Direct Magnetic Resonance Arthrography Research Articles

Impact of gadolinium-based MRI contrast agent and local anesthetics co-administration on chondrogenic gadolinium uptake and cytotoxicity

The gadolinium-based contrast agent DOTA-Gd is clinically used in combination with local anesthetics for direct magnetic resonance arthrography. It remains unclear whether gadolinium uptake into cartilage is influenced by co-administration of bupivacaine or ropivacaine and whether DOTA-Gd alters their chondrotoxicity. Gadolinium quantification of chondrogenic spheroids revealed enhanced gadolinium uptake after simultaneous exposure to local anesthetics. Analyses of the spatial gadolinium distribution using synchrotron X-ray-fluorescence scanning indicates gadolinium exposed chondrocytes. In vitro exposure to DOTA-Gd does not alter viability and proliferation of human chondrocytes and the chondrotoxic potential of the anesthetics. Reduced viability induced by ropivacaine was found to be reversible, while exposure to bupivacaine leads to irreversible cell death. Our data suggest that ropivacaine is more tolerable than bupivacaine and that DOTA-Gd exposure does not alter the cytotoxicity of both anesthetics. Enhanced gadolinium uptake into cartilage due to co-administration of anesthetics should find attention.

The 2D and 3D MR arthrographic description of aponeurotic expansion of supraspinatus tendon and biceps tendon anomaly in a large patient cohort.

To describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography. This was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness ≥1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial. An AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1-this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone-this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures. A 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types.

Can gadolinium contrast agents be replaced with saline for direct MR arthrography of the hip? A pilot study with arthroscopic comparison.

To compare image quality and diagnostic performance of preoperative direct hip magnetic resonance arthrography (MRA) performed with gadolinium contrast agent and saline solution. IRB-approved retrospective study of 140 age and sex-matched symptomatic patients with femoroacetabular impingement, who either underwent intra-articular injection of 15-20mL gadopentetate dimeglumine (GBCA), 2.0mmol/L ("GBCA-MRA" group, n = 70), or 0.9% saline solution ("Saline-MRA" group, n = 70) for preoperative hip MRA and subsequent hip arthroscopy. 1.5 T hip MRA was performed including leg traction. Two readers assessed image quality using a 5-point Likert scale (1-5, excellent-poor), labrum and femoroacetabular cartilage lesions. Arthroscopic diagnosis was used to calculate diagnostic accuracy which was compared between groups with Fisher's exact tests. Image quality was compared with the Mann-Whitney U tests. Mean age was 33years ± 9, 21% female patients. Image quality was excellent (GBCA-MRA mean range, 1.1-1.3 vs 1.1-1.2 points for Saline-MRA) and not different between groups (all p > 0.05) except for image contrast which was lower for Saline-MRA group (GBCA-MRA 1.1 ± 0.4 vs Saline-MRA 1.8 ± 0.5; p < 0.001). Accuracy was high for both groups for reader 1/reader 2 for labrum (GBCA-MRA 94%/ 96% versus Saline-MRA 96%/93%; p > 0.999/p = 0.904) and acetabular (GBCA-MRA 86%/ 83% versus Saline-MRA 89%/87%; p = 0.902/p = 0.901) and femoral cartilage lesions (GBCA-MRA 97%/ 99% versus Saline-MRA 97%/97%; both p > 0.999). Diagnostic accuracy and image quality of Saline-MRA and GBCA-MRA is high in assessing chondrolabral lesions underlining the potential role of non-gadolinium-based hip MRA. • Image quality of Saline-MRA and GBCA-MRA was excellent for labrum, acetabular and femoral cartilage, ligamentum teres, and the capsule (all p > 0.18). • The overall image contrast was lower for Saline-MRA (Saline-MRA 1.8 ± 0.5 vs. GBCA-MRA 1.1 ± 0.4; p < 0.001). • Diagnostic accuracy was high for Saline-MRA and GBCA-MRA for labrum (96% vs. 94%; p > 0.999), acetabular cartilage damage (89% vs. 86%; p = 0.902), femoral cartilage damage (97% vs. 97%; p > 0.999), and extensive cartilage damage (97% vs. 93%; p = 0.904).

