies that MR-arthro is reliable and valid for measuring bony defects of the glenoid. (orig.)

MR-guided biopsies of undetermined liver lesions: technique and results; MRT-gezielte perkutane Biopsie bei unklaren fokalen Leberlaesionen: Technik und Ergebnisse

Energy Technology Data Exchange (ETDEWEB)

Zangos, S.; Kiefl, D.; Eichler, K.; Engelmann, K.; Heller, M.; Herzog, C.; Mack, M.G.; Jacobi, V.; Vogl, T.J. [Inst. fuer Diagnostische und Interventionelle Radiologie, Johann-Wolfgang-Goethe-Univ. Frankfurt (Germany)

2003-05-01

Purpose: To evaluate safety and precision of liver tumor biopsies performed in an open low field system using different sequence techniques. Materials and Methods: In 47 patients with liver tumors, MR-guided biopsies were performed in a low field system (0.2 Tesla, Magnetom Open, Siemens) using two different sequences. The procedure was monitored with T1-weighted FLASH sequences (TR/TE = 100/9; 70 ) in all patients and with FISP-Rotated-Keyhole-sequence (TR/TE = 18/8; 90 ) in additional 20 patients. After positioning of the needle tip in the tumors, 166 biopsy specimens were acquired with 16 G cutting needles (Somatex{sup *}). The diameter of the biopsied lesions ranged from 1 to 10 cm (mean diameter 3.2 cm). Visibility of the needles and precision of the biopsies were evaluated. Results: All interventional biopsies were performed without vascular or organ injuries. Adequate specimens for histologic interpretation were obtained in 42 cases (89.3%). The biopsy results were non-specific in 2 patients (4.2%) and the lesions missed in 3 patients (6.3%). Mean in-room time was 35 minutes and the intervention time was 8.3 minutes. T1-weighted FLASH images proved optimal for confirming needle-tip placement during the biopsies or punctures. Organs, tumors and vessels were easily identified. The FISP sequence proved to be inferior in visualizing vessels and tumors. Conclusion: MR-guided liver biopsies are safely and precisely performed using T1-weighted FLASH-sequences with sufficient visualization of the lesions and might be complementary to US- or CT-guided biopsies. (orig.) [German] Zielsetzung: Evaluierung der Sicherheit und Genauigkeit MRT-gezielter Leberbiopsien unter Verwendung verschiedener Sequenzen. Methoden: Bei 47 Patienten mit unklaren Leberlaesionen wurden in einem offenen 0,2-Tesla-MR-System (Magnetom Open, Siemens) bildgesteuerte Biopsien unter Verwendung von zwei verschiedenen Sequenzen durchgefuehrt. Die Bildgebung erfolgte bei allen Patienten mittels T

MR imaging of the hip

International Nuclear Information System (INIS)

Kramer, J.

2006-01-01

Full text: MRI has been shown to gain increasing importance in recent years in the evaluation of disorders of the hip and pelvis. Nowadays, conventional or fast spin echo (T1, Turbo (Fast) T2 (or PD)) MR imaging sequences are used most commonly to examine the hip and pelvis. Three dimensional (3D) gradient echo (GE) imaging allows acquisition of very thin (1 mm) sections. MR imaging with fat suppression technique (STIR, TIRM, FAT SAT T2) represent an effective screening technique for the assessment of fluid, hemorrhage, pus, or tumor in the marrow, joint or soft tissues. These techniques increase the sensitivity for the detection of a variety of pathologic processes. Fat suppression MR imaging, when combined with intravenous (or intraarticular) administration of a gadolinium compound, also is effective and often is employed when evaluating neoplastic or infectious diseases (intravenous injection), abnormalities of articular cartilage or labrum, or possible intraarticular osteocartilaginous bodies (intraarticular injection). A lesion of the acetabular labrum based is one cause of chronic hip pain in patients with developmental dysplasia of the hips, as well as in patients with a history of hip trauma or femoroacetabular impingement. MR imaging and, in particular, MR arthrography, however, have been shown to be highly accurate in the detection of subtle intraarticular abnormalities such as labral lesion. Conventional MR imaging has shown poor accuracy in detecting labral lesions, due to its inability to depict small tears and the difficulty in determining if intralabral signal abnormalities extend to the surface of the labrum. MR arthrography, however has been shown to overcome these difficulties and to have excellent accuracy in detecting labral pathology. As labral abnormalities are believed to be a precursor of osteoarthritis, orthopedic surgeons believe that surgical intervention will be influenced substantially by the type, extension and location of labral

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

The posterior transtriceps approach for elbow arthrography: a forgotten technique?

International Nuclear Information System (INIS)

Lohman, M.; Borrero, C.; Casagranda, B.; Rafiee, B.; Towers, J.

2009-01-01

To evaluate the technical feasibility of performing elbow MR arthrography via a posterior approach through the triceps. The images of 19 patients with elbow MR arthrography via a posterior transtriceps approach were retrospectively studied. The injections were performed by four musculoskeletal radiologists, using fluoroscopic guidance and a 22- or 25-gauge needle. The fluoroscopic and subsequent MR images were reviewed by two musculoskeletal radiologists and evaluated for adequacy of joint capsular distention, degree and location of contrast leakage, and presence of gas bubbles. The injection was diagnostic in all 19 patients, with a sufficient amount of contrast agent seen in the elbow joint. No significant contrast leakage occurred in 12 patients who received injections of 8 cc or less of contrast agent, but moderate contrast leakage occurred in 6/7 patients who received injections of greater than 8 cc. Contrast leakage generally occurred within the triceps myotendinous junction. No gas bubbles were identified in the injected joints. Patients often present for MR arthrography of the elbow with medial or lateral elbow pain. Contrast leakage during a radiocapitellar approach may complicate evaluation of the lateral collateral ligament or the common extensor tendon origin. Transtriceps MR arthrography offers an alternative to the more commonly used radiocapitellar approach. With injected volumes not exceeding 8 cc, the risk of significant contrast leakage is small. An advantage of the transtriceps injection is that contrast leakage through the posterior needle tract does not interfere with evaluation of the lateral structures. (orig.)

Diagnosis of lesions of the acetabular labrum, of the labral-chondral transition zone, and of the cartilage in femoroacetabular impingement: Correlation between direct magnetic resonance arthrography and hip arthroscopy.

Science.gov (United States)

Crespo Rodríguez, A M; de Lucas Villarrubia, J C; Pastrana Ledesma, M A; Millán Santos, I; Padrón, M

2015-01-01

To determine the sensitivity and accuracy of direct MR arthrography in the diagnosis of intra-articular lesions associated with femoroacetabular impingement. We used direct MR arthrography to study 51 patients with femoroacetabular impingement who underwent arthroscopic hip surgery. Surgery demonstrated 37 labral tears, 44 lesions in the labral-chondral transitional zone, and 40 lesions of the articular cartilage. We correlated the findings at preoperative direct MR arthrography with those of hip arthroscopy and calculated the sensitivity, specificity, positive predictive value, negative predictive value, and validity index for direct MR arthrography. The sensitivity and specificity of MR arthrography were 94.5% and 100%, respectively, for diagnosing labral tears, 100% and 87.5%, respectively, for diagnosing lesions of the labral-chondral transition zone, and 92.5% and 54.5%, respectively, for diagnosing lesions of the articular cartilage. The negative predictive value of MR arthrography for lesions of the labral-chondral transitional zone was 100%. MR arthrography accurately defined extensive lesions of the cartilage and the secondary osseous changes (the main factor in poor prognosis), although its diagnostic performance was not so good in small chondral lesions. In patients with femoroacetabular impingement, direct MR arthrography can adequately detect and characterize lesions of the acetabular labrum and of the labral-chondral transitional zone as well as extensive lesions of the articular cartilage and secondary osseous changes. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

MR imaging of abnormal synovial processes

International Nuclear Information System (INIS)

Quinn, S.F.; Sanchez, R.; Murray, W.T.; Silbiger, M.L.; Ogden, J.; Cochran, C.

1987-01-01

MR imaging can directly image abnormal synovium. The authors reviewed over 50 cases with abnormal synovial processes. The abnormalities include Baker cysts, semimembranous bursitis, chronic shoulder bursitis, peroneal tendon ganglion cyst, periarticular abscesses, thickened synovium from rheumatoid and septic arthritis, and synovial hypertrophy secondary to Legg-Calve-Perthes disease. MR imaging has proved invaluable in identifying abnormal synovium, defining the extent and, to a limited degree, characterizing its makeup

MR imaging of central nervous system birth injuries

International Nuclear Information System (INIS)

Heier, L.A.; Zimmerman, R.D.

1991-01-01

This paper reports on head injuries due to birth trauma that have been evaluated with plain radiography, US, and CT. In the past, patient monitoring and transportation difficulties for a neonate have limited the use of MR. Does MR provide more information that would assist the management and prognostic assessment of these patients? An MR examination was requested on all neonates born or transferred to our institution with a documented traumatic delivery. CT and MR studies were compared for seven patients, including three cases of difficult forceps delivery, one case of double footling breech with forceps head extraction, two cases of shoulder dystocias, and one case of vacuum extraction. CT caused underestimation of subdural hematomas and contusions in three of five patients with this injury. The appreciation of a large subdural hematoma at MR resulted in surgical intervention. Both unsuspected cervical cord contusion and complete cord transection were identified on sagittal head MR images. Four of four skull fractures identified at CT were not seen at MR

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.)

Advanced imaging of the musculoskeletal system: Standard, three-dimensional, and contrast-enhanced CT and MR imaging, and quantitative bone densitometry

International Nuclear Information System (INIS)

Resnick, D.; Sartoris, D.J.

1987-01-01

This course reviews the application of advanced imaging techniques to a broad spectrum of musculoskeletal disorders. The indications for and utility of standard CT in both the axial and the appendicular skeleton is explored. The combined use of CT with air and contrast arthrography at sites including the hip, knee, and shoulder is discussed. A summary of the proved and potential applications of MR imaging in osseous, articular, bone marrow, and soft-tissue disorders is provided. The utility of intraarticular contrast agents in enhancing the diagnostic capabilities of MR imaging for disorders of hyaline cartilage and and fibrocartilage is demonstrated. The advantages of multiplanar reformation and three-dimensional image reconstruction of cross-sectional imaging data are described in conjunction with the fundamental technological principles of these strategies. Accepted methods as well as investigative techniques for the diagnosis and follow-up of metabolic bone disease are contrasted with regard to relative indications, advantages, and limitations

High-field MR imaging of the tendons

International Nuclear Information System (INIS)

Beltran, J.; Burk, J.M.; Herman, L.J.; Mosure, J.C.

1987-01-01

MR imaging was used to investigate normal anatomy and pathologic conditions of the tendons. Tendons of experimental animals, cadaver joints, normal volunteers, and patients with suspected tendon pathology were studied. Tendon anatomy is easily identified because of the hypointensity of the tendons contrasting with the hyperintendensity of the surrounding fat. Pathologic conditions including posttraumatic and postsurgical tendon rupture, peritendinous scarring, tendinitis, and tenosynovitis are well seen with MR imaging. A detailed study of normal and abnormal tendon anatomy of the finger, wrist, shoulder, knee, and ankle is displayed, including MR images, gross specimens, and line drawings

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.

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

International Nuclear Information System (INIS)

Buck, Florian M.; Nico, Marcelo A.C.; Gheno, Ramon; Trudell, Debra J.; Resnick, Donald

2011-01-01

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 o . Conclusion: In conclusion the DRUJ is accessible to US except in the central 13 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.

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)

Evaluation of shoulder pathology: three-dimensional enhanced T1 high-resolution isotropic volume excitation MR vs two-dimensional fast spin echo T2 fat saturation MR.

Science.gov (United States)

Park, H J; Lee, S Y; Kim, M S; Choi, S H; Chung, E C; Kook, S H; Kim, E

2015-03-01

To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T1 high-resolution isotropic volume excitation (eTHRIVE) shoulder MR for the detection of rotator cuff tears, labral lesions and calcific tendonitis of the rotator cuff in comparison with two-dimensional (2D) fast spin echo T2 fat saturation (FS) MR. This retrospective study included 73 patients who underwent shoulder MRI using the eTHRIVE technique. Shoulder MR images were interpreted separately by two radiologists. They evaluated anatomic identification and image quality of the shoulder joint on routine MRI sequences (axial and oblique coronal T2 FS images) and compared them with the reformatted eTHRIVE images. The images were scored on a four-point scale (0, poor; 1, questionable; 2, adequate; 3, excellent) according to the degree of homogeneous and sufficient fat saturation to penetrate bone and soft tissue, visualization of the glenoid labrum and distinction of the supraspinatus tendon (SST). The diagnostic accuracy of eTHRIVE images compared with routine MRI sequences was evaluated in the setting of rotator cuff tears, glenoid labral injuries and calcific tendonitis of the SST. Fat saturation scores for eTHRIVE were significantly higher than those of the T2 FS for both radiologists. The sensitivity and accuracy of the T2 FS in diagnosing rotor cuff tears were >90%, whereas sensitivity and accuracy of the eTHRIVE method were significantly lower. The sensitivity, specificity and accuracy of both images in diagnosing labral injuries and calcific tendonitis were similar and showed no significant differences. The specificity of both images for the diagnosis of labral injuries and calcific tendonitis was higher than the sensitivities. The accuracy of 3D eTHRIVE imaging was comparable to that of 2D FSE T2 FS for the diagnosis of glenoid labral injury and calcific tendonitis of SST. The 3D eTHRIVE technique was superior to 2D FSE T2 FS in terms of fat saturation. Overall, 3D eTHRIVE was inferior

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

Energy Technology Data Exchange (ETDEWEB)

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.

LOCUS MR: Localization of unaffected spins in MR tomography and MR spectroscopy

International Nuclear Information System (INIS)

Matthael, D.; Haase, A.

1986-01-01

Different pulse sequences have been proposed for localized in vivo MR spectroscopy. For localized MR tomography and MR spectroscopy, a method is proposed, dubbed LOCUS (LOCalization of Unaffected Spins) MR. The method uses the initial saturation of regions surrounding the region of interest (ROI) in the presence of gradients. This is followed by a conventional MR study of the unaffected ROI. In animals, human extremities, and phantoms, proton MR studies demonstrated that the method provides an optimal signal-to-noise ratio, an easily variable ROI, and ROI shim. The method can be combined with two- and three-dimensional imaging, and it allows localized measurement of MR parameters. The multinuclear capability is discussed

Osteochondrosis dissecans of the knee: Evaluation of the evolution of MR morphology during treatment

International Nuclear Information System (INIS)

Palczewski, P.; Golebiowski, M.; Strzelczyk, P.

2008-01-01

To assess the evolution of MR morphology of OCD lesions in response to treatment and feasibility of MRI as a control study in patients with treated OCD. 11 patients (6 women and 5 men, aged 11-24 years, average age 17 years) with lesions affecting 12 knee joints were followed for approximately 24.2 months with repeated clinical examination and MR imaging. All MR studies were performed on a 1.5 Tesla unit. MR arthrography was performed in 3 patients. The evolution of MR morphology of the lesions was assessed with a 5-point scale and correlated with the results of clinical assessment with a modified Lysholm scale. In 10 patients, a good clinical result was achieved. In 7 knee joints of patients from this group, the features of the healing of the OCD lesion were observed in MRI and in 4 knees the morphology of the OCD lesion was stable. In 5 MR examinations, a transient deterioration was observed, which in 4 cases preceded healing and in 1 case stabilization in MR morphology. Transient deterioration may be observed in MR studies prior to the healing of OCD lesions irrespective of the improvement in clinical examination. The follow up of patients with OCD should be based mainly on clinical examination, with MR studies reserved for late control or patients with clinical signs of deterioration. (author)

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

Energy Technology Data Exchange (ETDEWEB)

Merila, M.; Eller, A.; Haviko, T. [Department of Orthopaedics, Clinic of Traumatology and Orthopaedics, University of Tartu, Puusepa 8, 51014, Tartu (Estonia); Leibecke, T.; Gehl, H.B. [Institute of Diagnostic Radiology, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck (Germany); Busch, L.C. [Institute of Anatomy, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck (Germany); Russlies, M. [Clinic of Orthopaedics, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck (Germany); Kolts, I. [Institute of Anatomy, University of Tartu, Ravila 19, Biomedicum, 50411, Tartu (Estonia)

2004-08-01

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

Importance of transthoracic X-ray in arthrography of the shoulder

International Nuclear Information System (INIS)

Beck, A.; Papacharalampous, X.; Grosser, G.; Noeldge, G.

1988-01-01

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.) [de

Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography

International Nuclear Information System (INIS)

Sahin, Murat; Calisir, Cuneyt; Omeroglu, Hakan; Inan, Ulukan; Mutlu, Fezan; Kaya, Tamer

2014-01-01

To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p<0.05). The same values for acetabular cartilage assessment were 89/56, 40/60, 71/71 (p>0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa) Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology

Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

International Nuclear Information System (INIS)

Shortt, Conor P.; Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C.; Roberts, Catherine C.

2009-01-01

The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

Energy Technology Data Exchange (ETDEWEB)

Shortt, Conor P. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Roberts, Catherine C. [Mayo Clinic College of Medicine, Department of Radiology, Phoenix, AZ (United States)

2009-04-15

The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

A meniscus causing painful snapping of the elbow joint: MR imaging with arthroscopic and histologic correlation

Energy Technology Data Exchange (ETDEWEB)

Huang, Guo-Shu; Chen, Cheng-Yu [National Defense Medical Center, Department of Radiology, Tri-Service General Hospital, Taipei (Taiwan); Lee, Chian-Her [National Defense Medical Center, Department of Orthopedic Surgery, Tri-Service General Hospital, Taipei (Taiwan); Lee, Herng-Sheng [National Defense Medical Center, Department of Pathology, Tri-Service General Hospital, Taipei (Taiwan)

2005-12-01

Snapping of the elbow joint can cause pain. We report a case of painful snapping elbow produced by an interposed meniscus in the radiohumeral joint in a 20-year-old man. The MR arthrogram demonstrated a meniscus-like tissue interposed between the radial head and humeral capitellum. The MR-arthrographic findings were well correlated with surgical findings. The location and appearance of the meniscus-like tissue was similar to that of meniscus in the knee joint. Histologic findings of the excised meniscus-like tissue showed a typical presentation of fibrocartilage. A meniscus may exist in the elbow joint and can be a rare cause of painful snapping elbow. MR arthrography is helpful for identifying the snapping tissue in the elbow joint. (orig.)

Adhesive capsulitis: role of MR imaging in differential diagnosis

International Nuclear Information System (INIS)

Connell, David; Padmanabhan, Ravi; Buchbinder, Rachelle

2002-01-01

The purpose of this study was to describe and characterize the MR imaging findings in a group of patients who underwent surgery for adhesive capsulitis. Twenty-four MR imaging studies in 24 consecutive patients with clinical evidence of adhesive capsulitis were performed prior to arthroscopic capsulotomy. There were 17 women and 7 men with a mean age of 53.5 years. Images were scrutinised for changes in the synovium particularly in the rotator interval, around the biceps anchor and axillary pouch. Intravenous gadolinium was given routinely. We also examined a control group of 22 patients who underwent the same MR imaging protocol after referral for rotator cuff pathology. Soft tissue density showing variable enhancement after gadolinium administration was visible in the rotator interval in 22 of 24 studies on MR imaging. Seventeen patients showed soft tissue density partially encasing the biceps anchor. Ten patients showed thickening and gadolinium enhancement of the axillary pouch. Three patients from the study cohort had partial tears of the supraspinatus tendon. All the patients subsequently had surgery which confirmed fibrovascular scar tissue in the rotator interval, around the biceps anchor and a variable degree of synovial inflammation of the glenohumeral capsule. Two patients from a control group with suspected rotator cuff pathology showed abnormal intensity in the rotator interval on MR imaging. Magnetic resonance imaging can identify changes in the shoulder joint that correspond to abnormalities seen at surgery. This may be useful for discriminating adhesive capsulitis from other causes of shoulder pain. (orig.)

Magnetic resonance imaging of the shoulder

International Nuclear Information System (INIS)

Ziemianski, A.; Romanowski, L.

1994-01-01

The technique of the own method of shoulder examination was presented. Anatomy and the most common diseases of the shoulder are discussed. The diseases of the shoulder diagnosed on the basis of the MR are: rotator cuff disease, impingement syndrome and instability. MR findings occurred in these entities were demonstrated. The most common MR finding of the rotator cuff disease was higher signal intensity within the supraspinatus tendon, while in shoulder instability was labral abnormality. Impingement syndrome is the previous syndrome of the full MR imaging of the rotator cuff disease. (author)

Elimination of motion and pulsation artifacts using BLADE sequences in shoulder MR imaging

International Nuclear Information System (INIS)

Lavdas, E.; Zaloni, E.; Vlychou, M.; Vassiou, K.; Fezoulidis, I.; Tsagkalis, A.; Dailiana, Z.

2015-01-01

To evaluate the ability of proton-density with fat-suppression BLADE (proprietary name for periodically rotated overlapping parallel lines with enhanced reconstruction in MR systems from Siemens Healthcare, PDFS BLADE) and turbo inversion recovery magnitude-BLADE (TIRM BLADE) sequences to reduce motion and pulsation artifacts in shoulder magnetic resonance examinations. Forty-one consecutive patients who had been routinely scanned for shoulder examination participated in the study. The following pairs of sequences with and without BLADE were compared: (a) Oblique coronal proton-density sequence with fat saturation of 25 patients and (b) oblique sagittal T2 TIRM-weighed sequence of 20 patients. Qualitative analysis was performed by two experienced radiologists. Image motion and pulsation artifacts were also evaluated. In oblique coronal PDFS BLADE sequences, motion artifacts have been significantly eliminated, even in five cases of non-diagnostic value with conventional imaging. Similarly, in oblique sagittal T2 TIRM BLADE sequences, image quality has been improved, even in six cases of non-diagnostic value with conventional imaging. Furthermore, flow artifacts have been improved in more than 80% of all the cases. The use of BLADE sequences is recommended in shoulder imaging, especially in uncooperative patients because it effectively eliminates motion and pulsation artifacts. (orig.)

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.)

Rotator cuff tears noncontrast MRI compared to MR arthrography

International Nuclear Information System (INIS)

Lee, Ji Hyun; Yoon, Young Cheol; Jung, Jee Young; Yoo, Jae Chul

2015-01-01

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.)

MR arthrography in chondromalacia patellae diagnosis on a low-field open magnet system.

