Technique Of Arthrography Research Articles

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

Objective: 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. Subjects and methods: 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. Results: 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 significant difference among the techniques could be shown. Conclusion: All imaging technique studied had high specificity and accuracy in the detection and grading of CP; however, MRA was more sensitive than T1-weighted and proton density-weighted MR imaging on a LFOMS. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnosis was greatest with T2-weighted MRI.

Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management.

Soft-tissue and osseous impingement syndromes of the ankle can be an important cause of chronic pain, particularly in the professional athlete. The main impingement syndromes are anterolateral, anterior, anteromedial, and posterior impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performed and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging, but the accuracy and role of MR imaging in assessment of possible ankle impingement have not been clearly established. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes.

Subperiosteal ganglion cyst of the tibia

We report a patient with a subperiosteal ganglion cyst of the tibia which was imaged by radiography, arthrography, CT and MRI. The images were correlated with the arthroscopic surgical and histological findings. Spiculated formation of periosteal new bone on plain radiographs led to the initial suspicion of a malignant tumour. Demonstration of the cystic nature of the tumour using cross-sectional imaging was important for the precise diagnosis. Communication between the ganglion cyst and the knee was shown by a delayed arthrographic technique, and the presence of this communication was confirmed at arthroscopy and surgically.

MR arthrography of the shoulder: variants and pitfalls.

Use of magnetic resonance arthrography to evaluate pathologic conditions of the shoulder is becoming widespread. However, normal anatomy or anatomic variations can cause interpretive errors. The most common variations occur at the origins of the glenohumeral ligaments (GHLs) and the insertion of the joint capsule. Among the GHL variants, common origin of the superior and middle ligaments is the most frequent followed by thinning, thickening, or absence of a ligament, most often the middle one. Absence or thinning of one ligament is sometimes associated with thickening of another or changes in the size and shape of the anterior capsular recesses. Common normal variants of the labrum include foramen sublabrum (detachment of the anterosuperior labrum from the glenoid margin) and the Buford complex (absence of the anterosuperior labrum in association with a thick middle GHL). Pitfalls related to the arthrographic technique include (a) visualization of a deep sulcus between the insertion of the long head of the biceps tendon and the superior labrum and (b) an apparent type III capsular insertion due to overdistention of the capsule by injected contrast material.

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach

Twenty-five patients with chronic wrist pain and a preliminary diagnosis of carpal instability were examined with conventional MR imaging and MR arthrography with single compartment intra-articular injection. A new cine-MR arthrography technique, with image acquisition at every 5 s during intra-articular injection, was performed in 17 subjects. The purpose of this study was to determine the diagnostic value of MR arthrography in ligamentous lesions of the wrist and to assess the value of cine-MR arthrography in comparison with arthroscopy and/or surgery. Magnetic resonance arthrography, a semi-invasive technique, increased the diagnostic accuracy of intrinsic carpal ligament injuries. Cine-MR arthrography can be considered as a promising technique especially for the evaluation of lunatotriquetral and scapholunate ligament injuries of the wrist.

Radiographic anatomy and technique for arthrography of the cubital joint in clinically normal dogs

Summary A technique for arthrography of the cubital joint in clinically normal large-breed dogs was developed with the objective of improving visualization of the articular margin of the medial coronoid process. A lateral approach to the cubital joint for injection of contrast medium was selected. Arthrography of 24 cubital joints was performed by using 14 dogs. Twelve combinations of iodinated contrast medium, consisting of various concentrations (3) and volumes (4), were used. Two sets of arthrograms for each of the 12 combinations of contrast medium were obtained. Five radiographic views were used for each set. All arthrograms were examined by 3 evaluators, and each articular surface received a numerical rating for how well it could be seen in each view. Results of the evaluation indicated that low volumes of contrast medium were preferable to high volumes, with 2 ml providing the best visualization. Concentration of iodine seemed less important than did volume. The numerical ratings also indicated that the articular margin of the coronoid process was clearly observed a maximum of only 24% of the time on a slightly supinated mediolateral projection. The articular margins of the head of the radius, trochlea humeri, and trochlear notch were well visualized > 90% of the time. Arthrography of the cubital joint was technically easy to perform, and complications were not encountered, but arthrographic anatomy of the cubital joint is complex. Potential uses for arthrography of the cubital joint include diagnosis of osteochondrosis, intraarticular fragments, and joint capsule ruptures.

Comparison of the diagnostic accuracy of positive-contrast arthrography and arthrotomy in evaluation of osteochondrosis lesions in the scapulohumeral joint in dogs

Summary During a 6-year-period (1985-1991), 120 positive-contrast arthrograms were made in 70 dogs to evaluate osteochondrosis lesions in the scapulohumeral joint. In 76 shoulders, the arthrographic findings were compared with surgical or histopathologic findings to evaluate the accuracy of the arthrographic technique. Positive-contrast arthrography was found to be accurate in evaluation of the status of the articular cartilage. In revealing discontinuity of the articular cartilage, the results of arthrography were false-negative in 4 shoulders (58/66; accuracy, 88%). In detecting thick cartilage covering a subchondral defect, the results of positive-contrast arthrography were false-positive in 4 joints (6/11; accuracy, 55%). In detecting fragmentation of the cartilage, arthrography provided false-negative results in 4 joints (7/11; accuracy, 64%). This technique enabled detection of joint mice, especially within the bicipital tendon sheath (no false-positive results). Arthrography failed to reveal joint mice within the caudal pouch in 2 joints (15/17; accuracy, 88%). Joint effusion also could be evaluated and was correlated with synovitis, degenerative joint disease, and loose or detached cartilage flaps. Postarthrography complications were not observed with this technique.