Diagnostic performance of MRA in abduction and external rotation position in the detection of glenoid labral lesions: a systematic review and meta-analysis.

To compare the diagnostic performance of direct magnetic resonance arthrography (MRA) for labral lesions during conventional, abduction and external rotation (ABER), conventional plus abduction, and external rotation (ABER) positioning by using a systematic review and meta-analysis. A comprehensive literature search was performed on the two main concepts of magnetic resonance arthrography: extremity position and labral lesions. Inclusion criteria consisted of original studies that assessed the diagnostic accuracy of MR arthrography in ABER and conventional position alone or combined for the diagnosis of labral lesions by using surgical findings as the reference standard. Meta-analyses were performed that compared MR arthrography during conventional positioning, ABER, and conventional plus ABER positioning. Nine studies met the inclusion and exclusion criteria. A total of 733, 504, and 313 lesions assessed by conventional MRA, ABER MRA, and conventional plus ABER MRA, respectively, were included in our analysis. Pooled sensitivities of MRA in conventional, ABER, and conventional plus ABER position for labral tear diagnosis were 81.5%, 81.6%, and 95.7%, respectively. Pooled specificities of MRA in conventional, ABER, and conventional plus ABER position for labral tear diagnosis were 88.8%, 85.6%, and 94.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated improved accuracy of conventional plus ABER MRA compared with conventional MRA or ABER MRA with the area under the curve (AUC) of 0.99, 0.90, and 0.88, respectively. Conventional plus ABER MRA showed increased diagnostic accuracy compared to both ABER MRA and conventional MRA alone in the diagnosis of labral lesions.

Role Of Direct Magnetic Resonance Arthrography In Evaluation Of Wrist Joint Instability

Background: Magnetic resonance imaging (MRI) is an effective method for helping determine the cause of wrist pain by demonstrating a broad spectrum of abnormalities, including those of bone, cartilage, ligaments, and tendons.Aim: To assess the role of direct MR arthrography imaging in the diagnosis of tear and cartilaginous abnormalities of the triangular fibrocartilage and intrinsic ligaments of the wrist joint.Methods: A prospective cohort study conducted on 50 patients with chronic refractory unexplained wrist pain. All patients underwent initially a conventional MRI exam followed by conventional arthrography then MR arthrography while 20 patients only with suspected TFCC or ligamentous injuries clinically and radiologically underwent to MR arthroscope.Results: We compared MRI, MRA and arthroscopic findings of 20 patients, there were high statistically significant differences between the groups in terms of distal avulsion and LT ligament tear. As regarding central and peripheral TFCC tears; sensitivity, specificity, PPV, and NPV of MRI and MRA respectively were 82.4%, 87.8%, 80.5%, and 84.2% and 63.2%, 66.7%, 71.1%, and 68.5%.Conclusion: MR arthrography should be a fundamental part of the imaging protocol when wrist ligament injuries are suspected, as it achieves the highest level of diagnostic confidence especially for inconclusive cases, and also accurately delineates the location and type of the tear in conclusive ones.

Assessment of acetabular chondral damage and labral pathologies via direct MR arthrography: specialization matters