Science.gov (United States)

Harman, Mustafa; Ipeksoy, Umit; Dogan, Ali; Arslan, Halil; Etlik, Omer

2003-01-01

The purpose of this study was to compare the diagnostic efficacy conventional MRI and MR arthrography (MRA) in the diagnosis of chondromalacia patella (CP) on a low-field open magnet system (LFOMS), correlated with arthroscopy. Forty-two patients (50 knees) with pain in the anterior part of the knee were prospectively examined with LFOMS, including T1-weighted, proton density-weighted and T2-weighted sequences. All were also examined T1-weighted MRI after intraarticular injection of dilue gadopentetate dimeglumine. Two observers, who reached a consensus interpretation, evaluated each imaging technique independently. Thirty-six of the 50 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity and accuracy of each imaging technique in the diagnosis of each stage of CP were determined and compared by using the McNemar two-tailed analysis. Arthroscopy showed that 16 facets were normal. Four (30%) of 13 grade 1 lesions were detected with T1. Four lesions (30%) with T2 and three lesions (23%) with proton-weighted images were detected. Seven (53%) of 13 grade 1 lesions were detected with MRA. Grade 2 abnormalities were diagnosed in two (33%) of six facets with proton density-weighted pulse sequences, two (33%) of six facets with T1-weighted pulse sequences, in three (50%) of six facets with T2-weighted pulse sequences, in five (83%) of six facets with MRA sequences. Grade 3 abnormalities were diagnosed in three (71%) of seven facets with proton density- and T1-weighted images, five (71%) of seven facets with T2-weighted pulse sequences, six (85%) of seven facets with MRA sequences. Grade 4 CP was detected with equal sensitivity with T1-, proton density- and T2-weighted pulse sequences, all showing seven (87%) of the eight lesions. MRA again showed these findings in all eight patients. All imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesion, so that no

MR-fluid yield surface determination in disc-type MR rotary brakes

International Nuclear Information System (INIS)

Farjoud, Alireza; Vahdati, Nader; Fah, Yap Fook

2008-01-01

Magneto-rheological (MR) fluids are currently attracting a great deal of attention because of their unique rheological behavior. Many devices have been designed using MR fluids, and of potential interest here are disc-type MR rotary brakes. The plug flow region in MR devices is defined as the region where the fluid is not flowing. The plug flow region plays an important role in design and analysis of MR devices. In MR dampers, the damping coefficient is a function of the plug thickness. In MR valves, the plug thickness is used to control the flow rate through, and the pressure drop across, the MR valve. A MR clutch is performing at the highest efficiency when the entire MR gap is the plug region. For an MR rotary brake, the highest restraining torque is obtained when the entire gap is the plug region as far as there are no wall slip effects. In this paper, using the Bercovier and Engelman constitutive model, the MR fluid flow in disc-type MR brakes is modeled to determine the plug flow region. The resulting system of equations is solved numerically. It is shown that the existence of a plug flow region in the brake will affect the control torque ratio. Better estimation of the plug flow region results in better estimation of the viscous torque

Use of 3D MR reconstructions in the evaluation of glenoid bone loss: a clinical study

International Nuclear Information System (INIS)

Gyftopoulos, Soterios; Beltran, Luis S.; Yemin, Avner; Recht, Michael P.; Strauss, Eric; Meislin, Robert; Jazrawi, Laith

2014-01-01

To assess the ability of 3D MR shoulder reconstructions to accurately quantify glenoid bone loss in the clinical setting using findings at the time of arthroscopy as the gold standard. Retrospective review of patients with MR shoulder studies that included 3D MR reconstructions (3D MR) produced using an axial Dixon 3D-T1W-FLASH sequence at our institution was conducted with the following inclusion criteria: history of anterior shoulder dislocation, arthroscopy (OR) performed within 6 months of the MRI, and an estimate of glenoid bone loss made in the OR using the bare-spot method. Two musculoskeletal radiologists produced estimates of bone loss along the glenoid width, measured in mm and %, on 3D MR using the best-fit circle method, which were then compared to the OR measurements. There were a total of 15 patients (13 men, two women; mean age, 28, range, 19-51 years). There was no significant difference, on average, between the MRI (mean 3.4 mm/12.6 %; range, 0-30 %) and OR (mean, 12.7 %; range, 0-30 %) measurements of glenoid bone loss (p = 0.767). A 95 % confidence interval for the mean absolute error extended from 0.45-2.21 %, implying that, when averaged over all patients, the true mean absolute error of the MRI measurements relative to the OR measurements is expected to be less than 2.21 %. Inter-reader agreement between the two readers had an IC of 0.92 and CC of 0.90 in terms of percentage of bone loss. 3D MR reconstructions of the shoulder can be used to accurately measure glenoid bone loss. (orig.)

Use of 3D MR reconstructions in the evaluation of glenoid bone loss: a clinical study

Energy Technology Data Exchange (ETDEWEB)

Gyftopoulos, Soterios; Beltran, Luis S.; Yemin, Avner; Recht, Michael P. [NYU Langone Medical Center, Department of Radiology, New York, NY (United States); Strauss, Eric; Meislin, Robert; Jazrawi, Laith [NYU Langone Medical Center, Center for Musculoskeletal Care, Department of Orthopaedic Surgery, New York, NY (United States)

2014-02-15

To assess the ability of 3D MR shoulder reconstructions to accurately quantify glenoid bone loss in the clinical setting using findings at the time of arthroscopy as the gold standard. Retrospective review of patients with MR shoulder studies that included 3D MR reconstructions (3D MR) produced using an axial Dixon 3D-T1W-FLASH sequence at our institution was conducted with the following inclusion criteria: history of anterior shoulder dislocation, arthroscopy (OR) performed within 6 months of the MRI, and an estimate of glenoid bone loss made in the OR using the bare-spot method. Two musculoskeletal radiologists produced estimates of bone loss along the glenoid width, measured in mm and %, on 3D MR using the best-fit circle method, which were then compared to the OR measurements. There were a total of 15 patients (13 men, two women; mean age, 28, range, 19-51 years). There was no significant difference, on average, between the MRI (mean 3.4 mm/12.6 %; range, 0-30 %) and OR (mean, 12.7 %; range, 0-30 %) measurements of glenoid bone loss (p = 0.767). A 95 % confidence interval for the mean absolute error extended from 0.45-2.21 %, implying that, when averaged over all patients, the true mean absolute error of the MRI measurements relative to the OR measurements is expected to be less than 2.21 %. Inter-reader agreement between the two readers had an IC of 0.92 and CC of 0.90 in terms of percentage of bone loss. 3D MR reconstructions of the shoulder can be used to accurately measure glenoid bone loss. (orig.)

MR Imaging of the Triangular Fibrocartilage Complex.

Science.gov (United States)

Cody, Michael E; Nakamura, David T; Small, Kirstin M; Yoshioka, Hiroshi

2015-08-01

MR imaging has emerged as the mainstay in imaging internal derangement of the soft tissues of the musculoskeletal system largely because of superior contrast resolution. The complex geometry and diminutive size of the triangular fibrocartilage complex (TFCC) and its constituent structures can make optimal imaging of the TFCC challenging; therefore, production of clinically useful images requires careful optimization of image acquisition parameters. This article provides a foundation for advanced TFCC imaging including factors to optimize magnetic resonance images, arthrography, detailed anatomy, and classification of injury. In addition, clinical presentations and treatments for TFCC injury are briefly considered. Copyright © 2015 Elsevier Inc. All rights reserved.

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

International Nuclear Information System (INIS)

Lohan, Derek G.; Seeger, Leanne L.; Motamedi, Kambiz; Sayre, James; Hame, Sharon

2009-01-01

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

Synthesis and characterization of magneto-rheological (MR fluids for MR brake application

Directory of Open Access Journals (Sweden)

Bhau K. Kumbhar

2015-09-01

Full Text Available Magneto rheological (MR fluid technology has been proven for many industrial applications like shock absorbers, actuators, etc. MR fluid is a smart material whose rheological characteristics change rapidly and can be controlled easily in presence of an applied magnetic field. MR brake is a device to transmit torque by the shear stress of MR fluid. However, MR fluids exhibit yield stress of 50–90 kPa. In this research, an effort has been made to synthesize MR fluid sample/s which will typically meet the requirements of MR brake applications. In this study, various electrolytic and carbonyl iron powder based MR fluids have been synthesized by mixing grease as a stabilizer, oleic acid as an antifriction additive and gaur gum powder as a surface coating to reduce agglomeration of the MR fluid. MR fluid samples based on sunflower oil, which is bio-degradable, environmentally friendly and abundantly available have also been synthesized. These MR fluid samples are characterized for determination of magnetic, morphological and rheological properties. This study helps identify most suitable localized MR fluid meant for MR brake application.

Shoulder arthrography: A study for the correlation of anatomy and radiology

International Nuclear Information System (INIS)

Sung, K. J.; Kim, I. Y.; Park, C. Y.

1983-01-01

Shoulder arthrogram and dissection in cadaver were performed for clinical application. Puncture site for contrast injection was studied. The results were as follows: 1. Shoulder joints is located above the axillar and arthrography of shoulder is a simple, safe and easily interpreted. 2. The land mark for injection is a point 1.5 cm below the tip of coracoid process and very slightly medial to it. 3. There were contrast material leak from subscapular recess and distal end of the synovial sheath surrounding the long head of the biceps tendon in normal shoulder arthrogram. 4. Synoviad cavity margin show smoothness and no abnormal filling defect. 5. There were no communication between synovial cavity and subdeltoid bursa. 6. There were no specific anatomic variation in shoulder joint

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

International Nuclear Information System (INIS)

Ahn, Sang Hyuk; Park, Jung Hwan; Moon, Tae Yong; Lee, In Sook; Lee, Seung Jun

2012-01-01

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

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.

Value of new MR techniques in MR-PET; Stellenwert neuer MR-Techniken in der MR-PET

Energy Technology Data Exchange (ETDEWEB)

Attenberger, U.I.; Schoenberg, S.O. [Universitaetsmedizin Mannheim, Medizinische Fakultaet Mannheim der Universitaet Heidelberg, Institut fuer klinische Radiologie und Nuklearmedizin, Mannheim (Germany); Quick, H.H. [Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Institut fuer Medizinische Physik, Erlangen (Germany); Guimaraes, A. [Massachusetts General Hospital, Martinos Center for Biomedical Imaging, Department of Radiology, Charlestown (United States); Catalano, O. [University of Naples Federico II, Naples (Italy); Morelli, J.N. [The Johns Hopkins Hospital, The Russell H. Morgan Department of Radiology and Radiological Science, Baltimore (United States)

2013-12-15

The unparalleled soft tissue contrast of magnetic resonance imaging (MRI) and the functional information obtainable with 18-F fluorodeoxyglucose positron emission tomography (FDG-PET) render MR-PET well-suited for oncological and psychiatric imaging. The lack of ionizing radiation with MRI also makes MR-PET a promising modality for oncology patients requiring frequent follow-up and pediatric patients. Lessons learned with PET computed tomography (CT) over the last few years do not directly translate to MR-PET. For example, in PET-CT the Hounsfield units derived from CT are used for attenuation correction (AC). As 511 keV photons emitted in PET examinations are attenuated by the patient's body CT data are converted directly to linear attenuation coefficients (LAC); however, proton density measured by MRI is not directly related to the radiodensity or LACs of biological tissue. Thus, direct conversion to LAC data is not possible making AC more challenging in simultaneous MRI-PET scanning. In addition to these constraints simultaneous MRI-PET acquisitions also improve on some solutions to well-known challenges of hybrid imaging techniques, such as limitations in motion correction. This article reports on initial clinical experiences with simultaneously acquired MRI-PET data, focusing on the potential benefits and limitations of MRI with respect to motion correction as well as metal and attenuation correction artefacts. (orig.) [German] Die klinische Implementierung der neuen Hybridtechnologie MR-Positronenemissionstomographie (MR-PET) bietet durch die Kombination aus hochaufloesender Morphologie, Funktion und Metabolismus bisher ungeahnte diagnostische Moeglichkeiten, die nicht nur fuer die Diagnose und die Verlaufskontrolle onkologischer und psychiatrischer Erkrankungen von hoher Bedeutung sind. Verglichen mit der PET-CT wird dies mit reduzierter Strahlenbelastung fuer den Patienten moeglich, was wiederum insbesondere fuer Patienten in der Tumornachsorge, die

MR/PET quantification tools: Registration, segmentation, classification, and MR-based attenuation correction

Science.gov (United States)

Fei, Baowei; Yang, Xiaofeng; Nye, Jonathon A.; Aarsvold, John N.; Raghunath, Nivedita; Cervo, Morgan; Stark, Rebecca; Meltzer, Carolyn C.; Votaw, John R.

2012-01-01

Purpose: Combined MR/PET is a relatively new, hybrid imaging modality. A human MR/PET prototype system consisting of a Siemens 3T Trio MR and brain PET insert was installed and tested at our institution. Its present design does not offer measured attenuation correction (AC) using traditional transmission imaging. This study is the development of quantification tools including MR-based AC for quantification in combined MR/PET for brain imaging. Methods: The developed quantification tools include image registration, segmentation, classification, and MR-based AC. These components were integrated into a single scheme for processing MR/PET data. The segmentation method is multiscale and based on the Radon transform of brain MR images. It was developed to segment the skull on T1-weighted MR images. A modified fuzzy C-means classification scheme was developed to classify brain tissue into gray matter, white matter, and cerebrospinal fluid. Classified tissue is assigned an attenuation coefficient so that AC factors can be generated. PET emission data are then reconstructed using a three-dimensional ordered sets expectation maximization method with the MR-based AC map. Ten subjects had separate MR and PET scans. The PET with [11C]PIB was acquired using a high-resolution research tomography (HRRT) PET. MR-based AC was compared with transmission (TX)-based AC on the HRRT. Seventeen volumes of interest were drawn manually on each subject image to compare the PET activities between the MR-based and TX-based AC methods. Results: For skull segmentation, the overlap ratio between our segmented results and the ground truth is 85.2 ± 2.6%. Attenuation correction results from the ten subjects show that the difference between the MR and TX-based methods was <6.5%. Conclusions: MR-based AC compared favorably with conventional transmission-based AC. Quantitative tools including registration, segmentation, classification, and MR-based AC have been developed for use in combined MR

MR/PET quantification tools: Registration, segmentation, classification, and MR-based attenuation correction

Energy Technology Data Exchange (ETDEWEB)

Fei, Baowei, E-mail: bfei@emory.edu [Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1841 Clifton Road Northeast, Atlanta, Georgia 30329 (United States); Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, Georgia 30322 (United States); Department of Mathematics and Computer Sciences, Emory University, Atlanta, Georgia 30322 (United States); Yang, Xiaofeng; Nye, Jonathon A.; Raghunath, Nivedita; Votaw, John R. [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia 30329 (United States); Aarsvold, John N. [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia 30329 (United States); Nuclear Medicine Service, Atlanta Veterans Affairs Medical Center, Atlanta, Georgia 30033 (United States); Cervo, Morgan; Stark, Rebecca [The Medical Physics Graduate Program in the George W. Woodruff School, Georgia Institute of Technology, Atlanta, Georgia 30332 (United States); Meltzer, Carolyn C. [Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia 30329 (United States); Department of Neurology and Department of Psychiatry and Behavior Sciences, Emory University School of Medicine, Atlanta, Georgia 30322 (United States)

2012-10-15

Purpose: Combined MR/PET is a relatively new, hybrid imaging modality. A human MR/PET prototype system consisting of a Siemens 3T Trio MR and brain PET insert was installed and tested at our institution. Its present design does not offer measured attenuation correction (AC) using traditional transmission imaging. This study is the development of quantification tools including MR-based AC for quantification in combined MR/PET for brain imaging. Methods: The developed quantification tools include image registration, segmentation, classification, and MR-based AC. These components were integrated into a single scheme for processing MR/PET data. The segmentation method is multiscale and based on the Radon transform of brain MR images. It was developed to segment the skull on T1-weighted MR images. A modified fuzzy C-means classification scheme was developed to classify brain tissue into gray matter, white matter, and cerebrospinal fluid. Classified tissue is assigned an attenuation coefficient so that AC factors can be generated. PET emission data are then reconstructed using a three-dimensional ordered sets expectation maximization method with the MR-based AC map. Ten subjects had separate MR and PET scans. The PET with [{sup 11}C]PIB was acquired using a high-resolution research tomography (HRRT) PET. MR-based AC was compared with transmission (TX)-based AC on the HRRT. Seventeen volumes of interest were drawn manually on each subject image to compare the PET activities between the MR-based and TX-based AC methods. Results: For skull segmentation, the overlap ratio between our segmented results and the ground truth is 85.2 ± 2.6%. Attenuation correction results from the ten subjects show that the difference between the MR and TX-based methods was <6.5%. Conclusions: MR-based AC compared favorably with conventional transmission-based AC. Quantitative tools including registration, segmentation, classification, and MR-based AC have been developed for use in combined MR/PET.

MR/PET quantification tools: Registration, segmentation, classification, and MR-based attenuation correction

International Nuclear Information System (INIS)

Fei, Baowei; Yang, Xiaofeng; Nye, Jonathon A.; Raghunath, Nivedita; Votaw, John R.; Aarsvold, John N.; Cervo, Morgan; Stark, Rebecca; Meltzer, Carolyn C.

2012-01-01

Purpose: Combined MR/PET is a relatively new, hybrid imaging modality. A human MR/PET prototype system consisting of a Siemens 3T Trio MR and brain PET insert was installed and tested at our institution. Its present design does not offer measured attenuation correction (AC) using traditional transmission imaging. This study is the development of quantification tools including MR-based AC for quantification in combined MR/PET for brain imaging. Methods: The developed quantification tools include image registration, segmentation, classification, and MR-based AC. These components were integrated into a single scheme for processing MR/PET data. The segmentation method is multiscale and based on the Radon transform of brain MR images. It was developed to segment the skull on T1-weighted MR images. A modified fuzzy C-means classification scheme was developed to classify brain tissue into gray matter, white matter, and cerebrospinal fluid. Classified tissue is assigned an attenuation coefficient so that AC factors can be generated. PET emission data are then reconstructed using a three-dimensional ordered sets expectation maximization method with the MR-based AC map. Ten subjects had separate MR and PET scans. The PET with ["1"1C]PIB was acquired using a high-resolution research tomography (HRRT) PET. MR-based AC was compared with transmission (TX)-based AC on the HRRT. Seventeen volumes of interest were drawn manually on each subject image to compare the PET activities between the MR-based and TX-based AC methods. Results: For skull segmentation, the overlap ratio between our segmented results and the ground truth is 85.2 ± 2.6%. Attenuation correction results from the ten subjects show that the difference between the MR and TX-based methods was <6.5%. Conclusions: MR-based AC compared favorably with conventional transmission-based AC. Quantitative tools including registration, segmentation, classification, and MR-based AC have been developed for use in combined MR/PET.

Comparative analysis of anterior and posterior contrast injection approaches for shoulder MR arthrograms in adolescents

Energy Technology Data Exchange (ETDEWEB)

Gupton, Theodore B.; Cahill, Anne M. [The Children' s Hospital of Philadelphia, Division of Interventional Radiology, Department of Radiology, Philadelphia, PA (United States); Delgado, Jorge [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Jaramillo, Diego [Stanford University Medical Center, Diagnostic Radiology, Palo Alto, CA (United States); Chauvin, Nancy A. [The Children' s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Musculoskeletal Imaging, Department of Radiology, Philadelphia, PA (United States)

2016-12-15

There is no consensus in the literature concerning the optimal approach for performing a fluoroscopically guided shoulder arthrogram injection in a pediatric population. To compare adequacy of capsular injection and radiation doses between fluoroscopically guided anterior and posterior glenohumeral joint contrast injections in adolescents. We evaluated imaging in 67 adolescents (39 boys, 28 girls; mean age 16.0 years; range 11.7-19.1 years) who underwent an anterior approach glenohumeral contrast injection with subsequent MR imaging, and 67 age- and gender-matched subjects (39 boys, 28 girls; mean age 16.0 years; range 11.1-19.2 years) who underwent a posterior approach injection during the period June 2010 to September 2015. Two pediatric radiologists independently evaluated all MR shoulder arthrograms to assess adequacy of capsular distention and degree of contrast extravasation. We recorded total fluoroscopic time, dose-area product (DAP) and cumulative air kerma (CAK). There were no significant differences in age, gender, height, weight or body mass index between the populations (P-values > 0.6). The amount of contrast extravasation between the groups was not significantly different (P = 0.27). Three anterior injections (4.5%) and one posterior (1.5%) were suboptimal (P = 0.62). Fluoroscopy time was not different: 1.1 min anterior and 1.3 min posterior (P = 0.14). There was a significant difference in CAK (0.7 mGy anterior and 1.1 mGy posterior; P = 0.007) and DAP (5.3 μGym{sup 2} anterior and 9.4 μGym{sup 2} posterior; P = 0.008). Inter-rater agreement was excellent (Cohen kappa >0.81). Both techniques were technically successful. There was no difference in the fluoroscopy time for either approach. The radiation dose was higher with the posterior approach but this is of questionable clinical significance. (orig.)

MR-based source localization for MR-guided HDR brachytherapy

Science.gov (United States)

Beld, E.; Moerland, M. A.; Zijlstra, F.; Viergever, M. A.; Lagendijk, J. J. W.; Seevinck, P. R.

2018-04-01

For the purpose of MR-guided high-dose-rate (HDR) brachytherapy, a method for real-time localization of an HDR brachytherapy source was developed, which requires high spatial and temporal resolutions. MR-based localization of an HDR source serves two main aims. First, it enables real-time treatment verification by determination of the HDR source positions during treatment. Second, when using a dummy source, MR-based source localization provides an automatic detection of the source dwell positions after catheter insertion, allowing elimination of the catheter reconstruction procedure. Localization of the HDR source was conducted by simulation of the MR artifacts, followed by a phase correlation localization algorithm applied to the MR images and the simulated images, to determine the position of the HDR source in the MR images. To increase the temporal resolution of the MR acquisition, the spatial resolution was decreased, and a subpixel localization operation was introduced. Furthermore, parallel imaging (sensitivity encoding) was applied to further decrease the MR scan time. The localization method was validated by a comparison with CT, and the accuracy and precision were investigated. The results demonstrated that the described method could be used to determine the HDR source position with a high accuracy (0.4–0.6 mm) and a high precision (⩽0.1 mm), at high temporal resolutions (0.15–1.2 s per slice). This would enable real-time treatment verification as well as an automatic detection of the source dwell positions.

Generation of structural MR images from amyloid PET: Application to MR-less quantification.

Science.gov (United States)

Choi, Hongyoon; Lee, Dong Soo

2017-12-07

Structural magnetic resonance (MR) images concomitantly acquired with PET images can provide crucial anatomical information for precise quantitative analysis. However, in the clinical setting, not all the subjects have corresponding MR. Here, we developed a model to generate structural MR images from amyloid PET using deep generative networks. We applied our model to quantification of cortical amyloid load without structural MR. Methods: We used florbetapir PET and structural MR data of Alzheimer's Disease Neuroimaging Initiative database. The generative network was trained to generate realistic structural MR images from florbetapir PET images. After the training, the model was applied to the quantification of cortical amyloid load. PET images were spatially normalized to the template space using the generated MR and then standardized uptake value ratio (SUVR) of the target regions was measured by predefined regions-of-interests. A real MR-based quantification was used as the gold standard to measure the accuracy of our approach. Other MR-less methods, a normal PET template-based, multi-atlas PET template-based and PET segmentation-based normalization/quantification methods, were also tested. We compared performance of quantification methods using generated MR with that of MR-based and MR-less quantification methods. Results: Generated MR images from florbetapir PET showed visually similar signal patterns to the real MR. The structural similarity index between real and generated MR was 0.91 ± 0.04. Mean absolute error of SUVR of cortical composite regions estimated by the generated MR-based method was 0.04±0.03, which was significantly smaller than other MR-less methods (0.29±0.12 for the normal PET-template, 0.12±0.07 for multiatlas PET-template and 0.08±0.06 for PET segmentation-based methods). Bland-Altman plots revealed that the generated MR-based SUVR quantification was the closest to the SUVR values estimated by the real MR-based method. Conclusion

Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

International Nuclear Information System (INIS)

Chang, Weiling; Peduto, Anthony J.; Aguiar, Rodrigo O.C.; Trudell, Debra J.; Resnick, Donald L.