Unidirectional joint communications in wrist arthrography: an evaluation of 250 cases.

Although arthrographically demonstrable communications between various compartments of the wrist occur in older persons without symptoms, similar communications in younger persons may indicate clinically significant posttraumatic ligament tears and other pathologic processes. However, detection of communications varies depending on the arthrographic technique used. It has been claimed that if triple-compartment arthrography is not used in all patients, clinically significant unidirectional ligament tears may be overlooked. We determined the frequency and distribution of unidirectional intercompartmental communications, using a modification of techniques described in the literature. Separate injections of contrast material were made in sequence into the midcarpal, distal radioulnar, and radiocarpal joints of 250 consecutive patients. We found 38 unidirectional communications (17 lunotriquetral, nine scapholunate, three radial capsular, one ulnar capsular, six combined sites, and two indeterminate sites) between the midcarpal and radiocarpal joints. Nine unidirectional communications between the radiocarpal and distal radioulnar joints were found. Comparison of these results with the frequency and direction of unidirectional communications reported by others suggests that demonstration of communications depends on specific technical factors, such as which joint is injected first, the amount of contrast material used, and the delay between injections. This dependence on technical factors raises questions about the value of routine three-compartment wrist arthrography.

Puncture technique and portals of entry for diagnostic and operative arthroscopy of the temporomandibular joint

Cadaveric research, expansion of successful arthrography techniques, and improved understanding of normal anatomy, pathology, and open surgery have led to the development of safe, repeatable, and effective puncture techniques and portals of entry in the temporomandibular joint. Single and multiple punctures are described. Two-year outcomes of operative procedures with favorable results are presented for 145 joints in 95 patients. Complications are discussed.

Roentgenographic Findings in Massive Rotator Cuff Tears A Long-Term Observation

It is difficult to determine the size and localization of rotator cuff tears preoperatively. But with the special arthrographic technique, a diagnosis with about 80% accuracy was possible in 65 surgically confirmed rotator cuff tears. With this technique, 22 massive cuff tears were found in conservatively treated patients. In these patients, the plain roentgenograms obtained at the initial examination were also analyzed. The roentgenographic findings included narrowing of the acromiohumeral interval and degenerative changes of the humeral head, the tuberosities, the acromion, the acromioclavicular joint, and the glenohumeral joint. Based on these data, five roentgenographic grades of massive cuff tears were identified. Of seven patients with massive tears, which had been treated conservatively and followed for more than eight years, the roentgenographic grades advanced in five. One shoulder progressed to cuff-tear arthropathy. Based on these observations, it is proposed that the following pathogenetic mechanisms are responsible for the progressive roentgenographic changes: (1) arm elevation in activities of daily living, (2) rupture of the long head of biceps tendon, (3) the abnormal fulcrum of the humeral head against the acromion and the coracoacromial ligament, and (4) the weakness of external rotation. A massive cuff tear will progress to cuff-tear arthropathy, with each step of progression accompanied by characteristic roentgenographic changes.

各種顎関節腔造影法の比較検討

各種顎関節腔造影法の比較検討

Arthroscopy and arthrography. A combined procedure.

Arthrography and arthroscopy are invasive diagnostic procedures performed on all main joints of the human body. Both procedures are effective, with differing methods of visualizing intra-articular structures. Whereas the arthrogram reproduces a black-and-white, two-dimensional picture of a spatial structure (an indirect procedure), arthroscopy provides a colored picture facilitating a three-dimensional assessment of the joint cavity, palpation, and the arthroscopic operation. However, both procedures have their weaknesses. False-positive and false-negative results may occur in arthrographic techniques, whereas in arthroscopy, the inability to visualize particular joint regions resulting from the anatomical features of the joints is known. Arthroscopy and arthrography are complementary procedures in joint diagnosis. The present paper is based on experience gathered in 5188 arthroscopies of the six large human joints. Prior to all hand and hip arthroscopies, arthrographic examinations were performed. They provided essential information in 30% of all ankle-joint arthroscopies and in 10% of all knee arthroscopies, but in only a few elbow and shoulder arthroscopies.