AimsTo compare the diagnostic accuracy of investigators from different specialities (radiologists and orthopaedic surgeons) with varying levels of experience of 1.5 T direct magnetic resonance arthrography (dMRA) against intraoperative findings in patients with femoroacetabular impingement syndrome (FAIS).MethodsA total of 272 patients were evaluated with dMRA and subsequent hip arthroscopy. The dMRA images were evaluated independently by two non-hip-arthroscopy-trained orthopaedic surgeons, two fellowship-trained musculoskeletal radiologists, and two hip-arthroscopy-trained orthopaedic surgeons. The radiological diagnoses were compared with the intraoperative findings.ResultsHip arthroscopy revealed labral pathologies in 218 (79%) and acetabular chondral lesions in 190 (69%) hips. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for evaluating the acetabular labral pathologies were 79%, 18%, 79%, 18%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 83%, 36%, 83%, 36%, and 74% (fellowship-trained musculoskeletal radiologists), and 88%, 53%, 88%, 54% and 81% (hip-arthroscopy trained orthopaedic surgeons). The sensitivity, specificity, PPV, NPV and accuracy of dMRA for assessing the acetabular chondral damage were 81%, 36%, 71%, 50%, and 66% (non-hip-arthroscopy trained orthopaedic surgeons), 84%, 38%, 75%, 52%, and 70% (fellowship-trained musculoskeletal radiologists), and 91%, 51%, 81%, 73%, and 79% (hip-arthroscopy trained orthopaedic surgeons). The hip-arthroscopy trained orthopaedic surgeons displayed the highest percentage of correctly diagnosed labral pathologies and acetabular chondral lesions, which is significantly higher than the other two investigator groups (p < 0.05).ConclusionThe accuracy of dMRA on detecting labral pathologies or acetabular chondral lesions depends on the examiner and its level of experience in hip arthroscopy. The highest values are found for the hip-arthroscopy-trained orthopaedic surgeons.Level of evidenceRetrospective cohort study; III.

Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up.

Background:The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial.Purpose/Hypothesis:The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity.Study Design:Cohort study; Level of evidence, 3.Methods:We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya.Results:The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients.Conclusion:Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.

The lateral center-edge angle as radiographic selection criteria for periacetabular osteotomy for developmental dysplasia of the hip in patients aged above 13 years

BackgroundThis retrospective study sought to delineate the radiographic characteristics of DDH patients over 13 years of age and investigate whether the lateral center-edge angle (LCEA) could serve as radiographic selection criteria for periacetabular osteotomy.MethodsWe enrolled patients with Hartofilakidis type I DDH without dislocation who underwent periacetabular osteotomy between August 2009 and August 2012. LCEA, anterior central edge angle (ACEA), femoral neck-shaft angle (FNSA), Shenton line and Tönnis acetabular index (AI) were evaluated by anteroposterior and 65° false⁃profile pelvic X-ray radiographs in the standing position. Femoral neck anteversion angle (FNA), labral lesion, labral inversion and cartilage lesion were evaluated by direct magnetic resonance arthrography. DDH was categorized by LCEA into four grades (grade I: 10° ≤ LCEA< 20°, grade II: 0° ≤ LCEA< 10°, grade III: -10° ≤ LCEA< 0°, grade IV: LCEA<-10) and osteoarthritis (OA) severity was assessed using Tönnis OA classification. Pearson correlation analysis was done between LCEA and other variables.ResultsTotally patients (274 hips) with a mean age of 27.3 years (range 13–47 years) were included. The mean LCEA was 3.5° (range: − 30° to 20°). Based on LCEA grades, grade I DDH was present in 104 hips, grade II in 40 hips, grade III in 76 hips, and grade IV in 54 hips. Based on Tönnis OA classification, 54.5% hips (150/274) were grade 0, 33.1% hips (91/274) grade 1, 8.4% hips (23/274) grade 2 and 4% hips (11/274) grade 3. Pearson correlation analysis showed a negative correlation between LCEA grade and Tönnis OA grades (r = 0.3987; P < 0.001). Cochran-Armitage trend test further showed a positive correlation between LCEA grades and labral lesion (P < 0.001) and interrupted Shenton line (P < 0.001).ConclusionThe LCEA classification scheme offers a simple and practical approach to categorize the level of acetabulum coverage on the femoral head, hip deformity and characteristics of DDH. Our findings could provide clinically useful guidance for orthopedic surgeons in preparation for periacetabular osteotomy in DDH patients aged above 13 years.