2007-01-01

To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

Arcuate ligament of the wrist: normal MR appearance and its relationship to palmar midcarpal instability: a cadaveric study

Energy Technology Data Exchange (ETDEWEB)

Chang, Weiling [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Sharp-Grossmont Hospital, Department of Radiology, La Mesa, CA (United States); Peduto, Anthony J. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Westmead Hospital and Western Clinical School of Sydney University, Department of Radiology, Sydney (Australia); Aguiar, Rodrigo O.C. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Universidade Federal do Rio de Janeiro, Rio de Janerio (Brazil); Trudell, Debra J.; Resnick, Donald L. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States)

2007-07-15

To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate (THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing ligament. T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding MR images. The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted ''V'' joining the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging but can also be seen in standard imaging planes. SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. (orig.)

MR tractography

International Nuclear Information System (INIS)

Kinosada, Yasutomi; Okuda, Yasuyuki; Ono, Mototsugu

1993-01-01

We developed a new noninvasive technique to visualize the anatomical structure of the nerve fiber system in vivo, and named this technique magnetic resonance (MR) tractography and the acquired image an MR tractogram. MR tractography has two steps. One is to obtain diffusion-weighted images sensitized along axes appropriate for depicting the intended nerve fibers with anisotropic water diffusion MR imaging. The other is to extract the anatomical structure of the nerve fiber system from a series of diffusion-weighted images by the maximum intensity projection method. To examine the clinical usefulness of the proposed technique, many contiguous, thin (3 mm) coronal two-dimensional sections of the brain were acquired sequentially in normal volunteers and selected patients with paralyses, on a 1.5 Tesla MR system (Signa, GE) with an ECG-gated Stejskal-Tanner pulse sequence. The structure of the nerve fiber system of normal volunteers was almost the same as the anatomy. The tractograms of patients with paralyses clearly showed the degeneration of nerve fibers and were correlated with clinical symptoms. MR tractography showed great promise for the study of neuroanatomy and neuroradiology. (author)

Fibrous soft tissue tumor of neck and shoulder girdle: MR and CT characteristics

International Nuclear Information System (INIS)

Gu Yajia; Peng Weijun; Wang Peihua; Wang Jian

2005-01-01

Objective: To evaluate MR and CT imagings of desmoplastic fibroblastoma (DF) and aggressive fibromatosis (AF) in neck and shoulder girdle, and to emphasis upon the MRI findings with pathological correlation. Methods: MR and CT appearances of DFs (4 cases) and AFS (3 cases) confirmed by surgical and pathologic findings were retrospective analysed, which were correlated to the pathologic features. Four cases of DF were male patients, with a median age at 48 years. Two cases of AF were female (20, 29 years respectively), and another AF patient was male (79 years). Results: (1) Four DFs were round mass located in the inter muscle space of neck, and the margins were mostly well-circumscribed. Envelope was seen in one lesion on MRI. On unenhanced CT, the masses showed homogeneous low attenuation (2 cases) or slightly low attenuation with several heterogeneous areas in it (1 cases). Enhancement was not obvious on post-contrast CT images. MRI studies were done in two patients. Signal intensity (SI) on MR was homogeneous and heterogeneous one lesion respectively on unenhanced T 1 -weighted images. Mixed SI as low or high SI nodes within isointense compared with muscle on T 2 -weighted images. No evident enhancing was noted after administration of gadopentetate dimeglumine. (2) All three lesions of aggressive fibromatosis arose from musculoaponeurotic structures. The masses were irregular margin and appeared elongated, which oriented in the direction of the muscle bundle. On unenhanced CT examination, the masses had poorly defined and isodense relative to adjacent musculature (2 cases). On T 1 -weighted images, three masses consisted of poormargination and isointensity relative to adjacent muscle. On T 2 -weighted images, two lesions were heterogeneity of signal, which predominantly slightly high in SI with strip-or node-shape low SI, and one lesion had homogeneous high SI. On post-contrast T 1 -weighted images, all lesions showed marked enhancement, heterogeneity of signal

MR imaging after therapeutic injection of the subacromial bursa

International Nuclear Information System (INIS)

Major, N.M.

1999-01-01

Objective. As a therapeutic injection into the subacromial bursa (SAB) is commonly performed for impingement syndrome, it is important to know whether this fluid can be retained for a period of time and cause confusion with a pathologic collection of fluid. This study identifies and describes the appearance of recent subacromial injection using MR imaging, and the appearance of a potential complication.Design and patients. Fourteen asymptomatic shoulders were studied with MR imaging using fast spin echo T2-weighted imaging (1.5 T) prior to injection with 7 cm 3 of xylocaine. Four shoulders had subacromial fluid and were eliminated from the study. The remaining 10 (9 men, 1 woman; age range 27-36 years, average age 33 years) were then re-imaged immediately, and at 6, 12 and 24 h after the injection or until fluid resolved. Each set of images was reviewed for the presence of fluid in the SAB and for additional abnormalities.Results. Fluid was identified in all subjects in the SAB in the immediate, 6 and 12 h post-injection images. At 24 h, fluid was not identified within the SAB in eight of 10 patients. In one patient fluid resolved in 48 h. The other continued to demonstrate fluid in the SAB and in the joint as well as abnormal signal in the infraspinatus muscle from a presumed myositis. Imaging was performed up to 10 days after the injection in this patient.Conclusions. It is known that fluid identified in the SAB without evidence of a cuff tear may be due to bursitis. However, if MR imaging is performed within 24 h of injection, the presence of the fluid may be iatrogenic. In addition, the history of recent therapeutic injection is very important as complications such as myositis can occur as a result of the injection. Knowledge of injection prior to imaging is vital for accurate interpretation of MR shoulder examinations. (orig.)

MR imaging after therapeutic injection of the subacromial bursa

Energy Technology Data Exchange (ETDEWEB)

Major, N.M. [Duke University Medical Center, Department of Radiology, Division Musculoskeletal, Durham, NC (United States)

1999-11-01

Objective. As a therapeutic injection into the subacromial bursa (SAB) is commonly performed for impingement syndrome, it is important to know whether this fluid can be retained for a period of time and cause confusion with a pathologic collection of fluid. This study identifies and describes the appearance of recent subacromial injection using MR imaging, and the appearance of a potential complication.Design and patients. Fourteen asymptomatic shoulders were studied with MR imaging using fast spin echo T2-weighted imaging (1.5 T) prior to injection with 7 cm{sup 3} of xylocaine. Four shoulders had subacromial fluid and were eliminated from the study. The remaining 10 (9 men, 1 woman; age range 27-36 years, average age 33 years) were then re-imaged immediately, and at 6, 12 and 24 h after the injection or until fluid resolved. Each set of images was reviewed for the presence of fluid in the SAB and for additional abnormalities.Results. Fluid was identified in all subjects in the SAB in the immediate, 6 and 12 h post-injection images. At 24 h, fluid was not identified within the SAB in eight of 10 patients. In one patient fluid resolved in 48 h. The other continued to demonstrate fluid in the SAB and in the joint as well as abnormal signal in the infraspinatus muscle from a presumed myositis. Imaging was performed up to 10 days after the injection in this patient.Conclusions. It is known that fluid identified in the SAB without evidence of a cuff tear may be due to bursitis. However, if MR imaging is performed within 24 h of injection, the presence of the fluid may be iatrogenic. In addition, the history of recent therapeutic injection is very important as complications such as myositis can occur as a result of the injection. Knowledge of injection prior to imaging is vital for accurate interpretation of MR shoulder examinations. (orig.)

MR patterns of rotator cuff impingement lesions and histopathologic correlation of cadaver tendons

International Nuclear Information System (INIS)

Rafii, M.; Firooznia, H.; Minkoff, J.; Sherman, O.; Schinella, R.; Weinreb, J.C.; Golimbu, C.; Zazlav, K.

1989-01-01

This paper reports shoulder MR examinations of 250 patients retrospectively evaluated and correlated with surgical/arthrographic results in 68 patients and with clinical data in all for assessment of the signal pattern and the configuration of rotator cuff lesions. MR-histopathologic evaluation of the supraspinatus tendon of 8 cadaver shoulders was also correlated with these findings. MR imaging had a sensitivity of 92% in the diagnosis of cuff tears. The most common and accurate criterion for a tear was a tendinous defect, characterized by intense signal on T2-weighted images; less often the torn region consisted of an extremely degenerated and attenuated tendon or was obscured by scar. Presence of secondary findings was mandatory for diagnosis in the latter group. Signal pattern associated with tendonitis varied, and in some simulated that of tendon degeneration (fatty infiltration and fibrillation) or cellular proliferation observed on anatomic specimens. Associated tendinous enlargement and subacromial-subdeltoid bursitis in these patients best correlated with the severity of clinical and surgical findings

The POLPSA lesion: MR imaging findings with arthroscopic correlation in patients with posterior instability

International Nuclear Information System (INIS)

Yu, Joseph S.; Ashman, Carol J.; Jones, Grant

2002-01-01

Objective. To evaluate the features of the posterior labrocapsular periosteal sleeve avulsion (POLPSA) lesion on MR imaging in athletes with posterior shoulder instability.Design and patients. Six male athletes (age range 19-43 years) with avulsion of the posterior glenoid periosteum were identified on MR imaging. There were four football players, one wrestler, and one competitive weightlifter. The weightlifter had a bilateral condition so that seven shoulders were evaluated. MR imaging was performed with a 1.5 T magnet utilizing conventional and fat-saturated fast spin-echo coronal oblique and sagittal oblique sequences and a 3D-GRE transaxial sequence. Surgical correlation was available in all shoulders.Results. All patients presented with pain and a joint effusion. The size of the periosteal sleeve and redundant joint recess was variable. Fibrous proliferation was noted arthroscopically in four shoulders beneath the sleeve. Although the posterior labrum was detached in all studies, only one labrum had a tear while two showed marked degeneration.Conclusion. The POLPSA lesion is an abnormality that can be associated with posterior instability. It differs from a reverse Bankart lesion because the periosteum, although detached, remains intact with the posterior capsule and detached posterior labrum. This lesion may represent an acute form of a Bennett lesion. (orig.)

MR-guided biopsies

International Nuclear Information System (INIS)

Gehl, H.B.; Frahm, C.

1998-01-01

Biopsies were the first 'intervention' under MR guidance. After initial difficulties concerning ferromagnetic biopsy instruments and the design of MR scanners, the latest technological improvements rendered MR guidance for biopsies more feasible. In this article we illustrate present-day clinical experience in the field of abdominal, breast and bone biopsy. Important aspects regarding the different designs of 'interventional' MR scanners and the visualization of instruments for biopsy are discussed. (orig.) [de

Correction of distortion of MR pictures for MR-guided robotic sterotactic procedures

International Nuclear Information System (INIS)

Jonckheere, E.A.; Kwoh, Y.S.

1988-01-01

Ever since magnetic resonance (MR) invaded the medical imaging field, it has played an increasingly important role and is even currently being considered for stereotactic guidance of probes in the brain. While MR pictures indeed convey more clinical information than CT, the geometry of MR pictures is, unfortunately, not as accurate as the geometry of CT pictures. In other words, if a square grid phantom is scanned, then the CT picture will show a square grid, while the MR picture will rather reveal a distorted grid. This distortion is primarily due to small variations in the static magnetic field. This small distortion does not impede radiological diagnosis; however, it is a source of concern if one contemplates utilizing the MR pictures for accurate stereotactic positioning of a probe at a very precise point in the brain. Another area of application where the distortion of the MR picture should be compensated for is the superposition of CT and MR pictures so that both informations could be used for diagnosis or stereotactic purposes. This paper essentially addresses the nonlinear distortion of MR pictures and how it could be compensated for through software manipulation of the MR picture

The 'bridging sign', a MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

International Nuclear Information System (INIS)

Jung, Jin Young; Yoon, Young Cheol; Cha, Dong Ik; Yoo, Jae-Chul; Jung, Jee Young

2013-01-01

Background: In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the 'bridging sign', which has not been previously described. Purpose: To describe the 'bridging sign' on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods: Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the 'bridging sign' and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the 'bridging sign' was assessed and the sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the 'bridging sign' were compared. Results: The 'bridging sign' was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the 'bridging sign' had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of combined FTTs of the SSC tendon and anterior portion of the SSP tendon were 81.0%, 100%, and 86

The failed postoperative shoulder: Role of double contrast CT arthrography

International Nuclear Information System (INIS)

Singson, R.D.; Feldman, F.; Bigliani, L.

1986-01-01

Various types of reparative and corrective operations on the shoulder joint are being increasingly undertaken. Defining residual, new, or acutely acquired pathology in the postoperative period is exceedingly difficult because of extensive surgical alterations. Since patients may be symptomatic or recurrently symptomatic postoperatively, judgments must be made regarding the failure of the initial repair, or new superimposed insults. CT double-contrast arthrography, performed in a series of symptomatic patients after shoulder arthroplasty for instability, successfully demonstrated responsible residual or recurrent pathologic processes, including persistent Bankart lesions, glenoid rim fractures, improper hardware placement, and migration of metallic hardware. These and other examples of pathology are illustrated and discussed

Wrist arthrography

Energy Technology Data Exchange (ETDEWEB)

Fransson, S.G. (Dept. of Diagnostic Radiology, University Hospital, Linkoeping (Sweden))

1993-03-01

The ligaments of the proximal row of carpal bones and the triangular fibrocartilage (TFC) strongly influence the function and stability of the wrist. Injury to the ligaments may result in chronic wrist pain or instability. Wrist arthrography is valuable in the investigation of such damage when surgical intervention is considered and plain radiography is unrewarding. There are also several technical modifications of the standard radiocarpal arthrography available. Owing to the possibility of congential perforations and degenerative changes in these ligaments the arthrographic findings should be related to the clinical signs and the age of the patient. CT has less diagnostic importance in this respect while MR imaging is an alternative and may become the method of choice. Both these methods have great potential in the evaluation of soft tissues of the wrist other than the TFC. (orig.).

MR Imaging-Guided Attenuation Correction of PET Data in PET/MR Imaging.

Science.gov (United States)

Izquierdo-Garcia, David; Catana, Ciprian

2016-04-01

Attenuation correction (AC) is one of the most important challenges in the recently introduced combined PET/magnetic resonance (MR) scanners. PET/MR AC (MR-AC) approaches aim to develop methods that allow accurate estimation of the linear attenuation coefficients of the tissues and other components located in the PET field of view. MR-AC methods can be divided into 3 categories: segmentation, atlas, and PET based. This review provides a comprehensive list of the state-of-the-art MR-AC approaches and their pros and cons. The main sources of artifacts are presented. Finally, this review discusses the current status of MR-AC approaches for clinical applications. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of field of view on MR diagnosis of rotator cuff tears

International Nuclear Information System (INIS)

Tuite, M.J.; Yandow, D.R.; De Smet, A.A.; Orwin, J.F.; Quintana, F.A.

1995-01-01

One hundred shoulder MR scans with surgical correlation were evaluated for the presence or absence of a cuff tear. The sensitivity and specificity of MR relative to the surgical results were determined for the 59 patients scanned with a 24-cm FOV, and the 41 patients scanned with an 18-cm FOV. All other imaging parameters including acquisition time were identical. The sensitivity and specificity of the two groups were compared using a t-test. The specificity of MR for diagnosing a rotator cuff tear improved from 0.65 for the 24-cm FOV group to 0.89 for the 18-cm FOV group (P = 0.04). The sensitivity changed from 0.91 to 0.96 (P = 0.25). Reducing the FOV from 24 cm to 18 cm results in a statistically significant improvement in specificity of MR for diagnosing rotator cuff tears. (orig./MG)

Effect of field of view on MR diagnosis of rotator cuff tears

Energy Technology Data Exchange (ETDEWEB)

Tuite, M J [Dept. of Radiology, Univ. of Wisconsin Clinical Science Center, Madison, WI (United States); Yandow, D R [Dept. of Radiology, Univ. of Wisconsin Clinical Science Center, Madison, WI (United States); De Smet, A A [Dept. of Radiology, Univ. of Wisconsin Clinical Science Center, Madison, WI (United States); Orwin, J F [Div. of Orthopedic Surgery, Univ. of Wisconsin Clinical Science Center, Madison, WI (United States); Quintana, F A [Dept. of Biostatistics, Univ. of Wisconsin Clinical Science Center, Madison, WI (United States)

1995-10-01

One hundred shoulder MR scans with surgical correlation were evaluated for the presence or absence of a cuff tear. The sensitivity and specificity of MR relative to the surgical results were determined for the 59 patients scanned with a 24-cm FOV, and the 41 patients scanned with an 18-cm FOV. All other imaging parameters including acquisition time were identical. The sensitivity and specificity of the two groups were compared using a t-test. The specificity of MR for diagnosing a rotator cuff tear improved from 0.65 for the 24-cm FOV group to 0.89 for the 18-cm FOV group (P = 0.04). The sensitivity changed from 0.91 to 0.96 (P = 0.25). Reducing the FOV from 24 cm to 18 cm results in a statistically significant improvement in specificity of MR for diagnosing rotator cuff tears. (orig./MG)

Trends in utilization: has extremity MR imaging replaced diagnostic arthroscopy?

International Nuclear Information System (INIS)

Glynn, Nicole; Morrison, William B.; Parker, Laurence; Schweitzer, Mark E.; Carrino, John A.

2004-01-01

To examine the relative change in utilization of magnetic resonance (MR) imaging of the extremities versus diagnostic and therapeutic arthroscopy. Using the 1993, 1996, and 1999 nationwide Medicare Part B databases, utilization rates (per 100,000) were determined for upper and lower extremity MR imaging, diagnostic arthroscopy and therapeutic arthroscopy using CPT-4 codes. Utilization of extremity MR imaging was compared with that of diagnostic and therapeutic arthroscopy in 10 geographic regions of the United States and tracked over time. Combined lower and upper extremity MR imaging utilization per 100,000 increased from 393 to 1,056 in 1999 (+168.7%). Utilization of diagnostic arthroscopy of the extremities decreased from 18 in 1993 to 8 in 1999 (-55.6%); therapeutic arthroscopy rates increased from 461 in 1993 to 636 in 1999 (+40.0%). Specifically, from 1993 to 1999, utilization of lower extremity MR imaging increased from 270 to 661 (+144.8%). Utilization of diagnostic arthroscopy of the knee over the same time period decreased from 11 to 5 (-54.5%); therapeutic arthroscopy increased from 394 to 501 (+27.2%). Similarly, utilization rates for upper extremity MR imaging increased from 123 to 395 (+221.1%). Utilization of diagnostic arthroscopy of the shoulder over the same time period decreased from 7 to 2 (-71.4%); therapeutic arthroscopy increased from 44 to 104 (+136.4%). No specific geographic trends were ascertained. The utilization of MR imaging of the extremities has markedly increased from 1993 to 1999. During the same time period the utilization of diagnostic arthroscopy has decreased and that of therapeutic arthroscopy has increased. These findings support the hypothesis that there is increased reliance of clinical practitioners on the diagnostic information provided by MR imaging in preoperative clinical decision-making. (orig.)

Do carotid MR surface coils affect PET quantification in PET/MR imaging?

International Nuclear Information System (INIS)

Willemink, Martin J; Eldib, Mootaz; Leiner, Tim; Fayad, Zahi A; Mani, Venkatesh

2015-01-01

To evaluate the effect of surface coils for carotid MR imaging on PET quantification in a clinical simultaneous whole-body PET/MR scanner. A cylindrical phantom was filled with a homogeneous 2L water-FDG mixture at a starting dose of 301.2MBq. Clinical PET/MR and PET/CT systems were used to acquire PET-data without a coil (reference standard) and with two carotid MRI coils (Siemens Special Purpose 8-Channel and Machnet 4-Channel Phased Array). PET-signal attenuation was evaluated with Osirix using 51 (PET/MR) and 37 (PET/CT) circular ROIs. Mean and maximum standardized uptake values (SUVs) were quantified for each ROI. Furthermore, SUVs of PET/MR and PET/CT were compared. For validation, a patient was scanned with an injected dose of 407.7MBq on both a PET/CT and a PET/MR system without a coil and with both coils. PET/MR underestimations were -2.2% (Siemens) and -7.8% (Machnet) for SUVmean, and -1.2% (Siemens) and -3.3% (Machnet) for SUVmax, respectively. For PET/CT, underestimations were -1.3% (Siemens) and -1.4% (Machnet) for SUVmean and -0.5% (both Siemens and Machnet) for SUVmax, respectively using no coil data as reference. Except for PET/CT SUVmax values all differences were significant. SUVs differed significantly between PET/MR and PET/CT with SUVmean values of 0.51-0.55 for PET/MR and 0.68-0.69 for PET/CT, respectively. The patient examination showed that median SUVmean values measured in the carotid arteries decreased from 0.97 without a coil to 0.96 (Siemens) and 0.88 (Machnet). Carotid surface coils do affect attenuation correction in both PET/MR and PET/CT imaging. Furthermore, SUVs differed significantly between PET/MR and PET/CT.

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

International Nuclear Information System (INIS)

Kassarjian, Ara; Llopis, Eva; Schwartz, Richard B.; Bencardino, Jenny T.

2009-01-01

The purpose of the study was to demonstrate the prevalence of communication between the hip joint and the obturator externus bursa on hip MR arthrography. Following institutional review board approval, 200 hip MR arthrograms in 196 subjects were independently reviewed by two musculoskeletal radiologists. Discrepancies were resolved by adjudication. The presence or absence of communication between the hip joint and the obturator externus bursa was recorded. Associated lesions involving the acetabular labrum and articular cartilage were recorded. The obturator externus bursa was shown to communicate with the hip joint in 11 of the 200 (5.5%) hip MR arthrograms. Of these, six were in men and five were in women. The age range was 15-63 years with a mean age of 34 years. All 11 patients had labral tears. Eight of the 11 had cartilage lesions. The obturator externus bursa can be seen to communicate with the hip joint in 5.5% of hip MR arthrograms. Associated labral and cartilage lesions are common. (orig.)

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

Energy Technology Data Exchange (ETDEWEB)

Kassarjian, Ara [Corades, S.L., Majadahonda-Madrid (Spain); Massachusetts General Hospital, Division of Musculoksleletal Radiology, Boston, MA (United States); Llopis, Eva [Hospital de la Ribera, Department of Radiology, Alzira (Valencia) (Spain); Schwartz, Richard B. [Longwood MRI Specialists, Brookline, MA (United States); Bencardino, Jenny T. [NYU Department of Radiology, New York, NY (United States)

2009-11-15

The purpose of the study was to demonstrate the prevalence of communication between the hip joint and the obturator externus bursa on hip MR arthrography. Following institutional review board approval, 200 hip MR arthrograms in 196 subjects were independently reviewed by two musculoskeletal radiologists. Discrepancies were resolved by adjudication. The presence or absence of communication between the hip joint and the obturator externus bursa was recorded. Associated lesions involving the acetabular labrum and articular cartilage were recorded. The obturator externus bursa was shown to communicate with the hip joint in 11 of the 200 (5.5%) hip MR arthrograms. Of these, six were in men and five were in women. The age range was 15-63 years with a mean age of 34 years. All 11 patients had labral tears. Eight of the 11 had cartilage lesions. The obturator externus bursa can be seen to communicate with the hip joint in 5.5% of hip MR arthrograms. Associated labral and cartilage lesions are common. (orig.)

Double-contrast arthrography in recurrent dislocation of the shoulder

International Nuclear Information System (INIS)

Faletti, C.; Vassoney, P.F.; Indemini, E.; Clerico, P.

