Contrast Arthrography Research Articles

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

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

Syndrome LEOPARD : avec analyse du gène PTPN11

The objective of this study was to investigate whether new and different specialized fast spin-echo techniques could be used to accentuate signal within the site of meniscal repair, obviating the need for intra-articular contrast. With the use of the frequency- selective fat suppression technique, we were able to accentuate fluid in the repair site because of the inherent extended dynamic contrast range of the technique. We performed a blinded study to correlate specialized magnetic resonance imaging (MRI) sequences with standard contrast arthrography, which was used as a standard of reference. Thirty-six patients (36 meniscal repairs) agreed to have MRI followed by contrast arthrography of the affected knee, irrespective of their clinical symptoms. We found that MRI had a very high correlation with arthrography in assessing meniscal repair, with statistical significance. In eight cases that had a second-look arthroscopy, we were able to see that MRI proved to be more accurate than arthrography in discriminating partial or complete healing. This is the first report to show that specialized noncontrast MRI sequences are more effective in evaluating the physiological state of the repaired meniscus, without artifactual distention of the joint recesses by contrast and air. Noncontrast MRI can obviate the need for arthrography in assessment of meniscal repair.Arthroscopy 1998 Jan-Feb;14(1):2-8

Single air contrast arthrography for temporomandibular joint disorder using limited cone beam computed tomography for dental use

MRI has the problem of artefacts caused by metal or body motion and is also incompatible for patients with claustrophobia. Arthrography is invasive and involves the risk of perforation or allergy to a contrast medium. This report discusses a patient with temporomandibular joint (TMJ) disorder who required soft tissue imaging of the TMJ. As she had claustrophobia and a reaction to iodine, air contrast arthrography and pumping manipulation therapy using limited cone beam computed tomography for dental use (3DX) was performed. We conclude that the 3DX examination method used in the study is practical as a diagnostic procedure and thus recommend this method to be used for patients with TMJ disorder in the presence of iodine contraindication.

Giant intraosseous cyst-like lesions in rheumatoid arthritis report of a case

The term “intraosseous synovial cyst” is used to designate both the epiphyseal cyst-like lesions seen in patients with rheumatoid arthritis (RA) and mucoid cysts, which occur in a different setting. We report the case of a patient in whom a 4-cm cyst-like lesion developed in the left tibia 18 years after onset of RA and 6 years after osmic acid synovectomy of the left knee. Positive contrast arthrography and magnetic resonance imaging visualized a communication between the lesion and the joint space. Preexisting bone and joint lesions and increased intraarticular pressure play a major role in the genesis of cyst-like lesions in RA. In our patient, the osmic acid synovectomy may have contributed to the development of the lesion. “Synovial cyst” is a misnomer for these giant lesions, which are geodes rather than cysts. Despite their low incidence, these lesions deserve attention because they raise diagnostic and therapeutic problems.

Evaluation of Pain in Patients With Apparently Solidly Fixed Total Hip Arthroplasty Components

The cause of pain in a patient with an apparently solidly fixed total hip arthroplasty can be difficult to elucidate. A detailed history, careful examination, and plain radiographs provide the most useful information, especially in excluding causes not primarily related to the hip. Determining whether the pain is related to the implant, to soft tissue, or to bone can require laboratory tests, radiographic and fluoroscopic imaging, and contrast arthrography and local anesthetic injections. Particularly when pain is caused by occult infection, erythrocyte sedimentation rate, C-reactive protein level, hip aspiration, advanced radiologic imaging, and nuclear medicine scans can help determine the diagnosis.

Tarsal Coalition in Pediatric Patients.

A fibrous, cartilaginous, or bony (or a combination thereof) connection between two tarsal bones, or tarsal coalition usually involves the calcaneonavicular or talocalcaneal articulations. Foot pain, beginning when an initially fibrous coalition becomes partially or totally osseous and coinciding with trauma or increased stress such as athletic activity, is the usual presenting symptom. Although often identified on radiographs of the foot (including specialized projections), tarsal coalitions are increasingly imaged with computed tomography of the feet. Plain tomography, single contrast arthrography, and bone scintigraphy are no longer used in the evaluation of tarsal coalition. Magnetic resonance imaging has some advantages over computed tomography but its exact role remains undetermined. Surgical resection of symptomatic tarsal coalitions is used when conservative methods fail to alleviate symptoms.