Temporomandibular joint arthrography: A comparison between a fluoroscopic and a nonfluoroscopic technique

A nonfluoroscopic temporomandibular joint arthrographic technique is contrasted with a more widely employed fluoroscopically guided technique. The nonfluoroscopic technique uses a posterior approach to joint injection, as contrasted with the lateral injection approach of the fluoroscopically guided technique. The advantages of the nonfluoroscopic technique are less radiation does to the patient, less expensive and less sophisticated imaging equipment, and less potential for neurovascular trauma. The fluoroscopic technique offers greater control of the procedure, less patient and operator time, and the capability for a dynamic videofluoroscopic study. Both techniques appear to be safe and efficacious. Differences in anatomy, imaging modalities, patient radiation exposure, and potential complications are also discussed as part of this comparison.

Evaluation of Metrizamide Arthrography for Detection of Surgically Induced Lesions of the Canine Stifle Joint: a Pilot Investigation

Metrizamide arthrography was performed bilaterally on six dogs before and following surgical induction of stifle lesions to evaluate the technique of arthrography for identification of the surgically induced lesions. Observer identification of three articular cartilage lesions by arthrography varied from 0 to 50%; whereas the identification of meniscal (n = 7) and cruciate (n = 5) lesions varied from 0 to 50% and 0 to 60% respectively. Identification of a tenotomy of the long digital extensor tendon varied from 0 to 100%. Contrast arthrography, as defined by this pilot study, was inadequate for identification of surgically induced stifle disease and consequently cannot be recommended as a routine diagnostic technique for evaluation of stifle disorders.

Book reviews

First, let me state that this book is superbly written and beautifully illustrated. It has been a pleasure to read. The initial chapter is concerned with the technique of arthrography and the second chapter with the structures demonstrated. The rest of the book details the pathological processes encountered.

Bilateral arthrographic evaluation of unilateral temporomandibular joint pain and dysfunction

A group of 20 subjects with symptoms of unilateral TMJ and/or associated muscular problems was clinically assessed and the condition of the symptomatic and asymptomatic joints was investigated by using an arthrographic technique. The assumption that asymptomatic TMJs have a normal condyle/disk relationship is now in question.

Temporomandibular joint arthrography without fluoroscopy

An arthrographic technique for the temporomandibular joint that can be performed in a dental surgical room is described. This technique utilizes a dental radiographic unit and extraoral cassettes for visualization of the needle tip in the inferior synovial space for arthrography. The radiographic visualization is combined with tactile discernment of the needle tip on the mandibular condyle. The successful application of these two methods makes fluoroscopy unnecessary. After an initial success rate of 81% (34 of 42 attempts), we have used the technique successfully in more than 100 cases. Most of the problems encountered with this technique can be attributed to initial operator inexperience. This technique is not suggested as a replacement for fluoroscopy. However, it is a convenient, economical technique that can be used in the dental surgical room by trained clinicians when arthrography is indicated to determine meniscal-condylar relationships and meniscal perforations.

顎関節症患者に対する上下顎関節腔造影エックス線検査の経験

We would like to introduce the technique of arthrography used at the upper and lower compartments of TMJ in our Department. Typical cases were represented and some discussious were made.(1) The number of patients suspected to suffer from internal derangements of TMJ and accepted arthrography was 33 cases (37 joints). The results were as follows: 7 normal type joints, 11 clicking type joints (6 early clicking type joints and 5 late clicking type joints), 15 closed lock type joints, and 2 incoordination type. The arthrographic findings of 4 joints were different from the clinical diagnosis. Represented separately were closed lock type 3 joints, late clicking type 1 joints.(2) Complications as morphological disorder of TMJ's soft tissue were seen in all the joints with internal derangements as follows: 29 joints bad thickening or elongation of the disk, 4 joints folding of the disk, 3 joints perforation of the disk, 9 jointsadhesion of the disk (6 adhesion of the upper compartments, 1 adhesion of the lower compartments, and 3 adhesion of upper and lower compartments).(3) In almost all the cases after arthrography, the secondary complications were seen as follows: Incomplete occlusion of arthrogramed side, temporary paralysis of facial nerve, motor pain of arthrogramed side. Three cases of closed lock were discovered.

Ｘ線テレビシステムを用いる顎関節腔造影検査法について

Arthrography of the temporomandibular joint (TMJ) was introduced more than forty years ago, but did not become very popular, in Japan until recently. This is probably due to the fact that the arthrographic technique was considered to be difficult. Also at the time, we did not have any clear concept of treatment which was possible.We use the X-ray TV system (fluoroscopy) for TMJ arthrography, and to determine the puncture point of the TMJ compartment to the hard tissue, such as fossa, and condyle. As a result, we can enforce the TMJ arthrography very easily.TMJ arthrography provides a method for superior differentiation of TMJ afflications. Our technique is one way to produce information of great clinical significance.

Digital subtraction arthrography.

The technology of digital subtraction image processing was applied as a substitute for conventional arthrographic subtraction techniques in the evaluation of 29 joints in 27 patients. There were 15 total hip replacements, one total knee replacement, eight wrists, three shoulders, and two ankles. Information regarding prosthetic component loosening and ligamentous disruption of carpal bone articulations could be determined with a high degree of accuracy when compared with information gained using conventional radiographic methods. Our results indicate that this method may be a suitable substitute for other arthrographic techniques.