1988-01-01

One hundred and ninety-three shoulder arthrographies were performed between 1979 and 1985 on patients affected by recurrent dislocations. The diagnostic doubt was cleared up in 162 cases (83%). Athrographic diagnosis was confirmed by pathological findings in 92% of the patients who underwent surgery. The double-contrast technique under local anaesthesia with anterior access is suggested, since it allows several arthrograms in different projections. Thus, an analytic study of the articular damage can be carried out. The patterns of each projection are briefly shown. Revision of case histories points out that: a) the use of arthrography should always be assessed on a clinical-radiological basis for each patients; b) there is no doubt as to the usefulness of this examination as a direct means of exploration, as far as the articular damage is concerned, not only as an aid to future surgery, but also in the follow-up of the results of the treatment in the long run

Mr imaging and mr spectroscopy of brain metastases by mr perfusion

International Nuclear Information System (INIS)

Weber, Marc-Andre; Lichy, M.P.; Thilmann, C.; Guenther, M.; Bachert, P.; Delorme, S.; Schad, L.R.; Debus, J.; Schlemmer, H.P.; Maudsley, A.A.

2003-01-01

In follow-up examinations of irradiated brain metastases conventional contrast-enhanced morphological MR imaging is often unable to distinguish between transient radiation effects, radionecrosis, and tumor recurrence. To evaluate changes of relative cerebral blood flow (rCBF) in irradiated brain metastases arterial spin-labeling techniques (ASL) were applied and compared to the outcome of 1 H MR spectroscopy and spectroscopic imaging ( 1 H MRS, SI). Patients and methods In 2 patients follow-up examinations of irradiated brain metastases were performed on a 1.5-T tomograph (average single dose: 20 Gy/80% isodose). Relative CBF values of gray matter (GM), white matter (WM), and metastases (Met) were measured by means of the ASL techniques ITS-FAIR and Q2TIPS. 1 H MRS was performed with PRESS 1500/135. In both patients with initially hyperperfused metastases (Met/GM >1) the reduction of rCBF after stereotactic radiosurgery indicated response to treatment - even if the contrast-enhancing region increased - while increasing rCBF values indicated tumor progression. The findings were confirmed by 1 H MRS, SI and subsequent follow-up. The ASL techniques ITS-FAIR and Q2TIPS are able to monitor changes of rCBF in irradiated brain metastases. The two cases imply a possible role for ASL-MR perfusion imaging and 1 H MR spectroscopy in differentiating radiation effects from tumor progression. (orig.) [de

Deep Learning MR Imaging-based Attenuation Correction for PET/MR Imaging.

Science.gov (United States)

Liu, Fang; Jang, Hyungseok; Kijowski, Richard; Bradshaw, Tyler; McMillan, Alan B

2018-02-01

Purpose To develop and evaluate the feasibility of deep learning approaches for magnetic resonance (MR) imaging-based attenuation correction (AC) (termed deep MRAC) in brain positron emission tomography (PET)/MR imaging. Materials and Methods A PET/MR imaging AC pipeline was built by using a deep learning approach to generate pseudo computed tomographic (CT) scans from MR images. A deep convolutional auto-encoder network was trained to identify air, bone, and soft tissue in volumetric head MR images coregistered to CT data for training. A set of 30 retrospective three-dimensional T1-weighted head images was used to train the model, which was then evaluated in 10 patients by comparing the generated pseudo CT scan to an acquired CT scan. A prospective study was carried out for utilizing simultaneous PET/MR imaging for five subjects by using the proposed approach. Analysis of covariance and paired-sample t tests were used for statistical analysis to compare PET reconstruction error with deep MRAC and two existing MR imaging-based AC approaches with CT-based AC. Results Deep MRAC provides an accurate pseudo CT scan with a mean Dice coefficient of 0.971 ± 0.005 for air, 0.936 ± 0.011 for soft tissue, and 0.803 ± 0.021 for bone. Furthermore, deep MRAC provides good PET results, with average errors of less than 1% in most brain regions. Significantly lower PET reconstruction errors were realized with deep MRAC (-0.7% ± 1.1) compared with Dixon-based soft-tissue and air segmentation (-5.8% ± 3.1) and anatomic CT-based template registration (-4.8% ± 2.2). Conclusion The authors developed an automated approach that allows generation of discrete-valued pseudo CT scans (soft tissue, bone, and air) from a single high-spatial-resolution diagnostic-quality three-dimensional MR image and evaluated it in brain PET/MR imaging. This deep learning approach for MR imaging-based AC provided reduced PET reconstruction error relative to a CT-based standard within the brain compared

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

International Nuclear Information System (INIS)

Tuite, M.J.; Turnbull, J.R.; Orwin, J.F.

1998-01-01

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56. Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity for these tears is lower than in recent articles, we found no significant difference between the sensitivity of MR for diagnosing posterior tears versus tears in the anterior half of the supraspinatus tendon. Rim-rent tears can be mistaken for intratendinous signal, and should be carefully looked for in younger patients with shoulder pain. (orig.)

Magnetic resonance arthrography and the prevalence of acetabular labral tears in patients 50 years of age and older

International Nuclear Information System (INIS)

Jayakar, Rohit; Merz, Alexa; Wang, Dean; Hame, Sharon L.; Plotkin, Benjamin; Seeger, Leanne

2016-01-01

Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph. From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Toennis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Toennis grade and joint space width were measured on radiographs. On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Toennis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Toennis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool. (orig.)

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.)

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

International Nuclear Information System (INIS)

Suter, Aline; Dietrich, Tobias J.; Maier, Matthias; Pfirrmann, Christian W.A.; Dora, Claudio

2015-01-01

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.)

MR imaging of prostate cancer; MR-Tomographie des Prostatakarzinoms

Energy Technology Data Exchange (ETDEWEB)

Heuck, A.; Scheidler, J.; Sommer, B.; Graser, A. [Radiologisches Zentrum Muenchen-Pasing (Germany); Mueller-Lisse, U.G. [Institut fuer Klinische Radiologie, Universitaet Muenchen (Germany); Massmann, J. [Gemeinschaftspraxis Pathologie, Muenchen (Germany)

2003-06-01

Accurate diagnosis and staging of prostate cancer (PC) is developing into an important health care issue in light of the high incidence of PC and the improvements in stage-adapted therapy. The purpose of this paper is to provide an overview on the current role of MR imaging and MR spectroscopy in the diagnosis and staging of PC.Material and methods Pertinent literature was searched and evaluated to collect information on current clinical indications, study techniques, diagnostic value, and limitations of magnetic resonance imaging and spectroscopy. Major indications for MR imaging of patients with supected PC are to define tumor location before biopsy when clinical or TRUS findings are inconclusive, and to provide accurate staging of histologically proven PC to ascertain effective therapy. Current MR imaging techniques for the evaluation of PC include multiplanar high-resolution T2-weighted FSE and T1-weighted SE sequences using combined endorectal and phased-array coils. Using these techniques, the reported accuracy of MR imaging for the diagnosis of extracapsular tumor extension ranges between 82 and 88% with sensitivities between 80 and 95%, and specificities between 82 and 93%. Typical MR findings of PC in different stages of disease, as well as diagnostic problems, such as chronic prostatitis, biopsy-related hemorrhage and therapy-related changes of prostatic tissue are discussed. In addition, the current perspectives and limitations of MR spectroscopy in PC are summarized. Current MR imaging techniques provide important diagnostic information in the pretherapeutic workup of PC including a high staging accuracy, and is superior to TRUS. (orig.) [German] Der Diagnostik des Prostatakarzinoms kommt wegen seiner hohen Inzidenz und den verbesserten stadienadaptierten Therapiemoeglichkeiten eine grosse Bedeutung zu. Dabei spielen bildgebende Verfahren bei den klinisch oft unzureichend diagnostizierbaren Faellen eine wesentliche Rolle fuer die praetherapeutische

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

International Nuclear Information System (INIS)

Hall, F.M.; Goldberg, R.P.; Wyshak, G.; Kilcoyne, R.F.

1985-01-01

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

Interventional MR: vascular applications.

Science.gov (United States)

Smits, H F; Bos, C; van der Weide, R; Bakker, C J

1999-01-01

Three strategies for visualisation of MR-dedicated guidewires and catheters have been proposed, namely active tracking, the technique of locally induced field inhomogeneity and passive susceptibility-based tracking. In this article the pros and cons of these techniques are discussed, including the development of MR-dedicated guidewires and catheters, scan techniques, post-processing tools, and display facilities for MR tracking. Finally, some of the results obtained with MR tracking are discussed.

High-resolution MR imaging of glenohumeral instability lesions

International Nuclear Information System (INIS)

Rafii, M.; Firooznia, H.; Sherman, O.; Minkoff, J.; Sherman, M.; Golimbu, C.

1991-01-01

This paper determines the accuracy of conventual MR imaging in the diagnosis of glenohumeral instabilities and evaluates various pathologic aspects of these lesions. Records were reviewed in 80 consecutive patients with known or suspected instability who underwent MR imaging. The routine shoulder protocol included a proton density- or T2-weighted sequence. Surgical correlation was available in 31 cases. Diagnosis of glenohumeral instability was based on the presence of a combination of findings of appropriately located tear, osseous abnormality of glenoid margin, capsular abnormalities and Hill-Sachs deformity. In 28 surgically correlated patients with glenohumeral instability an accurate diagnosis was made in all but 1 case of posterior instability. A false diagnosis of instability was suggested in 3 cases by signal abnormality of the labrum and/or a prominent capsule

Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability

International Nuclear Information System (INIS)

Catalano, C.; Pavone, P.; Laghi, A.; Panebianco, V.; Scipioni, A.; Fanelli, F.; Brillo, R.; Passariello, R.

1998-01-01

The purpose of this study was to determine the possibility of integrating MR cholangiopancreatography (MRCP) and MR angiography (MRA) to conventional MR images in the diagnosis and assessment of resectability of pancreatic adenocarcinoma. Twenty-three patients with pancreatic adenocarcinoma were prospectively examined with MR. Conventional MR images were acquired in all patients. Three-dimensional MRCP and MRA images were acquired in all patients with suspected biliary and vascular involvement. Acquisition time was less than 45 min in all cases. Images were independently evaluated by two radiologists, with final reading decided by consensus among readers. Diagnosis was confirmed with surgery in 16 patients and with percutaneous biopsy in 7. Concordance among readers was high with a kappa value of 0.83. Pancreatic adenocarcinoma was observed in all patients. Correct assessment of unresectability due to vascular involvement was found in 22 of 23 patients. Biliary obstruction was evident in 13 patients, involving the biliary and pancreatic ducts in 9 and the biliary ducts only in 4. Technical advances permit extensive use of MRI in the evaluation of abdominal pathologies. The combination of MR imaging, MRCP, and MRA can provide sufficient information for the diagnosis and assessment of resectability of pancreatic adenocarcinoma, which otherwise would require three different exams. (orig.)

MR anatomy of the joints: an MR-cadaveric correlative study: part I. wrist

Energy Technology Data Exchange (ETDEWEB)

Kang, Heung Sik [Seoul National University College of Medicine, Seoul (Korea, Republic of); Donald Resnick [University of California, San Diego (United States)

1991-07-15

To acquire the anatomic information necessary for correct interpretation of MR images of the wrist, transverse, coronal, and sagittal MR images of 3 fresh cadaveric wrists were obtained and, subsequently, sectioned along the MR imaging planes. For the precise correlation of anatomic features depicted with MR and with specimen section, cadaveric wrists were fixed in a rectangular cardboard box using paraffin and frozen after MR imaging. High contrast and spatial resolution enabled delineation of small structures including tendons, nerves, vessels, and ligaments, as well as osseous structures. Transverse images provided the best delineation of the carpal tunnel, tendons, nerves, and vessels. Coronal images permitted optimal visualization of triangular fibrocartilage and lunotriquetral and scapholunate ligaments. We conclude that MR imaging accurately and reliably displays the anatomy of the wrist.

PET/MR in oncology: an introduction with focus on MR and future perspectives for hybrid imaging

Science.gov (United States)

Balyasnikova, Svetlana; Löfgren, Johan; de Nijs, Robin; Zamogilnaya, Yanna; Højgaard, Liselotte; Fischer, Barbara M

2012-01-01

After more than 20 years of research, a fully integrated PET/MR scanner was launched in 2010 enabling simultaneous acquisition of PET and MR imaging. Currently, no clinical indication for combined PET/MR has been established, however the expectations are high. In this paper we will discuss some of the challenges inherent in this new technology, but focus on potential applications for simultaneous PET/MR in the field of oncology. Methods and tracers for use with the PET technology will be familiar to most readers of this journal; thus this paper aims to provide a short and basic introduction to a number of different MRI techniques, such as DWI-MR (diffusion weighted imaging MR), DCE-MR (dynamic contrast enhanced MR), MRS (MR spectroscopy) and MR for attenuation correction of PET. All MR techniques presented in this paper have shown promising results in the treatment of patients with solid tumors and could be applied together with PET increasing the amount of information about the tissues of interest. The potential clinical benefit of applying PET/MR in staging, radiotherapy planning and treatment evaluation in oncology, as well as the research perspectives for the use of PET/MR in the development of new tracers and drugs will be discussed. PMID:23145362

MR angiography, MR imaging and proton MR spectroscopy in-vivo assessment of skeletal muscle ischemia in diabetic rats.

Directory of Open Access Journals (Sweden)

Stefano Delli Pizzi

Full Text Available To prospectively evaluate the feasibility of using magnetic resonance (MR techniques for in-vivo assessing a rat diabetic model of limb ischemia. Unilateral hind limb ischemia was induced by ligation of the iliac-femoral artery in male streptozotocin-treated and non-diabetic control rats. Four weeks after ligation, rats underwent MR Angiography (MRA, T(1-weighted and Short Time Inversion Recovery (STIR sequences and muscle Proton MR Spectroscopy ((1H-MRS on both hind limbs. After MR examinations, immunoblotting and immunofluorescence analysis were performed. MRA showed a signal void due to flow discontinuation distal to the artery ligation. T(1-weighted and STIR images showed, respectively, the presence of tissue swelling (p = 0.018 for non-diabetic; p = 0.027 for diabetic rats and signal hyperintensity in tissue affected by occlusion. Mean total creatine/water for the occluded limb was significantly lower than for the non-occluded limbs in both non-diabetic (5.46×10(-4 vs 1.14×10(-3, p = 0.028 and diabetic rats (1.37×10(-4 vs 1.10×10(-3; p = 0.018. MR Imaging and (1H-MRS changes were more pronounced in diabetic than in non-diabetic occluded limbs (p = 0.032. MR findings were confirmed by using histological findings. Combined MR techniques can be used to demonstrate the presence of structural and metabolic changes produced by iliac-femoral artery occlusion in rat diabetic model of limb ischemia.

Rotator cuff injury: fat suppression MR image

International Nuclear Information System (INIS)

Won, Jong Yoon; Suh, Jin Suck; Park, Chang Yun; Lee, Yeon Hee; Kim, Yong Soo

1994-01-01

We performed the study prospectively to evaluate the advantage of fat suppression MR in the diagnosis of rotator cuff injury. Ten symptomatic patients were studied with both conventional T2WI and FST2WI using chemical shift technique. Each image was analyzed for the assessment of injuries, conspicuity of the lesion, the presence of effusion in subacromical bursae and joint space, and presence of humeral head injury. Arthroscopy was done in 4 patients following MRI. We could made presumptive diagnoses on FSMR as identical as on conventional MR in six cases(1 normal, 2 tendinitis, 2 partial thickness tear, 1 full thickness tear), two of them were confirmed by arthroscopic procedures. Two cases of partial thickness tear proved by arthroscopy were detected on FST2WI, whereas they were considered tendinitis on conventional T2WI. There were another 2 cases who showed tendinitis on FSMR, but normal on conventional T2WI. They, however, were not confirmed by either arthroscopy or surgical procedure. We found the FSMR were superior to conventional T2WI in the conspicuity of lesions and detection of joint effusion and abnormalities on the humeral head. We think FSMR of the shoulder could have significant diagnostic advantages over the conventional spin-echo MR imaging

Rotator cuff injury: fat suppression MR image

Energy Technology Data Exchange (ETDEWEB)

Won, Jong Yoon; Suh, Jin Suck; Park, Chang Yun; Lee, Yeon Hee [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Yong Soo [Inje University College of Medicine, Busan (Korea, Republic of)

1994-04-15

We performed the study prospectively to evaluate the advantage of fat suppression MR in the diagnosis of rotator cuff injury. Ten symptomatic patients were studied with both conventional T2WI and FST2WI using chemical shift technique. Each image was analyzed for the assessment of injuries, conspicuity of the lesion, the presence of effusion in subacromical bursae and joint space, and presence of humeral head injury. Arthroscopy was done in 4 patients following MRI. We could made presumptive diagnoses on FSMR as identical as on conventional MR in six cases(1 normal, 2 tendinitis, 2 partial thickness tear, 1 full thickness tear), two of them were confirmed by arthroscopic procedures. Two cases of partial thickness tear proved by arthroscopy were detected on FST2WI, whereas they were considered tendinitis on conventional T2WI. There were another 2 cases who showed tendinitis on FSMR, but normal on conventional T2WI. They, however, were not confirmed by either arthroscopy or surgical procedure. We found the FSMR were superior to conventional T2WI in the conspicuity of lesions and detection of joint effusion and abnormalities on the humeral head. We think FSMR of the shoulder could have significant diagnostic advantages over the conventional spin-echo MR imaging.

MR evaluation of CSF fistulae

International Nuclear Information System (INIS)

Gupta, V.; Goyal, M.; Mishra, N.; Gaikwad, S.; Sharma, A.

1997-01-01

Purpose: To evaluate the role of MR imaging in the localisation of cerebrospinal fluid (CSF) fistulae. Material and Methods: A total of 36 consecutive unselected patients with either clincally proven CSF leakage (n=26) or suspected CSF fistula (n=10) were prospectively evaluated by MR. All MR examinations included fast spin-echo T2-weighted images in the 3 orthogonal planes. Thin-section CT was performed following equivocal or negative MR examination. MR and CT findings were correlated with surgical results in 33 patients. Results: CSF fistula was visualised as a dural-bone defect with hyperintense fluid signal continuous with that in the basal cisterns on T2-weighted images. MR was positive in 26 cases, in 24 of which the fistula was confirmed surgically. In 2 patients the CSF leakage was directly demonstrated on MR. MR sensitivity of 80% compared favourably with the reported 46-81% of CT cisternography (CTC). No significant difference in MR sensitivity in detecting CSF fistula was found between active and inactive leaks. (orig.)

C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

International Nuclear Information System (INIS)

Guggenberger, Roman; Ulbrich, Erika J.; Kaelin, Pascal; Pfammatter, Thomas; Alkadhi, Hatem; Andreisek, Gustav; Dietrich, Tobias J.; Scholz, Rosemarie; Koehler, Christoph; Elsaesser, Thilo; Le Corroller, Thomas

2017-01-01

To investigate radiation dose and diagnostic performance of C-arm flat-panel CT (FPCT) versus standard multi-detector CT (MDCT) shoulder arthrography using MRI-arthrography as reference standard. Radiation dose of two different FPCT acquisitions (5 and 20 s) and standard MDCT of the shoulder were assessed using phantoms and thermoluminescence dosimetry. FPCT arthrographies were performed in 34 patients (mean age 44 ± 15 years). Different joint structures were quantitatively and qualitatively assessed by two independent radiologists. Inter-reader agreement and diagnostic performance were calculated. Effective radiation dose was markedly lower in FPCT 5 s (0.6 mSv) compared to MDCT (1.7 mSv) and FPCT 20 s (3.4 mSv). Contrast-to-noise ratios (CNRs) were significantly (p < 0.05) higher in FPCT 20-s versus 5-s protocols. Inter-reader agreements of qualitative ratings ranged between κ = 0.47-1.0. Sensitivities for cartilage and rotator cuff pathologies were low for FPCT 5-s (40 % and 20 %) and moderate for FPCT 20-s protocols (75 % and 73 %). FPCT showed high sensitivity (81-86 % and 89-99 %) for bone and acromioclavicular-joint pathologies. Using a 5-s protocol FPCT shoulder arthrography provides lower radiation dose compared to MDCT but poor sensitivity for cartilage and rotator cuff pathologies. FPCT 20-s protocol is moderately sensitive for cartilage and rotator cuff tendon pathology with markedly higher radiation dose compared to MDCT. (orig.)

C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

Energy Technology Data Exchange (ETDEWEB)

Guggenberger, Roman; Ulbrich, Erika J.; Kaelin, Pascal; Pfammatter, Thomas; Alkadhi, Hatem; Andreisek, Gustav [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zuerich (Switzerland); Dietrich, Tobias J. [Balgrist University Hospital, Department of Radiology, Zurich (Switzerland); Scholz, Rosemarie; Koehler, Christoph; Elsaesser, Thilo [Siemens Healthcare GmbH, Business Area Advanced Therapies, Forchheim (Germany); Le Corroller, Thomas [Aix-Marseille Universite, CNRS, ISM UMR 7287, Marseille (France); Radiology Department, APHM, Marseille (France)

2017-02-15

To investigate radiation dose and diagnostic performance of C-arm flat-panel CT (FPCT) versus standard multi-detector CT (MDCT) shoulder arthrography using MRI-arthrography as reference standard. Radiation dose of two different FPCT acquisitions (5 and 20 s) and standard MDCT of the shoulder were assessed using phantoms and thermoluminescence dosimetry. FPCT arthrographies were performed in 34 patients (mean age 44 ± 15 years). Different joint structures were quantitatively and qualitatively assessed by two independent radiologists. Inter-reader agreement and diagnostic performance were calculated. Effective radiation dose was markedly lower in FPCT 5 s (0.6 mSv) compared to MDCT (1.7 mSv) and FPCT 20 s (3.4 mSv). Contrast-to-noise ratios (CNRs) were significantly (p < 0.05) higher in FPCT 20-s versus 5-s protocols. Inter-reader agreements of qualitative ratings ranged between κ = 0.47-1.0. Sensitivities for cartilage and rotator cuff pathologies were low for FPCT 5-s (40 % and 20 %) and moderate for FPCT 20-s protocols (75 % and 73 %). FPCT showed high sensitivity (81-86 % and 89-99 %) for bone and acromioclavicular-joint pathologies. Using a 5-s protocol FPCT shoulder arthrography provides lower radiation dose compared to MDCT but poor sensitivity for cartilage and rotator cuff pathologies. FPCT 20-s protocol is moderately sensitive for cartilage and rotator cuff tendon pathology with markedly higher radiation dose compared to MDCT. (orig.)

Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

International Nuclear Information System (INIS)

Zanetti, Marco; Hodler, Juerg

2000-01-01

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

Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

Energy Technology Data Exchange (ETDEWEB)

Zanetti, Marco E-mail: mzanetti@balgrist.unizh.ch; Hodler, Juerg

2000-08-01

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.

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.)