Acromioclavicular joint cyst and rotator cuff tear

T he acromioclavicular ioint cyst is uncommon and is usually associated with a rotator cuff tear. The importance of recognizing this association lies in the high recurrence rate after simple excision where the tear is not addressed. Double contrast arthrography has been used to show communication between the glenohumeral and acromioclavicular ioints. We present a case report in which magnetic resonance imaging noninvasively demonstrated the cyst and the relationship of the acromioclavicular ioint and subacromial space. We have found only 16 cases of a subcutaneous cyst situated over the acromioclavicular ‘oint (ACJ) in the literature. Only 3 of these were descri L ed as occurring in isolation3,lO; the rest were associated with full-thickness rotator cuff tears.4,6,8,9,‘3 It is recognized that failure to appreciate the true extent of its communication with the ACJ and glenohumeral ioint (GHJ) can lead to recurrence after attem excision.6 Given t R ts at aspiration4 or simple sur ical at some patients have sur tle or no symptoms associated with the s R rising y litT oulder,7#9 investigation b leakage from rl arthrography to demonstrate contrast t e GHJ into the ACJ and cyst has been recommended.5 This report describes a patient treated at this center in whom the clinical diagnosis of an ACJ cyst and rotator cuff tear was confirmed by noninvasive imaging by magnetic resonance imaging [MRI) before definitive surgery was planned.

Arthroscintigraphy in Suspected Rotator Cuff Rupture

In order to evaluate the diagnostic efficiency of arthroscintigraphy in suspected rotator cuff ruptures this new imaging procedure was performed 20 times in 17 patients with clinical signs of a rotator cuff lesion. The scintigraphic results were compared with sonography (n = 20), contrast arthrography (n = 20) and arthroscopy (n = 10) of the shoulder joint. After performing a standard bone scintigraphy with intravenous application of 300 MBq 99m-Tc-methylene diphosphonate (MDP) for landmarking of the shoulder region arthroscintigraphy was performed after an intraarticular injection of 99m-Tc microcolloid (ALBU-RES 400 MicroCi/5 ml). The application was performed either in direct combination with contrast arthrography (n = 10) or ultrasound conducted mixed with a local anesthetic (n = 10). Findings at arthroscopical surgery (n = 10) were used as the gold standard. In case of complete rotator cuff rupture (n = 5), arthroscintigraphy and radiographic arthrography were identical in 5/5. In one patient with advanced degenerative alterations of the shoulder joint radiographic arthrography incorrectly showed a complete rupture which was not seen by arthroscintigraphy and endoscopy. In 3 patients with incomplete rupture, 2/3 results were consistent. A difference was seen in one patient with a rotator cuff, that has been already revised in the past and that suffered of capsulitis and calcification. Arthroscintigraphy is a sensitive technique for detection of rotator cuff ruptures. Because of the lower viscosity of the active compound, small ruptures can be easily detected, offering additional value over radiographic arthrography and ultrasound, especially for evaluation of incomplete cuff ruptures.

Diagnostic Imaging of Osteochondrosis

This article includes imaging of the glenohumeral (shoulder), elbow, stifle, and tarsal joints. The imaging modalities discussed are survey radiography, contrast arthrography, linear tomography, ultrasound, computed tomography, scintigraphy and magnetic resonance. Survey radiography is the first choice imaging modality for diagnosing osteochondrosis dissecans in dogs. In cases where survey radiography fail to demonstrate a lesion other modalities such as scintigraphy, linear tomography, computed tomography, and magnetic resonance may be helpful. Survey radiography, contrast arthrography, computed tomography, and magnetic resonance may also provide additional information contributing to early diagnosis and treatment.

The use of noncontrast magnetic resonance imaging in evaluating meniscal repair: comparison with conventional arthrography

The objective of this study was to investigate whether new and different specialized fast spin-echo techniques could be used to accentuate signal within the site of meniscal repair, obviating the need for intra-articular contrast. With the use of the frequency- selective fat suppression technique, we were able to accentuate fluid in the repair site because of the inherent extended dynamic contrast range of the technique. We performed a blinded study to correlate specialized magnetic resonance imaging (MRI) sequences with standard contrast arthrography, which was used as a standard of reference. Thirty-six patients (36 meniscal repairs) agreed to have MRI followed by contrast arthrography of the affected knee, irrespective of their clinical symptoms. We found that MRI had a very high correlation with arthrography in assessing meniscal repair, with statistical significance. In eight cases that had a second-look arthroscopy, we were able to see that MRI proved to be more accurate than arthrography in discriminating partial or complete healing. This is the first report to show that specialized noncontrast MRI sequences are more effective in evaluating the physiological state of the repaired meniscus, without artifactual distention of the joint recesses by contrast and air. Noncontrast MRI can obviate the need for arthrography in assessment of meniscal repair. Arthroscopy 1998 Jan-Feb;14(1):2-8

