ADVANCED ARTHROGRAPHY OF THE SHOULDER WITH CT AND MR IMAGING

Abstract

Diagnostic imaging of the shoulder utilizing intra-articular contrast enhancement dates back to 1933, when Oberholzer used air as contrast medium to evaluate capsular distortions that occurred after dislocations. 80 Soon after, single-contrast arthrography using iodinated contrast material was described for evaluation of rotator cuff tears. 35 In the following decades this procedure was somewhat underutilized despite its ability to demonstrate rotator cuff ruptures and some capsular lesions. 29 The advent of double-contrast arthrography was responsible for improved visualization of rotator cuff tears as well as allowing visualization of the joint surfaces and capsular structures including the glenoid labrum. 20,39,40 Conventional tomography was then applied, albeit briefly, for arthrotomographic evaluation of the glenoid labrum in glenohumeral instability. 13 CT arthrography, however, had a greater impact in revealing the normal and pathologic anatomy of the capsular structures of the glenohumeral joint. 12,61,62,65 Another procedure, subacromial bursography, which has been only sporadically performed, should be mentioned even if only for historic purposes. 9,73 These procedures are now mostly replaced by conventional and contrast-enhancement MR imaging of the shoulder. In this article the basic principles of double-contrast shoulder arthrography, subacromial bursography, CT arthrography, and MR arthrography are presented and major indications and findings are discussed.