Normal anatomy and MR findings of fetal main organs at MR imaging

International Nuclear Information System (INIS)

Xia Liming; Zou Mingli; Feng Dingyi; Hu Junwu; Qi Jianpin; Wang Chengyuan

2005-01-01

Objective: To investigate normal anatomy and MR findings of fetal main organs. Methods: Forty-seven fetus underwented fast MR imaging, SSFSE sequence was used, the normal anatomy and MR findings of fetal main organs was observed in different gestational age. The organs included: brain, lungs, heart, liver, spleen, gastrointestinal tract, urinary collecting systems, bladder, bones, spine, and subcutaneous fat. Results: Results of MR in 47 fetus showed that the main organs had developed by 20-week-old fetus, about 20 weeks gestation, cerebral cortical surface was smooth, no cortical gyri and sulci, then cortical gyri and sulci developed slowly. The lungs, trachea, bronchus, gastrointestinal tract, renal collecting system and bladder showed high signal intensity; the heart, great vessels, liver, spleen, bones and muscles appeared hypointense; the kidneys appeared isointense, the spine had developed and subcutaneous fat was seen in 20-week-old fetus, the subcutaneous fat increased with fetus maturating. Conclusion: Normal anatomy and MR findings of fetal main organs were clearly showed by fast MR imaging, and they are different from the newborns. (authors)

MR imaging of articular cartilage; Gelenkknorpel in der MR-Tomographie

Energy Technology Data Exchange (ETDEWEB)

Schaefer, F.K.W.; Muhle, C.; Heller, M.; Brossmann, J. [Kiel Univ. (Germany). Klinik fuer Diagnostische Radiologie

2001-04-01

MR imaging has evolved to the best non-invasive method for the evaluation of articular cartilage. MR imaging helps to understand the structure and physiology of cartilage, and to diagnose cartilage lesions. Numerous studies have shown high accuracy and reliability concerning detection of cartilage lesions and early changes in both structure and biochemistry. High contrast-to-noise ratio and high spatial resolution are essential for analysis of articular cartilage. Fat-suppressed 3D-T{sub 1} weighted gradient echo and T{sub 2}-weighted fast spin echo sequences with or without fat suppression are recommended for clinical routine. In this article the anatomy and pathology of hyaline articular cartilage and the complex imaging characteristics of hyaline cartilage will be discussed. (orig.) [German] Die MR-Tomographie hat sich zur besten nichtinvasiven bildgebenden Methode fuer die Untersuchung von Gelenkknorpel entwickelt. Die MR-Tomographie liefert einen Beitrag zum Verstaendnis der Knorpelstruktur und der Physiologie sowie zur Diagnostik von Knorpelschaeden. Zahlreiche MR-Studien konnten eine hohe Genauigkeit und Zuverlaessigkeit bei der Detektion chondraler Laesionen sowie frueher Veraenderungen struktureller und biochemischer Natur zeigen. Neben einem hohen Kontrast/Rausch-Verhaeltnis ist fuer die Gelenkknorpelanalyse eine hohe raeumliche Aufloesung erforderlich. Im klinischen Routinebetrieb empfehlen sich fuer die Erkennung von Knorpellaesionen besonders fettunterdrueckte 3D-T{sub 1}-gewichtete Gradientenecho- und T{sub 2}-gewichtete Fastspinecho-Sequenzen mit oder ohne Fettunterdrueckung. Die vorliegende Arbeit geht auf die Anatomie und Pathologie des hyalinen Gelenkknorpels ein und diskutiert das komplexe MR-Signalverhalten. (orig.)

MR morphology of triangular fibrocartilage complex: correlation with quantitative MR and biomechanical properties

Energy Technology Data Exchange (ETDEWEB)

Bae, Won C.; Chang, Eric Y.; Chung, Christine B. [VA San Diego Healthcare System, Radiology Service, San Diego, CA (United States); University of California-San Diego, Department of Radiology, San Diego, CA (United States); Ruangchaijatuporn, Thumanoon [Mahidol University, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Rachathewi, Bangkok (Thailand); Biswas, Reni; Du, Jiang; Statum, Sheronda [University of California-San Diego, Department of Radiology, San Diego, CA (United States)

2016-04-15

To evaluate pathology of the triangular fibrocartilage complex (TFCC) using high-resolution morphologic magnetic resonance (MR) imaging, and compare with quantitative MR and biomechanical properties. Five cadaveric wrists (22-70 years) were imaged at 3 T using morphologic (proton density weighted spin echo, PD FS, and 3D spoiled gradient echo, 3D SPGR) and quantitative MR sequences to determine T2 and T1rho properties. In eight geographic regions, morphology of TFC disc and laminae were evaluated for pathology and quantitative MR values. Samples were disarticulated and biomechanical indentation testing was performed on the distal surface of the TFC disc. On morphologic PD SE images, TFC disc pathology included degeneration and tears, while that of the laminae included degeneration, degeneration with superimposed tear, mucinous transformation, and globular calcification. Punctate calcifications were highly visible on 3D SPGR images and found only in pathologic regions. Disc pathology occurred more frequently in proximal regions of the disc than distal regions. Quantitative MR values were lowest in normal samples, and generally higher in pathologic regions. Biomechanical testing demonstrated an inverse relationship, with indentation modulus being high in normal regions with low MR values. The laminae studied were mostly pathologic, and additional normal samples are needed to discern quantitative changes. These results show technical feasibility of morphologic MR, quantitative MR, and biomechanical techniques to characterize pathology of the TFCC. Quantitative MRI may be a suitable surrogate marker of soft tissue mechanical properties, and a useful adjunct to conventional morphologic MR techniques. (orig.)

MR morphology of triangular fibrocartilage complex: correlation with quantitative MR and biomechanical properties

International Nuclear Information System (INIS)

Bae, Won C.; Chang, Eric Y.; Chung, Christine B.; Ruangchaijatuporn, Thumanoon; Biswas, Reni; Du, Jiang; Statum, Sheronda

2016-01-01

To evaluate pathology of the triangular fibrocartilage complex (TFCC) using high-resolution morphologic magnetic resonance (MR) imaging, and compare with quantitative MR and biomechanical properties. Five cadaveric wrists (22-70 years) were imaged at 3 T using morphologic (proton density weighted spin echo, PD FS, and 3D spoiled gradient echo, 3D SPGR) and quantitative MR sequences to determine T2 and T1rho properties. In eight geographic regions, morphology of TFC disc and laminae were evaluated for pathology and quantitative MR values. Samples were disarticulated and biomechanical indentation testing was performed on the distal surface of the TFC disc. On morphologic PD SE images, TFC disc pathology included degeneration and tears, while that of the laminae included degeneration, degeneration with superimposed tear, mucinous transformation, and globular calcification. Punctate calcifications were highly visible on 3D SPGR images and found only in pathologic regions. Disc pathology occurred more frequently in proximal regions of the disc than distal regions. Quantitative MR values were lowest in normal samples, and generally higher in pathologic regions. Biomechanical testing demonstrated an inverse relationship, with indentation modulus being high in normal regions with low MR values. The laminae studied were mostly pathologic, and additional normal samples are needed to discern quantitative changes. These results show technical feasibility of morphologic MR, quantitative MR, and biomechanical techniques to characterize pathology of the TFCC. Quantitative MRI may be a suitable surrogate marker of soft tissue mechanical properties, and a useful adjunct to conventional morphologic MR techniques. (orig.)

MR morphology of triangular fibrocartilage complex: correlation with quantitative MR and biomechanical properties.

Science.gov (United States)

Bae, Won C; Ruangchaijatuporn, Thumanoon; Chang, Eric Y; Biswas, Reni; Du, Jiang; Statum, Sheronda; Chung, Christine B

2016-04-01

To evaluate pathology of the triangular fibrocartilage complex (TFCC) using high-resolution morphologic magnetic resonance (MR) imaging, and compare with quantitative MR and biomechanical properties. Five cadaveric wrists (22-70 years) were imaged at 3 T using morphologic (proton density weighted spin echo, PD FS, and 3D spoiled gradient echo, 3D SPGR) and quantitative MR sequences to determine T2 and T1rho properties. In eight geographic regions, morphology of TFC disc and laminae were evaluated for pathology and quantitative MR values. Samples were disarticulated and biomechanical indentation testing was performed on the distal surface of the TFC disc. On morphologic PD SE images, TFC disc pathology included degeneration and tears, while that of the laminae included degeneration, degeneration with superimposed tear, mucinous transformation, and globular calcification. Punctate calcifications were highly visible on 3D SPGR images and found only in pathologic regions. Disc pathology occurred more frequently in proximal regions of the disc than distal regions. Quantitative MR values were lowest in normal samples, and generally higher in pathologic regions. Biomechanical testing demonstrated an inverse relationship, with indentation modulus being high in normal regions with low MR values. The laminae studied were mostly pathologic, and additional normal samples are needed to discern quantitative changes. These results show technical feasibility of morphologic MR, quantitative MR, and biomechanical techniques to characterize pathology of the TFCC. Quantitative MRI may be a suitable surrogate marker of soft tissue mechanical properties, and a useful adjunct to conventional morphologic MR techniques.

Multidetector Computed Tomography Arthrography of the Shoulder: Diagnostic Accuracy and Indications

International Nuclear Information System (INIS)

De Filippo, M.; Bertellini, A.; Sverzellati, N.; Pogliacomi, F.; Costantino, C.; Vitale, M.; Zappia, M.; Corradi, D.; Garlaschi, G.; Zompatori, M.

2008-01-01

Background: The presence of subcutaneous implants, such as permanent defibrillators, is an absolute contraindication to the use of magnetic resonance imaging (MRI). Moreover, MRI is unadvisable in subjects with metallic hardware near the area of study, as artifacts generated by such materials distort image quality. Purpose: To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography arthrography (arthro-MDCT) of the shoulder in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Material and Methods: After intraarticular injection of iodixanol and volumetric acquisition, 70 shoulders in 70 patients (30 females, 40 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI because of absolute contraindications (subcutaneous electronic implants), surgical metal implants, or claustrophobia. In 28 of the 70 patients who had had previous shoulder surgery, the arthro-CT examination was preceded by an MRI on the same day. 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 the 42 non-operated patients, the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 87% and 100%. In the 28 operated shoulders, arthro-MDCT had an accuracy of 94% compared with 25% with MRI. Interobserver agreement was almost perfect (κ=0.95) in the evaluation of all types of lesions, both on MDCT and MRI. When arthro-MDCT was compared with MRI in the postoperative patients by a McNemar test, a significant difference (P<0.05) was found between these two techniques. Conclusion: Arthro-MDCT of the shoulder is a safe technique that provides

Multidetector Computed Tomography Arthrography of the Shoulder: Diagnostic Accuracy and Indications

Energy Technology Data Exchange (ETDEWEB)

De Filippo, M.; Bertellini, A.; Sverzellati, N.; Pogliacomi, F.; Costantino, C.; Vitale, M.; Zappia, M.; Corradi, D.; Garlaschi, G.; Zompatori, M. (Dept. of Clinical Sciences, Section of Radiological Sciences, Univ. of Parma, Parma Hospital, Parma (Italy))

2008-06-15

Background: The presence of subcutaneous implants, such as permanent defibrillators, is an absolute contraindication to the use of magnetic resonance imaging (MRI). Moreover, MRI is unadvisable in subjects with metallic hardware near the area of study, as artifacts generated by such materials distort image quality. Purpose: To evaluate the diagnostic accuracy and indications of arthrography with multidetector computed tomography arthrography (arthro-MDCT) of the shoulder in patients with absolute or relative contraindications to MRI and in patients with periarticular metal implants using diagnostic arthroscopy as the gold standard. Material and Methods: After intraarticular injection of iodixanol and volumetric acquisition, 70 shoulders in 70 patients (30 females, 40 males, age range 32-60 years) were examined with a 16-detector-row CT scanner. The patients had arthralgia but no radiologically detected fractures. They could not be studied by MRI because of absolute contraindications (subcutaneous electronic implants), surgical metal implants, or claustrophobia. In 28 of the 70 patients who had had previous shoulder surgery, the arthro-CT examination was preceded by an MRI on the same day. 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 the 42 non-operated patients, the comparison between arthro-MDCT and arthroscopy showed sensitivity and specificity ranging between 87% and 100%. In the 28 operated shoulders, arthro-MDCT had an accuracy of 94% compared with 25% with MRI. Interobserver agreement was almost perfect (kappa=0.95) in the evaluation of all types of lesions, both on MDCT and MRI. When arthro-MDCT was compared with MRI in the postoperative patients by a McNemar test, a significant difference (P<0.05) was found between these two techniques. Conclusion: Arthro-MDCT of the shoulder is a safe technique that provides

Initial experience with 3D isotropic high-resolution 3 T MR arthrography of the wrist.

Science.gov (United States)

Sutherland, John K; Nozaki, Taiki; Kaneko, Yasuhito; J Yu, Hon; Rafijah, Gregory; Hitt, David; Yoshioka, Hiroshi

2016-01-16

Our study was performed to evaluate the image quality of 3 T MR wrist arthrograms with attention to ulnar wrist structures, comparing image quality of isotropic 3D proton density fat suppressed turbo spin echo (PDFS TSE) sequence versus standard 2D 3 T sequences as well as comparison with 1.5 T MR arthrograms. Eleven consecutive 3 T MR wrist arthrograms were performed and the following sequences evaluated: 3D isotropic PDFS, repetition time/echo time (TR/TE) 1400/28.3 ms, voxel size 0.35x0.35x0.35 mm, acquisition time 5 min; 2D coronal sequences with slice thickness 2 mm: T1 fat suppressed turbo spin echo (T1FS TSE) (TR/TE 600/20 ms); proton density (PD) TSE (TR/TE 3499/27 ms). A 1.5 T group of 18 studies with standard sequences were evaluated for comparison. All MR imaging followed fluoroscopically guided intra-articular injection of dilute gadolinium contrast. Qualitative assessment related to delineation of anatomic structures between 1.5 T and 3 T MR arthrograms was carried out using Mann-Whitney test and the differences in delineation of anatomic structures among each sequence in 3 T group were analyzed with Wilcoxon signed-rank test. Quantitative assessment of mean relative signal intensity (SI) and relative contrast measurements was performed using Wilcoxon signed-rank test. Mean qualitative scores for 3 T sequences were significantly higher than 1.5 T (p < 0.01), with isotropic 3D PDFS sequence having highest mean qualitative scores (p < 0.05). Quantitative analysis demonstrated no significant difference in relative signal intensity among the 3 T sequences. Significant differences were found in relative contrast between fluid-bone and fluid-fat comparing 3D and 2D PDFS (p < 0.01). 3D isotropic PDFS sequence showed promise in both qualitative and quantitative assessment, suggesting this may be useful for MR wrist arthrograms at 3 T. Primary reasons for diagnostic potential include the ability to make reformations in any

MR imaging of normal bone marrow; Obraz MR prawidlowego szpiku kostnego

Energy Technology Data Exchange (ETDEWEB)

Stajgis, M.; Paprzycki, W. [Osrodek Diagnostyki Obrazowej IR, Akademia Medyczna, Poznan (Poland)

1994-12-31

Principles of MR bone marrow imaging on the basis of retrospective analysis of MR examinations of bone marrow in different anatomic sites in 200 patients have been discussed. Significance of different physiologic factors and processes such as age, steatosis, osteoporosis, conversion and reconversion, which influence on MR bone marrow images, have been emphasized. T1-weighted images obtained with spin-echo sequences give the most of information about bone marrow structure in MR. Thorough knowledge of bone marrow physiology and clinical status of the patient is indispensable in correct interpretation of hypointensive lesions on T1-weighted images. When presence of disseminated bone marrow disease is suspected, authors propose routine imaging of lumbar vertebral column, pelvis and proximal parts of femoral bones. (author) 7 refs, 7 figs

Anterior versus posterior, and rim-rent rotator cuff tears: prevalence and MR sensitivity

Energy Technology Data Exchange (ETDEWEB)

Tuite, M J; Turnbull, J R; Orwin, J F [Wisconsin Univ., Madison, WI (United States). Dept. of Radiology

1998-05-01

Purpose. To determine the relative distribution of the locations of rotator cuff tears, and the sensitivity of anterior versus posterior tears on MR images. Patients and methods. We identified 110 consecutive patients who had a shoulder MR and either a partial-thickness or a small full-thickness rotator cuff tear diagnosed at arthroscopy. From the arthroscopy videotapes, we classified the tears as centered in the anterior or posterior half of the cuff, and as either in the critical zone or adjacent to the bony insertion. The original MR interpretation was compared with the arthroscopic findings. MR sensitivity and patient age were compared between patients with tears in the anterior and posterior halves of the cuff. In addition, in patients with partial tears less than 2 cm in diameter, an age comparison between those with tears in the critical zone and those with articular surface tears adjacent to the bony insertion (rim-rent tear) was performed. Results. The tear was centered in the anterior half of the rotator cuff in 79% of the patients younger than 36 years old, and in 89% of the patients 36 years old and over. The average age of the patients with tears in the anterior half (44 years) was not significantly different from the average age of those with posterior tears (40 years)(P=0.23). The sensitivity of MR for anterior tears was 0.69, and for posterior tears it was 0.56 (P=0.17). The average age of the 9 patients with rim-rent tears was 31 years, while that of the 28 patients with similarly-sized partial tears not involving the insertion was 40 years old (P=0.048). Five of the nine rim-rent tears (0.56) were interpreted correctly on the original MR report; two of the other tears were misinterpreted as intratendinous fluid but were diagnosable in retrospect. Conclusion. Even in patients less than 36 years old, most partial and small full-thickness rotator cuff tears are centered in the anterior half of the supraspinatus. Although our figure for MR sensitivity

MR imaging of rhabdomyolysis

International Nuclear Information System (INIS)

Zagoria, R.J.; Karstaedt, N.; Koubek, T.D.

1986-01-01

The use of magnetic resonance (MR) imaging in two cases of rhabdomyolysis, one resulting from prolonged muscle compression and one from electrical burns, is described. The involved muscles were clearly demonstrated with MR. Recognition and assessment of the extent of rhabdomyolysis are important since life-threatening sequelae including severe metabolic disorders are possible. In one case, spin-echo and inversion-recovery MR imaging provided greater detail of muscle abnormalities than did 99mTc-pyrophosphate radionuclide scanning. Both cases illustrate the usefulness of MR in evaluation of skeletal muscle disorders

The 'bridging sign', a MR finding for combined full-thickness tears of the subscapularis tendon and the supraspinatus tendon

Energy Technology Data Exchange (ETDEWEB)

Jung, Jin Young [Dept. of Radiology, Saint Paul' s Hospital, The Catholic Univ. of Korea, Seoul (Korea, Republic of); Yoon, Young Cheol; Cha, Dong Ik [Dept. of Radiology, Samsung Medical Center, Sungkyunkwan Univ, School of Medicine, Seoul (Korea, Republic of)], e-mail: ycyoon@skku.edu; Yoo, Jae-Chul [Dept. of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of); Jung, Jee Young [Dept. of Radiology, School of Medicine, Chung-Ang Univ., Seoul (Korea, Republic of)

2013-02-15

Background: In daily practice, we discovered one of the secondary magnetic resonance (MR) findings of the subscapularis (SSC) tendon tear, the 'bridging sign', which has not been previously described. Purpose: To describe the 'bridging sign' on shoulder MR imaging and its radiological and clinical significance in patients with SSC tendon tear. Material and Methods: Twenty-nine patients who had undergone shoulder arthroscopy and had full-thickness tear of the subscapularis tendon were enrolled. The medical records of the 29 patients were retrospectively reviewed for the duration of shoulder pain, rotator cuff tears, and associated arthroscopic findings: biceps tendon abnormality and superior glenoid labral tear. Then, preoperative shoulder MR images were retrospectively reviewed for the presence or absence of the 'bridging sign' and associated MR findings: periarticular fluid and fatty atrophy of the supraspinatus and subscapularis muscles. The type of rotator cuff tear associated with the 'bridging sign' was assessed and the sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of a certain type of rotator cuff tear were calculated. Associated arthroscopic and MR findings and mean duration of the shoulder pain between the patients with and without the 'bridging sign' were compared. Results: The 'bridging sign' was seen in 17 of 29 patients and corresponded to a complex of the torn and superomedially retracted subscapularis tendon, coracohumeral ligament, and superior glenohumeral ligament, adhered to the anterior margin of the torn supraspinatus (SSP) tendon on arthroscopy. All patients with the 'bridging sign' had combined full-thickness tear (FTT) of the cranial 1/2 portion of the subscapularis tendon and anterior 1/2 portion of the SSP tendon. The sensitivity, specificity, and accuracy of the 'bridging sign' for the diagnosis of combined FTTs of

Contribution of abdoscan using MR cholangio-pancreatography and MR urography

International Nuclear Information System (INIS)

Lecesne, R.; Drouillard, J.; Cisse, R.; Schiratti, M.

1998-01-01

MR cholangio-pancreatography (MRCP) and MR Urography (MRU) are promising recent imaging modalities. Oral magnetic particles (Abdoscan, Nycomed SA, Oslo, Norway) is an negative contrast agent eliminating signal intensity of the gastro-intestinal tract thus improvising image quality at MRCP and MRU. (author)

MR imaging and MR angiography in popliteal artery entrapment syndrome

International Nuclear Information System (INIS)

Atilla, S.; Akpek, S.; Yuecel, C.; Tali, E.T.; Isik, S.; Ilgit, E.T.

1998-01-01

Popliteal artery entrapment (PAE) syndrome is an uncommon congenital anomaly seen in young adults causing ischemic symptoms in the lower extremities. It is the result of various types of anomalous relationships between the popliteal artery and the neighboring muscular structures. The purpose of this study was to define the role of MR imaging combined with MR angiography in the diagnosis of PAE cases. Four cases with segmental occlusion and medial displacement of popliteal artery in digital subtraction angiography (DSA) examinations were diagnosed as PAE syndrome by MR imaging and MR angiography. The DSA and MRA images are compared. All of the cases showed various degrees of abnormal intercondylar insertion of the medial head of the gastrocnemius muscle. The MR images showed detailed anatomy of the region revealing the cause of the arterial entrapment. Subclassification of the cases were done and fat tissue filling the normal localization of the muscle was evaluated. The DSA and MRA images demonstrated the length and localization of the occluded segment and collateral vascular developments equally. It is concluded that angiographic evaluation alone in PAE syndrome might result in overlooking the underlying cause of the arterial occlusion, which in turn leads to unsuccessful therapy procedures such as balloon angioplasty. Magnetic resonance imaging combined with MR angiography demonstrates both the vascular anatomy and the variations in the muscular structures in the popliteal fossa successfully, and this combination seems to be the most effective way of evaluating young adults with ischemic symptoms suggesting PAE syndrome. (orig.)

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.

Von Mr Classic zu Mr Nerd: Wie Forschende soziale Medien nutzen

Directory of Open Access Journals (Sweden)

Doreen Siegfried

2014-12-01

Full Text Available Unter Wissenschaftlerinnen und Wissenschaftlern lassen sich vier Typen differenzieren, die ein signifikant unterschiedliches Verhalten in ihrer Nutzung und ihrer Einstellung gegenüber Social-Web-Anwendungen zeigen: Ms Maker, Mr Tech, Mr Classic und Mr Nerd. Grundlage für die Identifizierung dieser Social-Media-Typen ist die Auswertung von 778 Online-Fragebögen, die von Anfang September bis Mitte Oktober 2013 erhoben wurden. Erfragt wurde die Nutzung von Social-Media-Instrumenten für die tägliche Arbeit in Forschung, Lehre, Administration und Wissenschaftskommunikation. Neben Intensität und Kontext der Nutzung von Web-2.0-Diensten wurden auch die Gründe für Nutzung bzw. Nicht-Nutzung einzelner Kanäle sowie generelle Einstellungen gegenüber Social-Media-Werkzeugen erfragt. Among scientists, four types of personality can be identified whose usage and attitude towards social web applications show significant variations: Ms Maker, Mr Tech, Mr Classic and Mr Nerd. This typification is based on 778 online questionnaires received between September and October 2013. The survey sampled the usage of social media tools for daily routines in research, teaching, administrative work and scholarly communication. The survey asked questions about the intensity and the context in which Web 2.0 services are used, about the reasons for (not using certain channels, and about general attitudes towards social media tools.