顎関節円板前方転位復位型以外のｃｌｉｃｋ音症例における顎関節音と下顎頭運動の特徴

Click sounds in cases other than ADDw/r were studied in order to clarify the specificity thereof. Three subjects were diagnosed by double contrast arthrography for adhesion in the lower joint cavity, posterior displacement of the disk with reduction at the maximum opening of the mouth and incoordination of the disk, respectively.Three joints of the subjects were compared with 20 joints of ADDw/r with click sounds as controls. The character of TMJ sounds and condylar movement were quantitatively studied using our original analyzing system.The results were as follows:1. MRI findings were false negative.2. There were click sounds with condylar movement deflection or sounds similar to reciprocal click sounds in cases other than ADDw/r; therefore, it was impossible to diagnose TMD only by click sounds at opening and closing of the mouth.3. Subject 1 had the same position for opening and closing sounds, and subjects 2 and 3 had markedly distinct sounds or condylar movement deflection at closing. These were different from those of ADDw/r.4. In the 3 cases, these characteristics enhanced distinction from ADDw/r.

Characterization of anatomic communications between the femoropatellar joint and lateral and medial femorotibial joints in cattle, using intra-articular latex, positive contrast arthrography, and fluoroscopy

Abstract Objective To evaluate the frequency of communication between the lateral and medial femorotibial joints and the femoropatellar joint in cattle. Design 1 of 3 injection sites was randomly assigned to each ox. Animais 102 limbs were obtained from 55 fresh bovine cadavers presented for necropsy with problems unrelated to the stifle. Procedure The joints were injected with a mixture of latex and barium sulfate. Communication between 2 or more joints was determined by the presence of latex and contrast material in a joint adjacent to the injected joint by examining frozen sections and positive-contrast arthrography. Results Communication between the 3 joints was present in 58 (56.9%) limbs. The femoropatellar and the medial femorotibial joints always communicated. Thirteen of 38 (34.2%) specimens injected in the lateral femorotibial joint did not communicate with the 2 other joints. The femoropatellar joint communicated with the lateral and medial femorotibial joints on the distal abaxial aspect of the trochlear ridge. Conclusion Individual anatomic variation of the stifle in cattle should be considered when diagnostic or treatment protocols are established. Clinical Relevance The lateral femorotibial joint should be treated separately because it does not consistently communicate with the femoropatellar or medial femorotibial joint. (Am J Vet Res 1996;57:798–802)

Evaluation of Positive Contrast Arthrography in Canine Cranial Cruciate Ligament Disease

SummaryArthrographic and intraoperative evaluations of stifles affected with cranial cruciate disease were compared. Arthrography did not appear to be helpful in predicting cranial cruciate ligament pathology. The caudal cruciate ligament was consistently not visualized in the arthrograms and was normal at surgery. The menisci were visualized consistently in the arthrograms, but conclusions could not be made as to the benefit of arthrography in predicting meniscal pathology. Arthrography was not helpful in predicting joint capsule and femoral articular surface pathology. Survey radiographic evaluation was better than arthrography in evaluating joint pathology. When cruciate injury is suspected, after history and physical examination, survey radiographs are better than positive contrast arthrograms at supporting the diagnosis.Positive contrast arthrography was evaluated as a diagnostic aid in canine cranial cruciate ligament disease. It did not appear to be useful in predicting joint pathology. With arthrography, both menisci could be visualized and evaluated for abnormalities. Joint effusion and presence of osteophytes evaluated on survey radiographs was better than arthrography in evaluating joint pathology.

The value of contrast arthrography in assessing loosening of symptomatic uncemented total hip components.

Twenty-five patients with symptomatic uncemented total hip components were studied with contrast arthrography prior to surgical exploration. All but one had uncemented femoral stems and 16 had an uncemented acetabular component. As judged by the findings at surgery, on the femoral side the sensitivity, specificity, and accuracy of arthrography were 57%, 60%, and 58% respectively. There was a relatively high incidence of both false positives (17%) and false negatives (25%). On the acetabular side sensitivity, specificity, and accuracy were 29%, 89%, and 62.5%. False negatives were common (31%), while there was only one false positive. The results in this small series show that arthrography has distinct limitations in identifying the fixation status of uncemented total hip components.

Application of Low Density Contrast Arthrography (LDC-A) for a Rotator Cuff Tear

Application of Low Density Contrast Arthrography (LDC-A) for a Rotator Cuff Tear

Clinical value of combined contrast and radionuclide arthrography in suspected loosening of hip prostheses.