Biceps Pulley: Normal Anatomy and Associated Lesions at MR Arthrography

The biceps pulley or "sling" is a capsuloligamentous complex that acts to stabilize the long head of the biceps tendon in the bicipital groove. The pulley complex is composed of the superior glenohumeral ligament, the coracohumeral ligament, and the distal attachment of the subscapularis tendon, and is located within the rotator interval between the anterior edge of the supraspinatus tendon and the superior edge of the subscapularis tendon. Because of its superior depiction of the capsular components, direct magnetic resonance arthrography is the imaging modality of choice for demonstrating both the normal anatomy and associated lesions of the biceps pulley. Oblique sagittal images and axial images obtained with a high image matrix are valuable for identifying individual components of the pulley system. Various pathologic processes occur in the biceps pulley as well as the rotator interval. These processes can be traumatic, degenerative, congenital, or secondary to injuries to the surrounding structures. The term hidden lesion refers to an injury of the biceps pulley mechanism and is derived from the difficulty in making clinical and arthroscopic identification. Pathologic conditions associated with pulley lesions include anterosuperior impingement, instability of the biceps tendon, biceps tendinopathy or tendinosis, superior labrum anterior and posterior lesions, and adhesive capsulitis. It is important to be familiar with the normal appearance of the biceps pulley so that abnormalities can be correctly assessed and effectively managed.

Comparison of MRI & direct MR arthrography with arthroscopy in diagnosing ligament injuries of wrist

IntroductionLigament injuries around the wrist leading to chronic wrist pain are often a diagnostic dilemma.Various imaging modalities like wrist radiographs, CT and MRI have been used to improve the diagnostic accuracy. The objective of this study was to assess the value of MRI & direct magnetic resonance arthrography (MRA) of the wrist for detecting & evaluating tears of the triangular fibrocartilage complex (TFCC) & scapholunate & luno triquetral interosseous ligament (LTIL & SLIL) injuries in comparison with arthroscopy of the wrist. Materials & methodsAll patients presenting with chronic wrist pain of more than 3 months duration with suspected ligament injuries were included. MRI was performed with 8 channel wrist coil on 1.5 T machine. (PHILIPS, Netherlands). MRA was performed after obtaining consent. Retrospective MR findings were then correlated with results in those patients who underwent arthroscopy. Arthroscopic correlation was obtained in 22 (46.8%) cases out of the 45 patients who underwent both MRI & MRA. ResultsThe gold standard arthroscopic procedure diagnosed 15 peripheral & 6 central TFCC tears in 22 patients. 4 scapholunate ligament tears were also identified. MRI diagnosed 16 peripheral & 5 central TFCC tears in these 22 patients. MRA identified 9 central tears and 14 peripheral tears. The sensitivity in diagnosing an overall TFCC tears with MRI as well as MRA was 94.4 & 100%. The specificity of the MRI and MRA in diagnosing an overall TFCC tear was 100% & 75% respectively. Discussion & conclusionsDirect MRA has better sensitivity in detecting TFCC central tears. In view of ‘substantial’ agreement between MRI & MRA with Kappa analysis, conventional MRI can be relied on, in diagnosing TFCC injury. With comparatively low specificity, caution and restraint is advised in interpreting MRA, which may influence decision on surgery.

Imaging of the Shoulder Bankart Lesion and its Variants

The glenoid labrum is an important soft tissue structure that provides stability to the shoulder joint. When the labrum is injured, affected patients may present with chronic shoulder instability and future recurrent dislocation. The Bankart lesion is the most common labral injury, and is often accompanied by a Hill-Sachs lesion of the humerus. Various imaging techniques are available for detection of the Bankart lesion and its variants, such as anterior labroligamentous periosteal sleeve avulsion and Perthes lesion. Direct magnetic resonance (MR) arthrography is currently the imaging modality of choice for evaluation of the various types of labral tears. As normal anatomical variants of glenoid labrum are not uncommonly encountered, familiarity with appearances of this potential pitfall helps avoid misdiagnosis.

The comparison of direct magnetic resonance arthrography with volumetric interpolated breath-hold examination sequence and multidetector computed tomography arthrography techniques in detection of talar osteochondral lesions