Functional MR imaging on an open 1T MR imaging system: exploiting the advantages of an open MR imaging system for functional MR imaging

NARCIS (Netherlands)

van de Giessen, E.; Groot, P. F. C.; Booij, J.; van den Brink, W.; Veltman, D. J.; Nederveen, A. J.

2011-01-01

Open MR imaging scanners are designed for imaging of specific patient groups that cannot be routinely scanned with conventional MR imaging scanners (eg, patients with obesity and claustrophobia). This study aims to determine whether BOLD sensitivity on an open 1T scanner is adequate for fMRI for

MR spectroscopy in dementia; MR-Spektroskopie bei Demenz

Energy Technology Data Exchange (ETDEWEB)

Hauser, T.; Gerigk, L.; Giesel, F.; Schuster, L.; Essig, M. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung E010, Radiologie, Heidelberg (Germany)

2010-09-15

With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia. (orig.) [German] Angesichts einer immer aelter werdenden Bevoelkerung sind wir mit dem Problem einer zunehmenden Zahl an Demenzerkrankungen konfrontiert. Neben klinischen, neuropsychologischen und laborchemischen Verfahren spielt die MRT zur Fruehdiagnostik einer Demenz eine wichtige Rolle. Morphologische Veraenderungen wie auch verschiedene funktionelle Verfahren helfen bei der Diagnostik und Differenzialdiagnostik einer Demenz. Insgesamt kann mittels MR-spektroskopischer Parameter die Diagnostik einer Demenz verbessert werden. In diesem Artikel soll auf MR-spektroskopische Veraenderungen im Rahmen des physiologischen Alterungsprozesses eingegangen werden. Ferner werden speziell Veraenderungen bei leichter kognitiver Beeintraechtigung, einer Vorform der Alzheimer-Demenz, bei Alzheimer-, frontotemporaler, vaskulaerer und Lewy-Koerper-Demenz eroertert. (orig.)

MR-guided pain therapy: principles and clinical applications; MR-gesteuerte Schmerztherapie: Prinzipien und klinische Applikationen

Energy Technology Data Exchange (ETDEWEB)

Fritz, J.; Pereira, P.L. [Diagnostische Radiologie, Eberhard-Karls-Universitaet, Tuebingen (Germany)

2007-09-15

X-ray fluoroscopy and computed tomography are frequently used to perform percutaneous interventions in pain therapy. The development of MR-compatible therapy needles now allows these interventions to be performed under MR imaging guidance. MR-guided interventions may be performed using most clinical MR scanners; however, systems with an open configuration are advantageous. Multiplanar pre- and intra-procedural MR imaging provides the interventionalist with essential information, such as evaluation of anatomy and pathology, as well as the planning of the procedure and monitoring of fluid distribution without the use of contrast agents. With the use of non-ionizing radiation, interventional MR imaging is especially suited for the treatment of children and young adults as well as for serial injection therapy. For spinal MR interventions, passive needle visualization is an easily achievable and reliable method. The resulting needle artifact is influenced by several factors such as the alloy of the needle, the strength of the static magnetic field, the sequence type, the spatial orientation of the therapy needle as well as the echo time and may further be optimized during the intervention by alteration of the last three factors. Fast acquisition techniques and image processing allow for continuous, near real-time MR imaging (so-called MR fluoroscopy) and interactive needle navigations, comparable to X-ray fluoroscopy and CT fluoroscopy. The purpose of this review is to illustrate and discuss general concepts of interventional MR imaging. A spectrum of interventional MR imaging procedures in spinal pain therapy is described and illustrated, including procedures such as lumbar facet joint injections, sacroiliac joint injections, lumbar spinal nerve root infiltrations and drug delivery to the lumbar sympathetic chain. (orig.)

MR imaging of colorectal carcinomas using an MR endoscopic coil

International Nuclear Information System (INIS)

Murano, Akihiko; Kido, Choichiro; Sasaki, Fumio; Nakamura, Tsuneya; Kobayashi, Semi; Katoh, Tomoyuki; Hirai, Takashi

1994-01-01

Diagnosis of the depth of wall invasion by rectal carcinoma using MR endoscopy was performed in ten resected specimens, including five rectal carcinomas, three colon carcinomas, two normal gastric wall. In addition, the gastric wall of a pig was examined. MR imaging was done with a 1.5-T Signa Advantage (GE Medical System) system, with the surface coil of the MR endoscope acting as the receiver coil. Five layers could be distinguished in the bowel wall: mucosa, submucosa and muscularis propria divided into circular muscle, longitudinal muscle and intervening connective tissue. Tumors had almost the same signal intensity as muscle. The MR images of colon carcinomas, rectal carcinomas, and extrinsically metastatic involvement of the sigmoid colon by rectal carcinoma all correlated well with the pathological findings. The normal structure of the gastric wall was similar to that of the colon. 3D-fast Spoiled Grass (SPGR) sequence has a fairly short scanning time. Thus, the possibility of precise clinical diagnosis by this method was suggested. (author)

Current status of MR colonography.

LENUS (Irish Health Repository)

Thornton, Eavan

2010-01-01

The search for an acceptable colorectal cancer screening examination has led to the development of virtual colonoscopy, which includes both computed tomographic (CT) colonography and magnetic resonance (MR) colonography. As indicated by the much larger number of published studies on CT colonography than on MR colonography, multidetector CT appears to be more suitable for colorectal screening than does MR colonography, in part reflecting the ease and speed of performing CT, as well as the increased spatial resolution, decreased cost, and wider availability of CT colonography. The main advantage of MR colonography over CT colonography is that it does not use ionizing radiation, which has important implications for colorectal cancer screening. The use of dark-lumen MR colonography to screen patients for colorectal cancer as well as other abdominopelvic disease could make it more attractive than CT. With the integration of 3.0-T MR colonography, fecal tagging, and parallel imaging into research and clinical settings, new MR colonography protocols must be optimized. Future MR colonography research should address issues such as image characteristics, presence of artifacts, management of specific absorption rate, and hardware-related modifications.

MR-assisted PET Motion Correction for eurological Studies in an Integrated MR-PET Scanner

Science.gov (United States)

Catana, Ciprian; Benner, Thomas; van der Kouwe, Andre; Byars, Larry; Hamm, Michael; Chonde, Daniel B.; Michel, Christian J.; El Fakhri, Georges; Schmand, Matthias; Sorensen, A. Gregory

2011-01-01

Head motion is difficult to avoid in long PET studies, degrading the image quality and offsetting the benefit of using a high-resolution scanner. As a potential solution in an integrated MR-PET scanner, the simultaneously acquired MR data can be used for motion tracking. In this work, a novel data processing and rigid-body motion correction (MC) algorithm for the MR-compatible BrainPET prototype scanner is described and proof-of-principle phantom and human studies are presented. Methods To account for motion, the PET prompts and randoms coincidences as well as the sensitivity data are processed in the line or response (LOR) space according to the MR-derived motion estimates. After sinogram space rebinning, the corrected data are summed and the motion corrected PET volume is reconstructed from these sinograms and the attenuation and scatter sinograms in the reference position. The accuracy of the MC algorithm was first tested using a Hoffman phantom. Next, human volunteer studies were performed and motion estimates were obtained using two high temporal resolution MR-based motion tracking techniques. Results After accounting for the physical mismatch between the two scanners, perfectly co-registered MR and PET volumes are reproducibly obtained. The MR output gates inserted in to the PET list-mode allow the temporal correlation of the two data sets within 0.2 s. The Hoffman phantom volume reconstructed processing the PET data in the LOR space was similar to the one obtained processing the data using the standard methods and applying the MC in the image space, demonstrating the quantitative accuracy of the novel MC algorithm. In human volunteer studies, motion estimates were obtained from echo planar imaging and cloverleaf navigator sequences every 3 seconds and 20 ms, respectively. Substantially improved PET images with excellent delineation of specific brain structures were obtained after applying the MC using these MR-based estimates. Conclusion A novel MR-based MC

Clinical arthrography

International Nuclear Information System (INIS)

Arndt, R.; Horns, J.W.; Gold, R.H.; Blaschke, D.D.

1985-01-01

This book deals with the method and interpretation of arthrography of the shoulder, knee, ankle, elbow, hip, wrist, and metacarpophalangeal, interphalangeal, and temporomandibular joints. The emphasis is on orthopaedic disorders, usually of traumatic origin, which is in keeping with the application of arthrography in clinical practice. Other conditions, such as inflammatory and degenerative diseases, congenital disorders and, in the case of the hip, arthrography of reconstructive joint surgery, are included. Each chapter is devoted to one joint and provides a comprehensive discussion on the method of arthrography, including single and double contrast techniques where applicable, normal radiographic anatomy, and finally, the interpretation of the normal and the abnormal arthrogram

MR imaging of the pelvis

International Nuclear Information System (INIS)

Hricak, H.

1987-01-01

MR imaging, CT, and US should be viewed as complementary studies for imaging the pelvis. MR imaging is relatively expensive, not widely available, and requires special facilities. However, it is noninvasive and offers a large field-of-view, direct imaging in all three orthogonal planes and excellent soft-tissue contrast. Surgical clips, which present a problem with other imaging modalities, do not create significant MR image artifacts. Image degradation due to bowel motion can be minimized by bowel preparation and/or the administration of glucagon. The value of MR imaging of the pelvis is in staging rather than diagnosis of pelvic neoplasms. The accuracy, sensitivity, and specificity of MR imaging in staging prostate or bladder tumors exceed those of US and CT. In prostate carcinoma, MR imaging can be used to evaluate periprostatic tumor extension, especially to the bladder base, rectum, or seminal vesicles. For early transcapsular extension, however, the accuracy of transrectal US reportedly surpasses that of MR imaging. In bladder carcinoma, the value of MR imaging is in direct tumor visualization, the ability to differentiate between tumor and normal bladder wall, and the evaluation of bladder tumors located at the dome of the bladder base, where imaging in the sagittal plane is essential. In the evaluation of benign entities of the female pelvis, US remains the preferred screening modality. The use of MR imaging is reserved for cases of infertility or for planning myomectomy when knowledge of the exact number, size, and location of tumors is essential. MR imaging is useful in evaluating patients with amenorrhea or any suspected congenital anomalies. The main application of MR imaging of the female pelvis is in the staging of neoplasms, including endometrial and cervical carcinomas

MR imaging of the brain: tumors

International Nuclear Information System (INIS)

Sartor, K.

1999-01-01

The radiologic modality that most likely provides the imaging information needed in a patient suspected of having a brain tumor is MR imaging. A brain tumor can be reliably ruled out if the MR examination is performed properly and experts interpret the results as negative. If there is a tumor, however, its exact location and topography must be determined. Important for therapy and prognosis are also tumor properties such as histologic type and grade, as well as effects on adjacent brain structures. Although potentially a noninvasive method of in vivo neuropathology, MR is still far from being sufficiently specific, as dissimilar lesions may look the same despite the use of refined imaging protocols. The evolution of MR imaging continues, however, making further methodologic improvement likely. Presently, advanced methods, such as diffusion- and perfusion-weighted MR imaging, functional MR imaging, neuronavigation based on MR imaging data, and the use of MR imaging during surgery (intraoperative MR imaging), influence the way patients are treated. Likewise, follow-up imaging (monitoring) of tumor patients by MR has become more effective, and experience has shown how to distinguish reactive changes from recurrent tumor. In the future, MR imaging may gain importance in the development of novel therapeutic concepts. (orig.)

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.)

Humeral head cysts and rotator cuff tears: an MR arthrographic study

International Nuclear Information System (INIS)

Williams, Martin; Lambert, Robert G.W.; Jhangri, Gian S.; Grace, Michael; Zelaso, Jay; Wong, Ben; Dhillon, Sukhvinder S.

2006-01-01

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.)

Safety issues and updates under MR environments

Energy Technology Data Exchange (ETDEWEB)

Kim, Soo Jung; Kim, Kyung Ah, E-mail: bellenina@daum.net

2017-04-15

Highlights: • Unexpected biological effects can occur within stronger magnetic fields. • MR safety for MR conditional items is not guaranteed beyond the tested conditions. • Updated knowledge about MR-related safety is important for a safe MR environment. - Abstract: Magnetic resonance (MR) imaging is a useful imaging tool with superior soft tissue contrast for diagnostic evaluation. The MR environments poses unique risks to patients and employees differently from ionizing radiation exposure originated from computed tomography and plain x-ray films. The technology associated with MR system has evolved continuously since its introduction in the late 1970s. MR systems have advanced with static magnetic fields, faster and stronger gradient magnetic fields and more powerful radiofrequency transmission coils. Higher field strengths of MR offers greater signal to noise capability and better spatial resolution, resulting in better visualization of anatomic detail, with a reduction in scan time. With the rapid evolution of technology associated with MR, we encounter new MR-related circumstances and unexpected dangerous conditions. A comprehensive update of our knowledge about MR safety is necessary to prevent MR-related accidents and to ensure safety for patients and staff associated with MR. This review presents an overview about MR-related safety issues and updates.

Magnetic resonance tomography-guided interventional procedure for diagnosis of prostate cancer; MRT-gezielte interventionelle Verfahren zur Abklaerung des Prostatakarzinoms

Energy Technology Data Exchange (ETDEWEB)

Schernthaner, M.; Helbich, T.H.; Fueger, B.J.; Memarsadeghi, M.; Stiglbauer, A.; Linhart, H.G.; Doan, A.; Pinker, K.; Brader, P. [Medizinische Universitaet Wien, Univ.-Klinik fuer Radiodiagnostik, Division fuer Molekulare und Gender-Bildgebung, Wien (Austria); Margreiter, M. [Medizinische Universitaet Wien, Univ.-Klinik fuer Urologie, Wien (Austria)

2011-11-15

In recent years magnetic resonance imaging (MRI) has been increasingly established in the diagnosis of prostate cancer in addition to transrectal ultrasonography (TRUS). The use of T2-weighted imaging allows an exact delineation of the zonal anatomy of the prostate and its surrounding structures. Other MR imaging tools, such as dynamic contrast-enhanced T1-weighted imaging or diffusion-weighted imaging allow an inference of the biochemical characteristics (multiparametric MRI). Prostate cancer, which could only be diagnosed using MR imaging or lesions suspected as being prostate cancer, which are localized in the anterior aspect of the prostate and were missed with repetitive TRUS biopsy, need to undergo MR guided biopsy. Recent studies have shown a good correlation between MR imaging and histopathology of specimens collected by MR-guided biopsy. Improved lesion targeting is therefore possible with MR-guided biopsy. So far data suggest that MR-guided biopsy of the prostate is a promising alternative diagnostic tool to TRUS-guided biopsy. (orig.) [German] Neben dem transrektalen Ultraschall (TRUS) hat sich in den letzten Jahren die MRT als nichtinvasive Methode zur Bildgebung von Prostatatumoren etabliert. Mittels T2-gewichteter Sequenzen ist eine exakte anatomische Darstellung der Prostata und ihrer umliegenden Strukturen moeglich. Andere MRT-Techniken ermoeglichen Rueckschluesse auf das biologische Verhalten des Tumors: dynamische kontrastmittelverstaerkte T1-gewichtete Sequenzen zur Darstellung der Angiogenese, diffusionsgewichtete Aufnahmen zur Beurteilung der Zelldichte und die Spektroskopie zur Bestimmung von Gewebemetaboliten wie Cholin und Kreatin (multiparametrische Bildgebung). Prostatatumoren, die nur mittels MRT nachweisbar sind oder verdaechtige Tumoren, die hauptsaechlich anterior in der Prostata lokalisiert sind und in wiederholten TRUS-gezielten Biopsien verfehlt wurden, benoetigen eine MRT-gezielte Biopsie zur Diagnosesicherung. Die bisherigen

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

Quality of MR thermometry during palliative MR-guided high-intensity focused ultrasound (MR-HIFU) treatment of bone metastases

NARCIS (Netherlands)

Lam, Mie K; Huisman, Merel; Nijenhuis, Robbert J; van den Bosch, Maurice; Viergever, Max A; Moonen, Chrit Tw; Bartels, LW

2015-01-01

BACKGROUND: Magnetic resonance (MR)-guided high-intensity focused ultrasound has emerged as a clinical option for palliative treatment of painful bone metastases, with MR thermometry (MRT) used for treatment monitoring. In this study, the general image quality of the MRT was assessed in terms of

Motion correction in simultaneous PET/MR brain imaging using sparsely sampled MR navigators

DEFF Research Database (Denmark)

Keller, Sune H; Hansen, Casper; Hansen, Christian

2015-01-01

BACKGROUND: We present a study performing motion correction (MC) of PET using MR navigators sampled between other protocolled MR sequences during simultaneous PET/MR brain scanning with the purpose of evaluating its clinical feasibility and the potential improvement of image quality. FINDINGS......: Twenty-nine human subjects had a 30-min [(11)C]-PiB PET scan with simultaneous MR including 3D navigators sampled at six time points, which were used to correct the PET image for rigid head motion. Five subjects with motion greater than 4 mm were reconstructed into six frames (one for each navigator...

Complications of rotator cuff surgery—the role of post-operative imaging in patient care

Science.gov (United States)

Thakkar, R S; Thakkar, S C; Srikumaran, U; Fayad, L M

2014-01-01

When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low “metal presence” and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms. PMID:24734935

Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis

Energy Technology Data Exchange (ETDEWEB)

Leeuwenburgh, Marjolein M.N., E-mail: m.m.leeuwenburgh@amc.uva.nl [Department of Surgery, Academic Medical Center, University of Amsterdam (Netherlands); Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands); Wiarda, Bart M. [Department of Radiology, Alkmaar Medical Center, Alkmaar (Netherlands); Jensch, Sebastiaan [Department of Radiology, Sint Lucas Andreas Hospital, Amsterdam (Netherlands); Wouter van Es, H. [Department of Radiology, Sint Antonius Hospital, Nieuwegein (Netherlands); Stockmann, Hein B.A.C. [Department of Surgery, Kennemer Gasthuis, Haarlem (Netherlands); Gratama, Jan Willem C. [Department of Radiology, Gelre Hospitals, Apeldoorn (Netherlands); Cobben, Lodewijk P.J. [Department of Radiology, Haaglanden Medical Center, Leidschendam (Netherlands); Bossuyt, Patrick M.M. [Department of Clinical Epidemiology, Academic Medical Center, University of Amsterdam (Netherlands); Boermeester, Marja A. [Department of Surgery, Academic Medical Center, University of Amsterdam (Netherlands); Stoker, Jaap [Department of Radiology, Academic Medical Center, University of Amsterdam (Netherlands)

2014-01-15

Objective: To compare accuracy and interobserver agreement between radiologists with limited experience in the evaluation of abdominal MRI (non-experts), and radiologists with longer MR reading experience (experts), in reading MRI in patients with suspected appendicitis. Methods: MR imaging was performed in 223 adult patients with suspected appendicitis and read independently by two members of a team of eight MR-inexperienced radiologists, who were trained with 100 MR examinations previous to this study (non-expert reading). Expert reading was performed by two radiologists with a larger abdominal MR experience (>500 examinations) in consensus. A final diagnosis was assigned after three months based on all available information, except MRI findings. We estimated MRI sensitivity and specificity for appendicitis and for all urgent diagnoses separately. Interobserver agreement was evaluated using kappa statistics. Results: Urgent diagnoses were assigned to 147 of 223 patients; 117 had appendicitis. Sensitivity for appendicitis was 0.89 by MR-non-expert radiologists and 0.97 in MR-expert reading (p = 0.01). Specificity was 0.83 for MR-non-experts versus 0.93 for MR-expert reading (p = 0.002). MR-experts and MR-non-experts agreed on appendicitis in 89% of cases (kappa 0.78). Accuracy in detecting urgent diagnoses was significantly lower in MR-non-experts compared to MR-expert reading: sensitivity 0.84 versus 0.95 (p < 0.001) and specificity 0.71 versus 0.82 (p = 0.03), respectively. Agreement on urgent diagnoses was 83% (kappa 0.63). Conclusion: MR-non-experts have sufficient sensitivity in reading MRI in patients with suspected appendicitis, with good agreement with MR-expert reading, but accuracy of MR-expert reading was higher.

Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis

International Nuclear Information System (INIS)

Leeuwenburgh, Marjolein M.N.; Wiarda, Bart M.; Jensch, Sebastiaan; Wouter van Es, H.; Stockmann, Hein B.A.C.; Gratama, Jan Willem C.; Cobben, Lodewijk P.J.; Bossuyt, Patrick M.M.; Boermeester, Marja A.; Stoker, Jaap

2014-01-01

Objective: To compare accuracy and interobserver agreement between radiologists with limited experience in the evaluation of abdominal MRI (non-experts), and radiologists with longer MR reading experience (experts), in reading MRI in patients with suspected appendicitis. Methods: MR imaging was performed in 223 adult patients with suspected appendicitis and read independently by two members of a team of eight MR-inexperienced radiologists, who were trained with 100 MR examinations previous to this study (non-expert reading). Expert reading was performed by two radiologists with a larger abdominal MR experience (>500 examinations) in consensus. A final diagnosis was assigned after three months based on all available information, except MRI findings. We estimated MRI sensitivity and specificity for appendicitis and for all urgent diagnoses separately. Interobserver agreement was evaluated using kappa statistics. Results: Urgent diagnoses were assigned to 147 of 223 patients; 117 had appendicitis. Sensitivity for appendicitis was 0.89 by MR-non-expert radiologists and 0.97 in MR-expert reading (p = 0.01). Specificity was 0.83 for MR-non-experts versus 0.93 for MR-expert reading (p = 0.002). MR-experts and MR-non-experts agreed on appendicitis in 89% of cases (kappa 0.78). Accuracy in detecting urgent diagnoses was significantly lower in MR-non-experts compared to MR-expert reading: sensitivity 0.84 versus 0.95 (p < 0.001) and specificity 0.71 versus 0.82 (p = 0.03), respectively. Agreement on urgent diagnoses was 83% (kappa 0.63). Conclusion: MR-non-experts have sufficient sensitivity in reading MRI in patients with suspected appendicitis, with good agreement with MR-expert reading, but accuracy of MR-expert reading was higher

PET/MR Imaging in Gynecologic Oncology.