Combined contrast and radionuclide arthrography was performed in 71 cemented, non-cemented and hybrid hip arthroplasties for diagnosis of component loosening. In 31 cases, either one or two prosthesis components were clearly loose upon clinical and radiological diagnosis, with subsequent intraoperative confirmation. The other 40 cases had doubtful component loosening, with discrepancy between clinical and radiological findings, and were investigated for clarification. Contrast and radionuclide arthrograms were compared with sequential plain radiographs and their ability to indicate component loosening was evaluated. The combined contrast and radionuclide arthrograms proved in 90.9% of the cases whether a loose component existed as confirmed by intraoperative findings. They had a high sensitivity, specificity and predictive accuracy for both the acetabular and the femoral component. Sensitivity and predictive accuracy were remarkably precise in comparison to those of plain radiographs on the acetabular side. In nearly all patients with contradictory clinical and radiological findings, conclusive diagnosis was possible on the basis of the contrast and radionuclide arthrograms. Coinciding positive results in both contrast and radionuclide arthrograms were verified in each operated case. The combination of contrast and radionuclide arthrography is an useful method to diagnose doubtful loosening of hip arthroplasty components, especially in addition to routine sequential plain radiographs.

低濃度肩関節充満造影の試み

Shoulder arthrography is a simple diagnostic technique used in shoulder disorders. However shoulder arthrography has been forgotten recently because of development of CT and MRI. We experimented with a new technique of shoulder arthrography using 10% urografin.We used the technique in cases with rotator cuff tears, recurrent dislocation and intra-capsular lesions.Contrast medium of 45% urografin is usually used for single contrast arthrography, or double contrast arthrography.The low density contrast medium of 10% urografin evaluated in this study was made by using 3ml of 60% urografin and 15ml of 0.5% xylocain.We evaluated the low density medium in comparison to the usual contrast agent in coses with rotator cuff tears, recurrent dislocations and intra-capsular lesions.We concluded that low density single contrast arthrography (using 10% urografin ) was useful for diagnosing shoulder disease.

OSTEOCHONDROSIS LESIONS OF THE CANINE SHOULDER: CORRELATION OF POSITIVE CONTRAST ARTHROGRAPHY AND ARTHROSCOPY

In this study the correlation between positive contrast arthrography and arthroscopy was evaluated in a series of 20 shoulder joints (12 dogs) with radiographic and clinical evidence of osteochondrosis. The joints were consecutively examined by arthrography and arthroscopy. In 12 joints arthrography revealed the presence of a cartilage flap, and this finding was confirmed by arthroscopy. In 3 out of 8 joints where arthrography failed to demonstrate rupture of the cartilage, arthroscopy revealed the presence of a distinct fissure line. In 2 joints arthroscopy demonstrated a lesion comparable with chondromalacia and in 3 only a dimple in the articular cartilage was found. In 2 joints arthroscopy revealed the presence of small joint mice not detected by arthrography. Kissing lesions on the surface of the glenoid cavity opposite to cartilage flaps could be demonstrated as well. Evaluation of synovial inflammation, judged by the aspect and pattern of the synovial villi, correlated well with histologic findings. These results indicate that arthroscopy is a complementary examination in painful joints where arthrography fails to demonstrate rupture of the articular cartilage. It could be the procedure of choice if diagnostic and surgical arthroscopy can be combined. However, arthrography remains the technique of choice to demonstrate joint mice within the bicipital tendon sheath.

Contrast arthrography in thumb polydactyly with variable morphological patterns

Contrast arthrography was performed in 20 patients with duplicated thumbs where the interphalangeal, metacarpophalangeal, and carpometacarpal joints were involved. Three groups were apparent, those with no joint alteration, those with joint involvement and separate articular impressions, and those with abnormal duplex joints.

False-positive Radionuclide Arthroscintigraphy with a Porous-coated Total Hip Prosthesis

The evaluation of a painful hip prosthesis for suspected loosening frequently requires a multi-modality approach. Radionuclide arthroscintigraphy is a valuable adjunct to contrast arthrography, demonstrating greater sensitivity than contrast arthrography in detecting loosening of the femoral component of the prosthesis. Despite its reliability in the evaluation of cemented hip prostheses, the value of arthroscintigraphy in patients with uncemented or porous-coated prostheses is undetermined. The case of a false-positive radionuclide arthroscintigram in a patient with an uncemented prosthesis is reported. The literature is briefly examined, and the potential implications regarding interpretation of arthroscintigraphy in patients with porous-coated prostheses are discussed.