ObjectiveThe aim of this study was to compare additive diagnostic values of magnetic resonance (MR) arthrography with volumetric interpolated breath-hold examination (VIBE) sequence and multidetector computed tomography (MDCT) arthrography for diagnosis and grading of talar osteochondral lesions. MethodsMDCT arthrography and MR arthrography with three dimensional VIBE sequence were performed in 27 patients. Findings of MR arthrography and MDCT arthrography images were compared with arthroscopic findings. Sensitivity, specificity, and accuracy rates were calculated for both MR arthrography and MDCT arthrography imaging findings. ResultsFor grade I osteochondral lesions; sensitivity, specificity and accuracy rates of MR arthrography were 95%, 73%, 90%, respectively; For grade I osteochondral lesions; sensitivity, specificity and accuracy rates of MDCT arthrography were 96%, 79%, 81%. For grade IV osteochondral lesions; sensitivity, specificity and accuracy rates of MDCT arthrography and MR arthrography were 100%. For grade II lesions, the sensitivity, specificity and accuracy rates of the MR arthrography were 80%, 76%, 77%, respectively; for grade III lesions, the sensitivity, specificity and accuracy rates of the MR arthrography were 78%, 68%, 75%. For grade II osteochondral lesions; the sensitivity, specificity and accuracy rates of the MDCT arthrography were 91%, 81%, 86%; for grade III osteochondral lesions; the sensitivity, specificity and accuracy rates of the MDCT arthrography were 90%, 83%, 89%; For grade II and III osteochondral lesions, MDCT arthrography had higher sensitivity, specificity and accuracy rates than MR arthrography. MDCT arthrography had higher diagnostic performance than MR arthrography for detection of grade II and III lesions (p = 0.041 and p = 0.038, respectively). ConclusionMDCT arthrography appears to be more reliable than MR arthrography with three dimensional VIBE sequence for accurate detection and grading of osteochondral lesions. Level of evidenceLevel III, Diagnostic Study.

Direct wrist magnetic resonance arthrography in triangular fibrocartilage lesions

Objective The objective of this study was to assess the diagnostic accuracy of direct wrist magnetic resonance arthrography (MRA) compared with arthroscopy in the diagnosis of triangular fibrocartilage complex (TFCC) lesions. Patients and methods A total of 25 (12 men and 13 women) consecutive patients, in the age range from 16 to 49 years (mean age: 28 years) complaining of unexplained chronic wrist pain and suspected to have TFCC lesions were prospectively examined by direct MRA with arthroscopic correlation. Results Compared with arthroscopic results, the sensitivity, specificity, and accuracy of direct MRA for central TFCC lesions were 100% for all three and 100, 90.9, 96%, respectively, for peripheral lesions. Conclusion Direct MRA can diagnose TFCC lesions with very high sensitivity and specificity and can help in reducing arthroscopies for pure diagnostic purposes.

Magnetic resonance-guided direct shoulder arthrography for the detection of superior labrum anterior-posterior lesions using an open 1.0-T MRI scanner.

PurposeDirect magnetic resonance arthrography (MRA) offers increased diagnostic accuracy compared to conventional magnetic resonance imaging (MRI) in the detection of superior labrum anterior-posterior (SLAP) lesions. The aim of the present study was to present the technique of magnetic resonance-guided direct shoulder arthrography (MDSA), to evaluate the diagnostic value of this novel MRA procedure to detect SLAP lesions in comparison to the currently practiced MRI, and to correlate the radiological findings to the respective arthroscopic findings.Material and methodsFifty-six patients with clinical signs of a SLAP lesion underwent both MRI examination and MDSA prior to arthroscopic surgery. The MRI of both interventions were compared with the arthroscopic findings. Statistical analysis was performed using the McNemar test.ResultsSensitivity, specificity, and accuracy for detecting SLAP lesions were 23%, 88%, and 54% on MRI and 80%, 81%, and 80% on MDSA, respectively. Sensitivity (p < 0.001) and accuracy (p = 0.001) in detection of SLAP lesions were significantly higher by MDSA whereas accuracy showed no significant differences (p = 0.625).ConclusionsThe MDSA can be performed in an open 1.0-T MRI scanner with a high level of technical success and a reasonable methodical effort. The modification of MRA provides the requirements as a practicable routine shoulder magnetic resonance examination including arthrography to detect SLAP lesions. The diagnostic value is significantly better than MRI examinations without included arthrography, which currently predominates the clinical practice to investigate shoulder pathology.