Science.gov (United States)

Ohliger, Michael A; Hope, Thomas A; Chapman, Jocelyn S; Chen, Lee-May; Behr, Spencer C; Poder, Liina

2017-08-01

MR imaging and PET using 2-Deoxy-2-[ 18 F]fluoroglucose (FDG) are both useful in the evaluation of gynecologic malignancies. MR imaging is superior for local staging of disease whereas fludeoxyglucose FDG PET is superior for detecting distant metastases. Integrated PET/MR imaging scanners have great promise for gynecologic malignancies by combining the advantages of each modality into a single scan. This article reviews the technology behind PET/MR imaging acquisitions and technical challenges relevant to imaging the pelvis. A dedicated PET/MR imaging protocol; the roles of PET and MR imaging in cervical, endometrial, and ovarian cancers; and future directions for PET/MR imaging are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

A 16-channel MR coil for simultaneous PET/MR imaging in breast cancer

International Nuclear Information System (INIS)

Dregely, Isabel; Lanz, Titus; Mueller, Matthias F.; Metz, Stephan; Kuschan, Marika; Nimbalkar, Manoj; Ziegler, Sibylle I.; Nekolla, Stephan G.; Schwaiger, Markus; Bundschuh, Ralph A.; Haase, Axel

2015-01-01

To implement and evaluate a dedicated receiver array coil for simultaneous positron emission tomography/magnetic resonance (PET/MR) imaging in breast cancer. A 16-channel receiver coil design was optimized for simultaneous PET/MR imaging. To assess MR performance, the signal-to-noise ratio, parallel imaging capability and image quality was evaluated in phantoms, volunteers and patients and compared to clinical standard protocols. For PET evaluation, quantitative 18 F-FDG PET images of phantoms and seven patients (14 lesions) were compared to images without the coil. In PET image reconstruction, a CT-based template of the coil was combined with the MR-acquired attenuation correction (AC) map of the phantom/patient. MR image quality was comparable to clinical MR-only examinations. PET evaluation in phantoms showed regionally varying underestimation of the standardised uptake value (SUV; mean 22 %) due to attenuation caused by the coil. This was improved by implementing the CT-based coil template in the AC (<2 % SUV underestimation). Patient data indicated that including the coil in the AC increased the SUV values in the lesions (21 ± 9 %). Using a dedicated PET/MR breast coil, state-of-the-art MRI was possible. In PET, accurate quantification and image homogeneity could be achieved if a CT-template of this coil was included in the AC for PET image reconstruction. (orig.)

Magnetic resonance imaging of traumatic anterior instability of the shoulder

International Nuclear Information System (INIS)

Horii, Motoyuki

1994-01-01

The diagnostic capability of MRI in depicting abnormalities in traumatic anterior instability of the shoulder (TAI) was evaluated with special attention to MR arthrogram enhanced by joint effusion or saline solution. Sixty five shoulders with TAI and 19 control shoulders were scanned using the field gradient echo method (STAGE technique) on axial plane with a 1.0 or 1.5 Tesla system. MR arthrogram was obtained in 36 shoulders with TAI (Group A) and 11 control shoulders (Group C). Conventional MRI was obtained in 29 shoulders with TAI (Group B) and 8 control shoulders (Group D). Abnormalities in Bankart lesion were assessed according to signal intensity and labral shape. Abnormal signal was obtained in 8 shoulders (27.6%) in group B. Changes in shape were seen in 35 shoulders (97.2%) in group A and 18 (62.1%) in group B. Interruption of the anterior capsule was suspected in 3 (8.3%) in group A. Hill-Sachs lesion was suspected in 60 shoulders. Shoulders in the control group showed no abnormal change. Details of Bankart lesion confirmed by subsequent arthroscopy were diagnosed correctly in all of 14 shoulders on MR arthrogram and 8 of 16 shoulders on conventional MRI. These results show that MRI, MR arthrogram in particular, is useful for depicting abnormalities in TAI. (author)

Abdominal MR angiography

International Nuclear Information System (INIS)

Wegmueller, H.; Vock, P.

1993-01-01

The two techniques currently most often used for MR angiography, those based on time-of-flight effects and on phase-contrast, are introduced, and our results with three-dimensional phase contrast angiography of the abdomen are presented. Several basic differences from other imaging procedures render MR angiography clinically useful for screening for renal artery stenosis in critical situations, such as renal failure or intolerance to contrast agents. In the future, the spectrum of applications of MR angiography will broaden and include other indications, such as portal venous hypertension and follow-up studies after surgical portal systemic shunting. (orig.) [de

Visit of Mr. Susumu Yoda, Japanese Atomic Energy Commission, Mr. Nobuo Natsume, Vice-President, Central Research Institute of Electric Power Industry, Japan (CRIEPI), Mr. Nobuya Yoshiki, CRIEPI, Mrs. Seiko Ichikawa, Interpreter, with Mr. Taylor of CERN, visiting SM18

CERN Multimedia

Laurent Guiraud

2000-01-01

Visit of Mr. Susumu Yoda, Japanese Atomic Energy Commission, Mr. Nobuo Natsume, Vice-President, Central Research Institute of Electric Power Industry, Japan (CRIEPI), Mr. Nobuya Yoshiki, CRIEPI, Mrs. Seiko Ichikawa, Interpreter, with Mr. Taylor of CERN, visiting SM18

The value of MR imaging of PDFASAT sequence in the diagnosis of extremities occult fractures

International Nuclear Information System (INIS)

Lu Lingquan; Xu Mingshen; Wu Qianzhi; Mao Chunnan; Wang Shuzi; Zhou Xingfan; Wang Liping

2004-01-01

Objective: To investigate the value of MR imaging of proton density weighted-fat saturated (PDFASAT) sequence in detecting the occult fracture of extremities. Methods: Thirty-one patients with acute trauma were studied using radiography and MR imaging within 45 days. MR sequences included FSE T 1 WI, T 2 WI, and PDFASAT. 21 occult fractures occurred in the knee joint, 6 in the hip joint, 1 in the elbow joint, 2 in the shoulder, and 1 in the ankle. Results: All 31 cases had normal radiographic results. 10 cases with proximal fibula, 4 with proximal tibia and 7 with femur condyle occult fractures were found in 21 knee joint acute trauma cases. 2 cases with intertrochanteric, 2 with femoral neck and 2 with cotyle occult fractures were found in 6 hip joint trauma cases. 2 proximal humerus occult fractures were found in 2 shoulder cases. 1 distal humerus and 1 distal fibula occult fracture was found in elbow and ankle cases. MR imaging demonstrated irregular linear low signal in the subcortical region on both T 1 WI and T 2 WI, and high signal changes around low signal were seen on T 2 WI in some cases. The high signal in PDFASAT sequence was more remarkable and wider than that on both T 1 WI and T 2 WI. Conclusion: MR imaging could determine the diagnosis of acute and chronic occult fractures. MRI should be the next choice when plain films fail to reveal suspected fractures in setting of suggestive symptoms and positive physical examination. PDFASAT would be the best effective sequence among the T 1 WI, T 2 WI, and PDFASAT. (author)

MR myelography of sacral meningeal cysts

International Nuclear Information System (INIS)

Tsuchiya, K.; Katase, S.; Hachiya, J.

1999-01-01

Purpose: To describe the findings of sacral meningeal cysts (SMCs) on MR myelography and assess its value for the diagnosis of SMCs. Material and Methods: We evaluated the MR images and MR myelograms obtained from 10 patients with SMC. MR myelograms were obtained using a 2D or 3D single-shot fast spin-echo sequence. In 5 patients, X-ray myelograms and postmyelographic CT images were compared with the MR myelograms. Results: A total of 33 SMCs were diagnosed within the spinal canal and/or sacral foramen. MR myelograms clearly revealed each cyst as a well-defined mass showing hyperintensity (10 cysts) or isointensity (23 cysts) compared to cerebrospinal fluid. MR myelograms demonstrated SMCs better than X-ray myelograms and postmyelographic CT images in 3 of the 5 patients. Conclusion: MR myelography can be an adjunct to conventional imaging techniques when surgical treatment is indicated, because it can precisely delineate the extent of SMCs. (orig.)

Characterization of a prototype MR-compatible Delta4 QA system in a 1.5 tesla MR-linac

Science.gov (United States)

de Vries, J. H. W.; Seravalli, E.; Houweling, A. C.; Woodings, S. J.; van Rooij, R.; Wolthaus, J. W. H.; Lagendijk, J. J. W.; Raaymakers, B. W.

2018-01-01

To perform patient plan quality assurance (QA) on a newly installed MR-linac (MRL) it is necessary to have an MR-compatible QA device. An MR compatible device (MR-Delta4) has been developed together with Scandidos AB (Uppsala, Sweden). The basic characteristics of the detector response, such as short-term reproducibility, dose linearity, field size dependency, dose rate dependency, dose-per-pulse dependency and angular dependency, were investigated for the clinical Delta4-PT as well as for the MR compatible version. All tests were performed with both devices on a conventional linac and the MR compatible device was tested on the MRL as well. No statistically significant differences were found in the short-term reproducibility (tesla magnetic field of the Elekta MR-linac

MR appearance of central neurocytoma

International Nuclear Information System (INIS)

Chang, K.H.; Han, M.H.; Kim, D.G.; Chi, J.G.; Suh, D.C.; Kim, S.J.; Cha, S.H.; Han, M.C.

1993-01-01

To provide a detailed description of the MR appearances of central neurocytoma, MR images of 13 patients with central neurocytoma were retrospectively reviewed and compared with CT examinations. The histology was confirmed by ultrastructural and immunohistochemical studies. In 12 patients the tumors were histologically benign and located in the anterior part of the lateral ventricle, 6 of which extended to the 3rd ventricle. There was one case of a histologically malignant variant involving the thalamus and lateral ventricle. The tumors were primarily solid, but contained cysts (85%, 11/13), calcifications (69%, 9/13), and signal void from tumor vessels (62%, 8/13), frequently producing heterogeneous signal intensity on both T1- and T2-weighted images. Most of the solid portion appeared isointense or slightly hyperintense relative to the cerebral cortex on all MR pulse sequences. Calcifications were iso- or hypointense on MR, making them difficult to characterize with MR alone. Intratumoral hemorrhage was seen in 2 patients on MR but not on CT. Contrast enhancement was variable in degree and pattern. Coronal and sagittal MR images were valuable in evaluating the tumor extent and origin site, and in planning the surgical approach. It is concluded that MR imaging appears to be more useful than CT in the overall evaluation of central neurocytoma, even though calcification is better characterized with CT. (orig.)

First MR images obtained during megavoltage photon irradiation from a prototype integrated linac-MR system

International Nuclear Information System (INIS)

Fallone, B. G.; Murray, B.; Rathee, S.; Stanescu, T.; Steciw, S.; Vidakovic, S.; Blosser, E.; Tymofichuk, D.

2009-01-01

The authors report the first magnetic resonance (MR) images produced by their prototype MR system integrated with a radiation therapy source. The prototype consists of a 6 MV linac mounted onto the open end of a biplanar 0.2 T permanent MR system which has 27.9 cm pole-to-pole opening with flat gradients (40 mT/m) running under a TMX NRC console. The distance from the magnet isocenter to the linac target is 80 cm. The authors' design has resolved the mutual interferences between the two devices such that the MR magnetic field does not interfere with the trajectory of the electron in the linac waveguide, and the radiofrequency (RF) signals from each system do not interfere with the operation of the other system. Magnetic and RF shielding calculations were performed and confirmed with appropriate measurements. The prototype is currently on a fixed gantry; however, in the very near future, the linac and MR magnet will rotate in unison such that the linac is always aimed through the opening in the biplanar magnet. MR imaging was found to be fully operational during linac irradiation and proven by imaging a phantom with conventional gradient echo sequences. Except for small changes in SNR, MR images produced during irradiation were visually and quantitatively very similar to those taken with the linac turned off. This prototype system provides proof of concept that the design has decreased the mutual interferences sufficiently to allow the development of real-time MR-guided radiotherapy. Low field-strength systems (0.2-0.5 T) have been used clinically as diagnostic tools. The task of the linac-MR system is, however, to provide MR guidance to the radiotherapy beam. Therefore, the 0.2 T field strength would provide adequate image quality for this purpose and, with the addition of fast imaging techniques, has the potential to provide 4D soft-tissue visualization not presently available in image-guided radiotherapy systems. The authors' initial design incorporates a

Characterization of a prototype MR-compatible Delta4 QA-system in a 1.5 tesla MR-linac

NARCIS (Netherlands)

de Vries, Wilfred J H; Seravalli, Enrica; Houweling, Anette; Woodings, Simon J; van Rooij, Rob; Wolthaus, Jochem W H; Lagendijk, JJW; Raaymakers, Bas W

2018-01-01

To perform patient plan-quality assurance (QA) on the newly installed MR-Linac (MRL) there was a need for having an MR-compatible QA-device. An MR compatible device (MR-Delta4) was developed together with Scandidos AB (Uppsala, Sweden). The basic characteristics of the detector response

Long bicipital tendon of the shoulder: normal anatomy and pathologic findings on MR imaging.

Science.gov (United States)

Erickson, S J; Fitzgerald, S W; Quinn, S F; Carrera, G F; Black, K P; Lawson, T L

1992-05-01

The tendon of the long head of the biceps muscle (long bicipital tendon) has a complex course from its muscle belly to its insertion onto the supraglenoid tubercle/glenoid labrum. It is stabilized by numerous tendinous and ligamentous structures and is, in turn, partly responsible for maintenance of normal glenohumeral function. In this report we describe the anatomy of this tendon, correlating high-resolution MR images with cryomicrotome sections. We illustrate typical MR findings in pathologic conditions affecting the long bicipital tendon sheath, the substance of the tendon, and finally the tendon position.

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

International Nuclear Information System (INIS)

Nimkin, K.; Kleinman, P.K.; Teeger, S.; Spevak, M.R.

1995-01-01

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.)

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

Energy Technology Data Exchange (ETDEWEB)

Nimkin, K. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Kleinman, P.K. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Teeger, S. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States); Spevak, M.R. [Dept. of Radiology, Univ. of Massachusetts, Medical Center, Worcester, MA (United States)

1995-09-01

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.)

A study of artefacts in simultaneous PET and MR imaging using a prototype MR compatible PET scanner

International Nuclear Information System (INIS)

Slates, R.B.; Farahani, K.; Marsden, P.K.; Taylor, J.; Summers, P.E.; Williams, S.; Beech, J.

1999-01-01

We have assessed the possibility of artefacts that can arise in attempting to perform simultaneous positron emission tomography (PET) and magnetic resonance imaging (MRI) using a small prototype MR compatible PET scanner (McPET). In these experiments, we examine MR images for any major artefacts or loss in image quality due to inhomogeneities in the magnetic field, radiofrequency interference or susceptibility effects caused by operation of the PET system inside the MR scanner. In addition, possible artefacts in the PET images caused by the static and time-varying magnetic fields or radiofrequency interference from the MR system were investigated. Biological tissue and a T 2 -weighted spin echo sequence were used to examine susceptibility artefacts due to components of the McPET scanner (scintillator, optical fibres) situated in the MR field of view. A range of commonly used MR pulse sequences was studied while acquiring PET data to look for possible artefacts in either the PET or MR images. Other than a small loss in signal-to-noise using gradient echo sequences, there was no significant interaction between the two imaging systems. Simultaneous PET and MR imaging of simple phantoms was also carried out in different MR systems with field strengths ranging from 0.2 to 4.7 T. The results of these studies demonstrate that it is possible to acquire PET and MR images simultaneously, without any significant artefacts or loss in image quality, using our prototype MR compatible PET scanner. (author)

Diagnostic Efficiency of MR Imaging of the Knee. Relationship to time Interval between MR and Arthroscopy

International Nuclear Information System (INIS)

Barrera, M. C.; Recondo, J. A.; Aperribay, M.; Gervas, C.; Fernandez, E.; Alustiza, J. M.

2003-01-01

To evaluate the efficiency of magnetic resonance (MR) in the diagnosis of knee lesions and how the results are influenced by the time interval between MR and arthroscopy. 248 knees studied by MR were retrospectively analyzed, as well as those which also underwent arthroscopy. Arthroscopy was considered to be the gold standard, MR diagnostic capacity was evaluated for both meniscal and cruciate ligament lesions. Sensitivity, specificity and Kappa index were calculated for the set of all knees included in the study (248), for those in which the time between MR and arthroscopy was less than or equal to three months (134) and for those in which the time between both procedures was less than or equal to one month. Sensitivity, specificity and Kappa index of the MR had global values of 96.5%, 70% and 71%, respectively. When the interval between MR and arthroscopy was less than or equal to three months, sensitivity, specificity and Kappa index were 95.5%, 75% and 72%, respectively. When it was less than or equal to one month, sensitivity was 100%, specificity was 87.5% and Kappa index was 91%. MR is an excellent tool for the diagnosis of knee lesions. Higher MR values of sensitivity, specificity and Kappa index are obtained when the time interval between both procedures is kept to a minimum. (Author) 11 refs

Gadolinium-enhanced excretory MR urography: comparison with MR urography using HASTE technique

International Nuclear Information System (INIS)

Jin, Gong Yong; Lee, Jeong Min; Han, Young Min; Cheong, Gyung Ho; Oh, Hee Sul; Kim, Chong Soo; Park, Sung Kwang; Kim, Young Gon

2000-01-01

To compare the feasibility of gadolinium-enhanced excretory MR urography (GEMRU) and conventional MR urography using the half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequence in patients with hydronephrosis or non-visualized kidney. Fifteen patients with hydronephrosis or non-visualized kidney, as demonstrated by ultrasonography or intravenous urography, were enrolled in this study. Nine were men and six were women, and their age ranged from 18 to 77 (mean, 60.6) years. For all MR examinations, a 1.5T MR unit was employed. For breath-hold MR urography, the HASTE technique (MRU) was used, and reconstruction involved the use of a maximum intensity-projection (MIP) algorithm. For gadolinium-enhanced excretory MR urography, the fast low angle shot (FLASH) 3-D method was used and images were obtained at 5, 10, 20, and 30 minutes, and reconstruction again involved the use of MIP algorithm. In some cases, additional GEMRU was obtained 24 hour after contrast material injection, and an MIP algorithm was used for reconstruction. MRU and GEMRU were independently interpreted by two radiologists who for quantitative analysis compared SNR with CNR, and at each anatomic level qualitatively analyzed morphologic accuracy and diagnostic value of the lesions. In quantitative analysis, SNR and CNR differences between the two sequences at the renal pelvis and the level of the ureter were not significant (p greater than 0.05). In qualitative analysis, GEMRU was superior to MRU for the assessment of evaluated ureter at each level (p less than 0.05), anatomic anomaly and intrinsic tumor. Ureteral stones, however, were more easily diagnosed with MRU. For assessment of the ureter GEMRU is superior to MRU and has the advantage of evaluating renal function. We believe that for evaluation of the urinary tract, especially the distal ureter, GEMRU may be a valuable adjunct to routine MR urography. (author)

MR cholangiography: usefulness in obstructive jaundice

International Nuclear Information System (INIS)

Bae, Sang Hoon; Lee, In Jae; Nam, Kung Sook; Hong, Myung Sun; Lee, Kyung Hwan; Yun, Ku Sub

1994-01-01

Three-dimensional(3D) magnetic resonance(MR) projection imaging was evaluated as a noninvasive alternative to direct cholangiography for the assessment of its reliability in patients with obstructive jaundice. A heavily T2-weighted gradient-echo sequence(PSIF) was used for 3D MR projection imaging of the biliary system in five healthy volunteers and 25 patients with obstructive jaundice. The 3D images of the bile ducts were formed by stacking consecutive coronal MR images obtained with a fast imaging method to a maximum-intensity projection algorithm. In the volunteers, MR cholangiography could demonstrate the anatomy of the biliary tract in only two subjects. The extrahepatic and intrahepatic bile ducts were well visualized in 23 patients with obstructive jaundice. The leve of obstruction and the grade of dilatation were depicted with MR cholangiography in all cases. And the cause of obstruction could be determined with MR cholangiography in 18 cases, MR cholangiography wa successful in two patients in whom ERCP failed. The gallbladder or dilated pancreatic duct not demonstrated by means of direct cholangiography was demonstrated with MR cholangiography in six cases. MR cholangiography may be a useful adjunctive tool for the noninvasive evaluation of patients with obstructive Jaundice

Ultrasonography and arthrography in rotator cuff lesions: algorithmic approach

Energy Technology Data Exchange (ETDEWEB)

Kim, Eui Jong; Ryu, Kyung Nam; Lee, Sun Wha; Lim, Jae Hoon; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yu, Pil Mun [Dankuk University College of Medicine, Chenona (Korea, Republic of)

1992-11-15

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.

Ultrasonography and arthrography in rotator cuff lesions: algorithmic approach

International Nuclear Information System (INIS)

Kim, Eui Jong; Ryu, Kyung Nam; Lee, Sun Wha; Lim, Jae Hoon; Rhee, Yong Girl; Yu, Pil Mun

1992-01-01

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

T2-weighted MR imaging of the liver: Qualitative and quantitative comparison of SPACE MR imaging with turbo spin-echo MR imaging

Energy Technology Data Exchange (ETDEWEB)

Dohan, Anthony, E-mail: anthony.dohan@lrb.aphp.fr [Department of Body and Interventional Imaging, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75475 Paris Cedex 10 (France); Université Paris-Diderot, Sorbonne Paris Cité, 10 Rue de Verdun, 75010 Paris (France); UMR INSERM 965, Hôpital Lariboisière, 2 Rue Amboise Paré, 75010 Paris (France); Gavini, Jean-Philippe, E-mail: jpgavini@gmail.com [Department of Body and Interventional Imaging, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75475 Paris Cedex 10 (France); Université Paris-Diderot, Sorbonne Paris Cité, 10 Rue de Verdun, 75010 Paris (France); Placé, Vinciane, E-mail: vinciane.place@gmail.com [Department of Body and Interventional Imaging, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75475 Paris Cedex 10 (France); Sebbag, Delphine, E-mail: delphinesebbag@gmail.com [Department of Body and Interventional Imaging, Hôpital Lariboisière, AP-HP, 2 Rue Ambroise Paré, 75475 Paris Cedex 10 (France); Université Paris-Diderot, Sorbonne Paris Cité, 10 Rue de Verdun, 75010 Paris (France); Vignaud, Alexandre, E-mail: alexandre.vignaud@cea.fr [LRMN, Neurospin, CEA-SACLAY, Bâtiment 145, 91 191 Gif-sur-Yvette Cedex (France); and others

2013-11-01

Objective: To qualitatively and quantitatively compare T2-weighted MR imaging of the liver using volumetric spin-echo with sampling perfection with application-optimized contrast using different flip angle evolutions (SPACE) with conventional turbo spin-echo (TSE) sequence for fat-suppressed T2-weighted MR imaging of the liver. Materials and methods: Thirty-three patients with suspected focal liver lesions had SPACE MR imaging and conventional fat-suppressed TSE MR imaging. Images were analyzed quantitatively by measuring the lesion-to-liver contrast-to-noise ratio (CNR), and the signal-to-noise ratio (SNR) of main focal hepatic lesions, hepatic and splenic parenchyma and qualitatively by evaluating the presence of vascular, respiratory motion and cardiac artifacts. Wilcoxon signed rank test was used to search for differences between the two sequences. Results: SPACE MR imaging showed significantly greater CNR for focal liver lesions (median = 22.82) than TSE MR imaging (median = 14.15) (P < .001). No differences were found for SNR of hepatic parenchyma (P = .097), main focal hepatic lesions (P = .35), and splenic parenchyma (P = .25). SPACE sequence showed less artifacts than TSE sequence (vascular, P < .001; respiratory motion, P < .001; cardiac, P < .001) but needed a longer acquisition time (228.4 vs. 162.1 s; P < .001). Conclusion: SPACE MR imaging provides a significantly increased CNR for focal liver lesions and less artifacts by comparison with the conventional TSE sequence. These results should stimulate further clinical studies with a surgical standard of reference to compare the two techniques in terms of sensitivity for malignant lesions.

MR imaging features of spindle cell lipoma

Energy Technology Data Exchange (ETDEWEB)

Kirwadi, Anand; Abdul-Halim, Rehan; Highland, Adrian; Kotnis, Nikhil [Sheffield Teaching Hospitals NHS Trust, Radiology Department, Sheffield (United Kingdom); Fernando, Malee [Sheffield Teaching Hospitals NHS Trust, Histopathology Department, Sheffield (United Kingdom)

2014-02-15

To assess the MR imaging features of spindle cell lipomas (SCL) and to compare these appearances directly with the histopathological findings. A retrospective review of our soft tissue tumor database was performed. This yielded 1,327 histologically proven lipomas, of which 25 were confirmed as being SCLs. Fourteen of the 25 patients had MR examinations available for review and only these patients were included in our study. Lesions were assessed at MR examination for the degree of internal fat signal content with grade 0 representing 0 % fat signal and grade 4 100 % fat signal. The degree of fat suppression and contrast-enhancement pattern were also recorded. The excision specimens were independently reviewed by a consultant histopathologist. The histology specimens were assessed for the amount of internal fat and non-adipose tissue and graded using the same scale applied for the imaging. Where core needle biopsy (CNB) was performed, the CNB specimens were also examined for positive features of SCL. In our study, 93 % (13/14) of our patients were male and the average age was 58 years. 65 % (9/14) of the lesions presented in the upper back, shoulder, or neck. All lesions were subcutaneous. 35 % (5/14) of the SCLs demonstrated grade 3 (>75 %) or grade 4 (100 %) fat signal on MR examination. 35 % (5/14) of the lesions had grade 2 (25-75 %) fat signal and 29 % (4/14) of the lesions demonstrated grade 0 (0 %) or grade 1 (<25 %) fat signal. 43 % (6/14) of lesions demonstrated homogenous fat suppression, 28 % (4/14) showed focal areas of high internal signal, and 28 % (4/14) had diffuse internal high signal on fluid-sensitive fat-saturated sequences. 86 % (6/7) of the cases demonstrated septal/nodular enhancement. The diagnosis was evident on the CNB specimen in 100 % (9/9) cases. The histopathology fat content grade was in agreement with the imaging grade in 86 % (12/14) cases. The internal signal pattern of SCL can range broadly, with low fat content lesions seen almost

MR imaging of the brachial plexus: comparison between 1.5-T and 3-T MR imaging: preliminary experience

Energy Technology Data Exchange (ETDEWEB)

Tagliafico, Alberto; Neumaier, Carlo Emanuele; Calabrese, Massimo [National Institute for Cancer Research, Department of Radiology, Genova (Italy); Succio, Giulia; Serafini, Giovanni; Ghidara, Matteo [Santa Corona Hospital, Radiology Department, Savona (Italy); Martinoli, Carlo [Universita di Genova, Radiology Department, Genova (Italy)

2011-06-15

To compare 1.5-T and 3-T magnetic resonance (MR) imaging of the brachial plexus. Institutional review board approval and informed consent were obtained from 30 healthy volunteers and 30 consecutive patients with brachial plexus disturbances. MR was prospectively performed with comparable sequence parameters and coils with a 1.5-T and a 3-T system. Imaging protocols at both field strengths included T1-weighted turbo spin-echo (tSE) sequences and T2-weighed turbo spin-echo (tSE) sequences with fat saturation. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) between muscle and nerve were calculated for both field strengths. The visibility of brachial plexus nerve at various anatomic levels (roots, interscalene area, costoclavicular space, and axillary level) was analyzed with a four-point grading scale by two radiologists. MR imaging diagnoses and pathological findings were also compared qualitatively. SNR and CNRs were significantly higher on 3-T MR images than on 1.5-T MR images (Friedman test) for all sequences. Nerve visibility was significantly better on 3-T MR images than on 1.5-T MR images (paired sign test). Pathological findings (n = 30/30) were seen equally well with both field strengths. MR imaging diagnoses did not differ for the 1.5- and 3-T protocols. High-quality MR images of the brachial plexus can be obtained with 3-T MR imaging by using sequences similar to those used at 1.5-T MR imaging. In patients and healthy volunteers, the visibility of nerve trunks and cords at 3-T MR imaging appears to be superior to that at 1.5-T MR imaging. (orig.)

MR imaging of the kidneys: new diagnostic strategies; MR-Bildgebung der Nieren. Neue Ansaetze in der Diagnostik

Energy Technology Data Exchange (ETDEWEB)

Schoenberg, S.O.; Knopp, M.V.; Bock, M.; Floemer, F.; Essig, M.; Hawighorst, H.; Kaick, G. van [Deutsches Krebsforschungszentrum, Heidelberg (Germany). Forschungsschwerpunkt Radiologische Diagnostik; Kallinowski, F. [Heidelberg Univ. (Germany). Chirurgische Universitaetsklinik; Just, A. [Heidelberg Univ. (Germany). 1. Physiologisches Inst.; Laub, G. [Siemens AG, Erlangen (Germany). Unternehmensbereich Medizinische Technik; Prince, M.R [Michigan Univ., Ann Arbor, MI (United States). Dept. of Radiology

1999-05-01

Aim: New diagnostic strategies for evaluation of the kidney by fast MR imaging of renal morphology, multiphase 3D gadolinium MR angiography, MR urography and MR flow measurements. A signal MR examination is designed to grade renovascular disease and assess the hemodynamic and functional significance, detect and characterize renal lesions and evaluate the urinary tract. Results: The combined analysis of morphologic and functional data allows reliable assessment of renal artery stenosis, benign and malignant renal masses and diseases of the renal collecting system and ureters, as well as congenital abnormalities in good agreement to the results of conventional imaging modalities. The improved tissue contrast and additional functional information compensates for the disadvantage of a lower spatial resolution. Conclusion: Combined morphologic and functional MR examination represents a reliable, non-invasive and cost-effective alternative imaging modality for comprehensive diagnostic evaluation of renal disease. (orig.) [Deutsch] Fragestellung: Darstellung neuer diagnostischer Moeglichkeiten im Bereich der Niere mittels schneller Magnetresonanz (MR)-Bildgebung. Methodik: Vorgestellt wird ein kombiniertes morphologisches und funktionelles Untersuchungskonzept bestehend aus schneller morphologischer Bildgebung, multiphasischer 3D-Gadolinium-MR-Angiographie, MR-Urographie und MR-Flussmessung. In einer einzigen MR-Untersuchung sollen vaskulaere Erkrankungen erfasst, eingestuft und auf ihre haemodynamische und funktionelle Signifikanz ueberprueft werden, renale Laesionen detektiert und differenziert sowie die Harnabflusswege beurteilt werden. Ergebnisse: Durch Integration der gewonnenen morphologischen und funktionellen Daten lassen sich Nierenarterienstenosen, benigne und maligne renale Tumoren, Harnabflussstoerungen und kongenitale Fehlbildungen mit aehnlicher Genauigkeit wie in den konventionellen radiologischen Verfahren erfassen. Der Nachteil der geringeren raeumlichen

MR-guided lumbar sympathicolysis

Energy Technology Data Exchange (ETDEWEB)

Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, University of Tuebingen (Germany); Schneider, Wilke [Department of Vascular Surgery, University of Tuebingen (Germany)

2002-06-01

The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

MR-guided lumbar sympathicolysis

International Nuclear Information System (INIS)

Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H.; Schneider, Wilke

2002-01-01

The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

MR findings of tuberculous arthritis; significance of tuberculoma

International Nuclear Information System (INIS)

Jang, Han Won; Kim, Jeen Woo; Cho, Kil Ho

2001-01-01

To determine the magnetic resonance (MR) imaging findings of tuberculous arthritis, and the frequency-in such cases-with which tuberculoma occurs. MR images of 26 patients (M;F, 14;12: mean age, 46.2 years) with pathologically proven tuberculous arthritis were retrospectively reviewed. The presence of joint effusion, subchondral erosion, synovial proliferation and soft tissue abscess, and whether the inner wall of this abscess was smooth, were assessed. In particular, we determined whether a nodular lesion which showed low SI on T1WI, central low SI with peripheral hjigh SI on T2WI, and rim enhancement on contrast study, was a tuberculoma. The joints involved were those of the knee (n=7), hip (n=7), shoulder (n=4), sacroiliac region (n=3), elbow (n=3), and ankle (n=2). Joint effusion was noted in 15 cases (58%), and subchondral erosion in 24 (92%). synovial proliferation was found in 23 cases (88%), and soft tissue abscess in 24 (92%). The inner wall of this abscess was irregular in 17 cases (71%). A tuberculoma was present in intra-or extra-or extra-articular soft tissue in 18 cases (69%). The MR findings of tuberculous arthritis were subchondral erosion, synovial proliferation, and soft tissue abscess. The presence of a tuberculoma in intra-or extra-articular soft tissue, a specific finding in tuberculous arthritis, was noted in 69% of our cases

MR findings of tuberculous arthritis; significance of tuberculoma

Energy Technology Data Exchange (ETDEWEB)

Jang, Han Won; Kim, Jeen Woo; Cho, Kil Ho [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of)

2001-02-01

To determine the magnetic resonance (MR) imaging findings of tuberculous arthritis, and the frequency-in such cases-with which tuberculoma occurs. MR images of 26 patients (M;F, 14;12: mean age, 46.2 years) with pathologically proven tuberculous arthritis were retrospectively reviewed. The presence of joint effusion, subchondral erosion, synovial proliferation and soft tissue abscess, and whether the inner wall of this abscess was smooth, were assessed. In particular, we determined whether a nodular lesion which showed low SI on T1WI, central low SI with peripheral hjigh SI on T2WI, and rim enhancement on contrast study, was a tuberculoma. The joints involved were those of the knee (n=7), hip (n=7), shoulder (n=4), sacroiliac region (n=3), elbow (n=3), and ankle (n=2). Joint effusion was noted in 15 cases (58%), and subchondral erosion in 24 (92%). synovial proliferation was found in 23 cases (88%), and soft tissue abscess in 24 (92%). The inner wall of this abscess was irregular in 17 cases (71%). A tuberculoma was present in intra-or extra-or extra-articular soft tissue in 18 cases (69%). The MR findings of tuberculous arthritis were subchondral erosion, synovial proliferation, and soft tissue abscess. The presence of a tuberculoma in intra-or extra-articular soft tissue, a specific finding in tuberculous arthritis, was noted in 69% of our cases.

Skeletal MR imaging: Correlation with skeletal scintigraphy

International Nuclear Information System (INIS)

Colletti, P.M.; Raval, J.K.; Ford, P.V.; Benson, R.C.; Kerr, R.M.; Boswell, W.D.; Siegel, M.E.; Ralls, P.W.

1987-01-01

Skeletal MR images bone marrow while skeletal scintigraphy uses bone metabolism to demonstrate abnormalities. The purpose of this paper is to correlate these MR and scintigraphic findings. T1 and T2 MR images at 0.5 T were correlated with planar bone scintigraphy (RN) using Tc-99m MDP in 56 patients. Of 23 cases with suspected spinal metastases, 19 were positive by MR imaging, 16 by RN. Individual lesions were shown better by MR imaging in five and by RN in two. These two cases had scoliosis, a potential difficulty with MR imaging. In 14 cases of suspected avascular necrosis (AVN), MR imaging was positive in 13 while RN was positive in ten. One negative case by RN had bilateral AVN by MR imaging. Four skull lesions shown easily by RN were seen only in retrospect on MR images. MR imaging is advantageous in evaluating bones with predominant marrow such as vertebrae or the femoral head, while RN is superior in areas primarily composed of cortical bone such as the skull

Intracranial MR angiography

International Nuclear Information System (INIS)

Davis, W.L.; Blatter, D.D.; Parker, D.L.; Robison, R.O.; Harnsberger, H.R.

1991-01-01

This paper compares the more traditional three-dimensional (3D) time-of-flight MR angiography with a novel new technique, MOTSA, in the evaluation of both normal and abnormal intracranial anatomy. The authors performed sequential, location-matched 3D TOF and MOTSA MR angiography in 10 subjects with normal and 25 with abnormal intracranial anatomy. Images were evaluated for visualization of specific vessels and depiction of pathologic anatomy. All images were subjected to an objective scoring system. Digital angiography was available in 15 of 25 abnormal cases. In the normal cases, large- and small-vessel visualization was improved. Significant improvement in visualization of venous anatomy was also observed. In the abnormal cases, pathologic anatomy was better visualized, providing important diagnostic information. Multiple overlapping thin-slab-acquisition MR angiography demonstrates vessel visualization that is increased over that of 3D TOF MR angiography in both normal and abnormal cases. Because of the decrease in saturation effects and phase dispersion, MOTSA is especially useful in the evaluation of complex intracranial vascular abnormalities

MR of acute subarachnoid hemorrhage

International Nuclear Information System (INIS)

Spickler, E.; Lufkin, R.; Frazee, J.; Lylyk, P.; Vinuela, F.; Bentson, J.; Dion, J.

1987-01-01

Subarachnoid hemorrhage was produced in four Macaca nemestrina monkeys using the technique of Frazee. CT and MR imaging was performed immediately after the procedure and at frequent intervals up to 2 weeks after hemorrhage. The imaging studies were compared with clinical evaluations and pathologic specimens of all animals. Additional human clinical CT/MR studies of subarachnoid hemorrhage were also studied. Acute hemorrhage was recognized on MR images as an increase in signal in the region of clot compared with surrounding cerebrospinal fluid. This most likely reflects T1 shortening due to proton binding rather than a pure paramagnetic effect. While CT is sensitive to the hemoglobin protein in acute hemorrhage, the superior resolution of MR of the basal cisterns results in equal or better definition of acute subarachnoid hemorrhage on MR studies in many cases

Magnetic Resonance (MR) Defecography

Science.gov (United States)

... to a CD or uploaded to a digital cloud server. Magnetic resonance (MR) defecography is a special ... with you. top of page What are the benefits vs. risks? Benefits MR defecography helps assess pelvic ...

US and MR imaging of pelvic masses

International Nuclear Information System (INIS)

Angtuaco, T.L.; Boyd, C.M.; Mattison, D.R.; Williamson, M.R.; Sanders, M.M.; Bard, D.S.

1987-01-01

US and MR imaging were compared in benign and malignant pelvic masses to determine where MR imaging may replace US. With regard to benign masses, MR imaging showed a significant advantage only in the imaging of teratomas. In malignancy, US was better than MR imaging in delineating internal architecture. MR imaging was superior in suggesting the origin and extent of masses, especially in large neoplasms. US remains a reliable tool in the initial evaluation of pelvic masses. When US studies are suboptimal, MR imaging should be performed as complementary study. MR imaging may replace US in the initial examination of large masses where US cannot depict the origin and extent

Mr. Ansar Shamsi, Member Finance, Mr. Malik Adalat Khan, Director Finance, Pakistan Atomic Energy Commission

CERN Multimedia

Patrice Loïez

2003-01-01

Photo 01: Mr Ansar Shamsi, Member Finance, Pakistan Atomic Energy Commission (centre), visiting the ATLAS Tile Calorimeter in building 191 with, from left to right, Mr Syed Shaukat Hussain, Pakistan Mission in Geneva and Dr Peter Jenni, ATLAS Spokesperson. Photo 02: Mr Ansar Shamsi, Member Finance, Pakistan Atomic Energy Commission (2nd form left), visiting the ATLAS Tile Calorimeter in building 191 with, from left to right, Mr Syed Shaukat Hussain, Pakistan Mission in Geneva; Dr Peter Jenni, ATLAS Spokesperson; Dr David Jacobs and Dr Philip Bryant, Joint Pakistan-CERN Committee.

MR imaging of prostate cancer

International Nuclear Information System (INIS)

Heuck, A.; Scheidler, J.; Sommer, B.; Graser, A.; Mueller-Lisse, U.G.; Massmann, J.

2003-01-01

Accurate diagnosis and staging of prostate cancer (PC) is developing into an important health care issue in light of the high incidence of PC and the improvements in stage-adapted therapy. The purpose of this paper is to provide an overview on the current role of MR imaging and MR spectroscopy in the diagnosis and staging of PC.Material and methods Pertinent literature was searched and evaluated to collect information on current clinical indications, study techniques, diagnostic value, and limitations of magnetic resonance imaging and spectroscopy. Major indications for MR imaging of patients with supected PC are to define tumor location before biopsy when clinical or TRUS findings are inconclusive, and to provide accurate staging of histologically proven PC to ascertain effective therapy. Current MR imaging techniques for the evaluation of PC include multiplanar high-resolution T2-weighted FSE and T1-weighted SE sequences using combined endorectal and phased-array coils. Using these techniques, the reported accuracy of MR imaging for the diagnosis of extracapsular tumor extension ranges between 82 and 88% with sensitivities between 80 and 95%, and specificities between 82 and 93%. Typical MR findings of PC in different stages of disease, as well as diagnostic problems, such as chronic prostatitis, biopsy-related hemorrhage and therapy-related changes of prostatic tissue are discussed. In addition, the current perspectives and limitations of MR spectroscopy in PC are summarized. Current MR imaging techniques provide important diagnostic information in the pretherapeutic workup of PC including a high staging accuracy, and is superior to TRUS. (orig.) [de

MR arthrogram findings of luxatio erecta in a pediatric patient - arthroscopic confirmation and review of the literature

International Nuclear Information System (INIS)

Stensby, J.D.; Fox, Michael G.

2014-01-01

Luxatio erecta or inferior glenohumeral dislocation is a rare type of shoulder dislocation, accounting for less than 1 % of all reported shoulder dislocations. We describe a 15-year-old male who presented with luxatio erecta following an injury to his shoulder that resulted from a mountain biking accident. Clinically, the patient had shoulder pain and fixed abduction of the arm. Radiographs confirmed the diagnosis of luxatio erecta. A magnetic resonance arthrogram (MRA) performed 9 days after presentation demonstrated both a greater tuberosity fracture and avulsion of the anterior and posterior inferior glenohumeral ligaments from their humeral attachment. The MR findings were confirmed on arthroscopy. The bone and soft tissue injury pattern seen in our patient clearly supports the described mechanism of injury for luxatio erecta and lends credence to the theory that a fracture of the greater tuberosity spares injury to the rotator cuff, especially in children. A review of the literature failed to reveal any prior description of the MRI or MRA findings of luxatio erecta in a pediatric patient or any publication with arthroscopic confirmation of the MR findings. (orig.)

MR arthrogram findings of luxatio erecta in a pediatric patient - arthroscopic confirmation and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Stensby, J.D.; Fox, Michael G. [University of Virginia, Department of Radiology and Medical Imaging, 1218 Lee Street, Box 800170, Charlottesville, VA (United States)

2014-08-15

Luxatio erecta or inferior glenohumeral dislocation is a rare type of shoulder dislocation, accounting for less than 1 % of all reported shoulder dislocations. We describe a 15-year-old male who presented with luxatio erecta following an injury to his shoulder that resulted from a mountain biking accident. Clinically, the patient had shoulder pain and fixed abduction of the arm. Radiographs confirmed the diagnosis of luxatio erecta. A magnetic resonance arthrogram (MRA) performed 9 days after presentation demonstrated both a greater tuberosity fracture and avulsion of the anterior and posterior inferior glenohumeral ligaments from their humeral attachment. The MR findings were confirmed on arthroscopy. The bone and soft tissue injury pattern seen in our patient clearly supports the described mechanism of injury for luxatio erecta and lends credence to the theory that a fracture of the greater tuberosity spares injury to the rotator cuff, especially in children. A review of the literature failed to reveal any prior description of the MRI or MRA findings of luxatio erecta in a pediatric patient or any publication with arthroscopic confirmation of the MR findings. (orig.)

Mr. Wolfgang Petritsch, Austrian Ambassador

CERN Multimedia

Patrice Loïez

2002-01-01

Dr.Peter Schmid/CERN/EP, Dr.Wolfgang Petritsch, Austrian Ambassador, Permanent representative at UN, Mrs.Nora Petritsch, Dr.Kurt Hubner/CERN/AC, Mrs. Frederike Klaus-Salesin, Adviser, Mrs.Andrea Strohmeier, Secretary of the Ambassador, Mr.Heinz Klaus, Attaché, Dr.Theodor Tortschanoff/CERN/LHC, Mr.Peter Storer, Advisor. Dr.Peter Schmid/CERN/EP, Dr.Wolfgang Petritsch, Austrian Ambassador, Permanent representative at UN, Mrs.Nora Petritsch, Dr.Kurt Hubner/CERN/AC, Mrs. Frederike Klaus-Salesin, Adviser, Mrs.Andrea Strohmeier, Secretary of the Ambassador, Mr.Heinz Klaus, Attaché, Dr.Theodor Tortschanoff/CERN/LHC, Mr.Peter Storer, Advisor.

Arterial pseudoaneurysms of the shoulder mimicking other entities: utilization of pulsation artifact on musculoskeletal MR for accurate diagnosis in 2 cases

Energy Technology Data Exchange (ETDEWEB)

Samim, Mohammad [New York University, Department of Radiology, Hospital for Joint Disease, New York, NY (United States); Mandell, Jacob; Smith, Stacy; Kapoor, Neena; Czuczman, Gregory [Harvard Medical School, Department of Radiology, Brigham and Women' s Hospital, Boston, MA (United States)

2017-08-15

We present two cases of pseudoaneurysm (PSA) about the shoulder mimicking more common clinical entities - soft tissue neoplasm and septic arthritis - for which biopsy of the mass and joint aspiration were requested respectively. We review the imaging findings of PSA with emphasis on findings in musculoskeletal protocol MRI, including the identification of pulsation artifact in both cases, which was critical to establishing the correct diagnosis. In the proper clinical setting, with imaging findings demonstrating a complex mass or fluid collection, MR images should be scrutinized for the presence of pulsation artifact, which can help diagnose a high-flow vascular lesion and avoid a potentially harmful invasive procedure such as biopsy. (orig.)

Intracranial tuberculoma: MR imaging

Energy Technology Data Exchange (ETDEWEB)

Salgado, P; Zenteno, M A; Rodriguez-Carbajal, J; Brutto, O.H. del; Talamas, O

1989-09-01

MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.).

Intracranial tuberculoma: MR imaging

International Nuclear Information System (INIS)

Salgado, P.; Zenteno, M.A.; Rodriguez-Carbajal, J.; Brutto, O.H. del; Talamas, O.

1989-01-01

MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.)

Arthrography

Medline Plus

Full Text Available ... felt to be inadequate in assessing a joint abnormality. There are several methods to perform direct arthrography. ... The procedure is most often used to identify abnormalities within the: shoulder elbow wrist hip knee ankle ...

Arthrography

Medline Plus

Full Text Available ... a table on which the patient lies. The traditional MRI unit is a large cylinder-shaped tube ... MRI) - Shoulder X-ray, Interventional Radiology and Nuclear Medicine Radiation Safety Images related to Direct Arthrography Videos ...

Chondromalacia patellae: diagnosis with MR imaging.

Science.gov (United States)

McCauley, T R; Kier, R; Lynch, K J; Jokl, P

1992-01-01

Most previous studies of MR imaging for detection of chondromalacia have used T1-weighted images. We correlated findings on axial MR images of the knee with arthroscopic findings to determine MR findings of chondromalacia patellae on T2-weighted and proton density-weighted images. The study population included 52 patients who had MR examination of the knee with a 1.5-T unit and subsequent arthroscopy, which documented chondromalacia patellae in 29 patients and normal cartilage in 23. The patellar cartilage was assessed retrospectively for MR signal and contour characteristics. MR diagnosis based on the criteria of focal signal or focal contour abnormality on either the T2-weighted or proton density-weighted images yielded the highest correlation with the arthroscopic diagnosis of chondromalacia. When these criteria were used, patients with chondromalacia were detected with 86% sensitivity, 74% specificity, and 81% accuracy. MR diagnosis based on T2-weighted images alone was more sensitive and accurate than was diagnosis based on proton density-weighted images alone. In conclusion, most patients with chondromalacia patellae have focal signal or focal contour defects in the patellar cartilage on T2-weighted MR images. These findings are absent in most patients with arthroscopically normal cartilage.