High-concentration iodinated contrast media for T1-weighted direct magnetic resonance arthrography

To quantify invitro the T1-weighted (T1W) expression of iodinated contrast media (CM), and to compare the invivo performances of iodinated CM and gadolinium-based CM for T1W direct magnetic resonance imaging (MRI) arthrography. An invitro study on a 1.5 T MRI system was performed using Gd-DOTA, a mixture of iopromide and Gd-DOTA, and iopromide alone. The fat-suppressed (FS) T1W signal intensities were measured and analysed. In an invivo study, 15 normal rabbits were used to compare the expression of iopromide (370 mg iodine/ml), and the mixture of iopromide and diluted Gd-DOTA. In nine of the 15 rabbits, extra-articular administrations of CM were performed to mimic the situation of CM leak. The rabbits were scanned on a 1.5 T MRI system, and the FS T1W sequence and an axial iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL) T1W sequence were acquired. Signal intensities were measured and signal-to-noise ratios (SNR) were analysed. In the invitro study, a higher SNR was noted in a higher concentration of iopromide, and the highest SNR of iopromide was 45.9% of that of Gd-DOTA. In the invivo study, the iopromide and the mixture were well identified in all rabbits. The SNRs of the intra-articular and extra-articular iopromide and the mixture were significantly higher than the SNR of the muscles in the FS T1W images (all, p<0.01) and the IDEAL images (all, p<0.01). A high-concentration iodinated CM can provide good imaging quality for T1W direct MRI arthrography, and may be an alternative option in certain clinical situations.

Systematic review and meta-analysis of magnetic resonance imaging features for diagnosis of adhesive capsulitis of the shoulder.

To perform a systematic review and meta-analysis to identify magnetic resonance imaging (MRI) features that will aid in the diagnosis of adhesive capsulitis of the shoulder (ACS) and provide a summary of the diagnostic accuracy of the identified features METHODS: The MEDLINE and EMBASE databases were searched for studies assessing the diagnostic accuracy of MRI features of ACS. Overlapping descriptors used to denote the same imaging finding in different studies were subsumed under a single feature. The pooled accuracy including the diagnostic odd ratios (DORs) with 95% confidence intervals (CIs) of the identified features was calculated using a bivariate random-effects model. In total, 15 studies were included, and 74 overlapping descriptors were subsumed under six features. All six features were found to be informative for ACS diagnosis [coracohumeral ligament thickening: DOR, 13; 95% CI, 6-29; fat obliteration of the rotator interval (RI): DOR, 8; 95% CI, 3-24; RI enhancement: DOR, 44; 95% CI, 14-141; axillary joint capsule enhancement: DOR, 52; 95% CI, 27-98; inferior glenohumeral ligament (IGHL) hyperintensity: DOR, 31; 95% CI, 8-115; IGHL thickening: DOR, 28; 95% CI, 11-70]. The sensitivity and specificity of enhancement of the RI and axillary joint capsule and IGHL hyperintensity were > 80%. Six informative MRI features for ACS diagnosis were identified in this study with RI and axillary joint capsule enhancement and IGHL hyperintensity showing the highest diagnostic accuracy. Informative features observed on non-arthrogram MRI can be as helpful as features observed on direct magnetic resonance arthrography for ACS diagnosis. • Six informative MRI features for ACS diagnosis were identified (diagnostic odds ratio > 1). • RI and axillary joint capsule enhancement and IGHL hyperintensity showed high sensitivities/specificities (> 80%). • The use of non-arthrogram MRI is recommended for ACS diagnosis.

Intra-articular Lesions: Imaging and Surgical Correlation.

AbstractThe past 2 decades have seen a substantial increase in hip joint preserving procedures, primarily secondary to not only hip dysplasia, but the recognition and description of femoroacetabular impingement (FAI), and its association with chondral lesions, as a potentially pre-arthritic condition. Morphological magnetic resonance imaging (MRI) plays an essential role in the preoperative assessment of osseous deformities and in particular of the resulting joint degeneration. An accurate descriptive report of chondrolabral lesions is warranted describing the tear pattern, size, localization, and extension of the lesions. This is important because different damage patterns and localization of the lesions may determine the surgical approach. The current imaging standard is direct magnetic resonance arthrography (MRA) with a small field of view, with acquisition of radial images in addition to the classic coronal, sagittal, and axial-oblique images. Early cartilage damage detected on direct MRA obtained with or without traction can predict long-term failure after FAI surgery.

Assessment of factors that could affect the success of US-guided contrast injection for hip MR arthrography

BackgroundTo retrospectively evaluate the association between possible influencing factors and failed first attempts to inject a contrast agent intra-articularly under ultrasound (US)-guidance for direct magnetic resonance (MR) arthrography of the hip joint. MethodsNinety consecutive patients (38 women and 52 men; mean age, 42 years) undergoing US-guided hip MR arthrography (3 bilaterally) were retrospectively included in this study. The potential influencing factors were sex, age, body mass index (BMI), side of injection, target site, trajectory of the needle, additional use of needle tip rotation, failed first-attempt, and capsule elongation at the site of needle insertion. ResultsFirst-attempt failure was significantly associated with reduced capsule elongation at the target site and no additional use of needle tip rotation (OR 10.708; 95% CI 1.847–62.059; OR 3.518; 95% CI 1.120–11.047). Capsule elongation (sufficient for needle bevel insertion) was significantly larger at the femoral head-neck junction (5.2 ± 1.5 mm) than at the femoral head (2.9 ± 1.3 mm) (p < 0.001). ConclusionLess capsular elongation of the femoral head and no additional use of needle tip rotation to reduce the difficulty in contrast material delivery can increase the first-attempt failure rate in patients undergoing US-guided hip arthrography.

Diagnosis of Superior Labrum Anterior-to-Posterior Tears by Using MR Imaging and MR Arthrography: A Systematic Review and Meta-Analysis.

Purpose To evaluate the diagnostic accuracies of nonenhanced magnetic resonance (MR) imaging and MR arthrography for diagnosis of superior labrum anterior-to-posterior (SLAP) tears by using a systematic review and meta-analysis. Materials and Methods A comprehensive literature search was performed on the two main concepts of MR imaging (MR imaging, and direct and indirect MR arthrography) and SLAP tears. Inclusion criteria consisted of original studies that assessed the diagnostic accuracy of MR imaging, direct MR arthrography, and/or indirect MR arthrography for the detection of SLAP tears, by using surgical findings as the reference standard. The Quality Assessment of Diagnostic Accuracy Studies 2, or QUADAS-2 Quality Assessment of Diagnostic Accuracy Studies 2 Quality Assessment of Diagnostic Accuracy Studies 2 , tool was used to assess methodologic quality. Meta-analyses were performed that compared MR imaging studies to direct MR arthrography studies and indirect MR arthrography studies, 3-T studies to 1.5-T studies, and low-bias MR imaging studies to low-bias direct MR arthrography studies. Study variation was analyzed by using the Cochran Q test of heterogeneity and the I2 statistic. Results Thirty-two studies met inclusion and exclusion criteria, including 3524 imaging examinations: 1963 direct MR arthrography examinations (23 studies), 1402 MR examinations (14 studies), and 159 indirect MR arthrography examinations (three studies). Twelve studies had low risk for bias, two had questionable risk, and 18 had high risk. Mean sensitivities of direct MR arthrography, MR imaging, and indirect MR arthrography for SLAP tear diagnosis were 80.4%, 63.0%, and 74.2%, respectively. Mean specificities of direct MR arthrography, MR imaging, and indirect MR arthrography were 90.7%, 87.2%, and 66.5%, respectively. Summary receiver operator characteristic (ROC) curve demonstrated superior accuracy of direct MR arthrography compared with those of MR imaging and indirect MR arthrography. Similar findings were observed in the low-bias subanalysis. Summary ROC curve demonstrated overall superiority of 3-T imaging, with or without intra-articular contrast material compared with 1.5-T imaging, with or without intra-articular contrast material. Significant variance was observed for MR imaging and direct MR arthrography (P < .001) studies for both mean sensitivity and specificity. Conclusion Direct MR arthrography appears to be more accurate than nonenhanced MR imaging for diagnosis of SLAP tears, whereas 3-T MR imaging with or without intra-articular contrast material appears to improve diagnostic accuracy compared with 1.5-T MR imaging with or without intra-articular contrast material. © RSNA, 2017 Online supplemental material is available for this article.

Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain.

III.