MRI Arthrography Research Articles

Deep Learning Reconstruction of Accelerated MRI: False-Positive Cartilage Delamination Inserted in MRI Arthrography Under Traction.

The radiological imaging industry is developing and starting to offer a range of novel artificial intelligence software solutions for clinical radiology. Deep learning reconstruction of magnetic resonance imaging data seems to allow for the acceleration and undersampling of imaging data. Resulting reduced acquisition times would lead to greater machine utility and to greater cost-efficiency of machine operations. Our case shows images from magnetic resonance arthrography under traction of the right hip joint from a 30-year-old, otherwise healthy, male patient. The undersampled image data when reconstructed by a deep learning tool can contain false-positive cartilage delamination and false-positive diffuse cartilage defects. In the future, precision of this novel technology will have to be put to thorough testing. Bias of systems, in particular created by the choice of training data, will have to be part of those assessments.

Addressing the Burden of Rotator Cuff Tears in India: Current Practices, Challenges, and Opportunities for Improved Diagnosis and Management in Healthcare and Service

Background: Rotator cuff tears (RCTs) are a significant musculoskeletal issue in India, driven by lifestyle changes, an aging population, and increased physical activity. These injuries can result in pain, disability, and reduced quality of life. The complexity of diagnosing and managing RCTs in India is compounded by limited access to advanced imaging technologies, a shortage of specialized healthcare providers, and disparities in the healthcare infrastructure. Methods and Materials: This study reviews existing literature and data from various sources, including the Indian Orthopedic Association, the Ministry of Health, and the World Health Organization. It examines the current practices for diagnosing and managing RCTs, assesses the prevalence and risk factors, and evaluates the effectiveness of various treatment modalities. Diagnostic tools like MRI, ultrasound, and arthroscopy were analyzed for their sensitivity and specificity in detecting RCTs. Results: RCTs are prevalent in India, particularly among individuals over 50, with an estimated prevalence of 22.5%. Men are more commonly affected due to physically demanding jobs. Advanced diagnostic tools like diffusion-weighted MRI and MR Arthrography provide accurate diagnoses. Arthroscopic rotator cuff repair (RCR) shows high success rates, ranging from 70% to 90%. Early diagnosis and appropriate treatment, including physical therapy and surgical intervention, are crucial for optimal outcomes. Conclusion: Managing RCTs in India requires a comprehensive approach involving enhanced healthcare infrastructure, increased access to advanced imaging, and specialized training for healthcare providers. Despite progress, challenges remain, such as the need for standardized treatment protocols and specialized care facilities. Addressing these issues through research collaboration and knowledge exchange can improve patient outcomes and reduce the burden of RCTs in India.

Differences in Anatomic Adaptation and Injury Patterns Related to Valgus Extension Overload in Overhead Throwing Athletes.

The purpose of our study was to determine differences in adaptative and injury patterns in the elbow related to valgus extension overload (VEO) in overhead throwing athletes by age. A total of 86 overhead throwing athletes and 23 controls underwent MRI or MR arthrography (MRA) of the elbow. Throwing athletes were divided by age into three groups: ≤16 years (26 subjects), 17-19 years (25 subjects), and ≥20 years (35 subjects). Consensus interpretation of each MRI was performed, with measurements of ulnar collateral ligament (UCL) thickness and subchondral sclerosis at the radial head, humeral trochlea, and olecranon process. A higher frequency of apophyseal and stress injuries was seen in adolescent athletes and increased incidence of soft tissue injuries was observed in older athletes. Early adaptive and degenerative changes were observed with high frequency independent of age. Significant differences were observed between athletes and controls for UCL thickness (p < 0.001) and subchondral sclerosis at the radial head (p < 0.001), humeral trochlea (p < 0.001), and olecranon process (p < 0.001). Significant differences based on athlete age were observed for UCL thickness (p < 0.001) and subchondral sclerosis at the olecranon process (p = 0.002). Our study highlights differences in anatomic adaptations related to VEO at the elbow between overhead throwing athletes and control subjects, as well as across age in throwing athletes.

Evaluation of a novel MRI-safe needle guidance toolkit for streamlined arthrography procedures

Currently, Magnetic Resonance arthrography procedures require two rooms and two imaging modalities: fluoroscopically guided needle insertion in a fluoroscopy suite, followed by diagnostic MRI in a separate MRI suite. The use of fluoroscopy for needle placement exposes patients to ionizing radiation, which is an important concern, especially in pediatrics. The need for two different rooms and coordinating times for these rooms complicates hospital resource scheduling and logistics. In addition, the added delays could expose younger children to additional risks associated with the use of general anesthesia. To address these issues, we propose a new technique to streamline the arthrography procedure. Our proposed technology aims to eliminate exposure to ionizing radiation and to streamline arthrography procedures that are conducted solely under MRI. This toolkit consists of a 3D slicer-based user interface, a spatially unique silicone grid template, and a hand-held needle guidance device. Together, these tools are intended to simplify and shorten the procedure while maintaining accuracy and precision comparable to the current gold standard procedure. In our cadaver study, we evaluated the feasibility and accuracy of our novel MRI-safe Needle Guidance Toolkit for MRI arthrography procedures, achieving an average targeting accuracy of 3.2 ± 1.0 mm. The results presented in this study showed the feasibility and promise of our novel MRI-safe needle guidance toolkit for arthrography procedures.

Role of MRI in Early Detection of Non-Neoplastic Articular Causes of Hip Joint Disability in Adults

Background Painful hip is a common problem in the absence of a known acute trauma, it can be a diagnostic problem as it can be attributed to many causes. The most common causes are avascular necrosis, transient osteoporosis, osteoarthritis, FAI or inflammatory causes. Aim of the Work The aim of this study is to clarify the role of MRI in diagnosis of the etiology of hip pain in adults that causes hip joint disability and to compare between the accuracy of both conventional radiography and MRI in various abnormalities and conventional MRI and MR arthrography in FAI and labrum tear. Patients and Methods This study was conducted on 96 symptomatic patients (14 males and 16 females with age ranged from 18 to 68 years) diagnosed clinically with hip joint disability due to certain hip pathology at Orthopedic and Physiotherapy Departments and referred to Radiodiagnosis Department of Ain shams University Hospitals. Results After statistical analysis of the results depending on the final outcome of the cases, it was found that MRI is more sensitive and specific than conventional radiography in detection of different hip joint pathologies with MRI sensitivity, specificity, and total accuracy ranging from 80 to 100% and conventional radiography sensitivity and specificity and total accuracy ranging from 50 to 90 %. Conclusion MRI has become an essential imaging modality in musculoskeletal system in general and in hip region specifically. It is a non-invasive technique with no radiation hazards, informative and essential in painful hip.

Subscapularis tendon tear classification and diagnosis: A systemic review and meta-analysis.

In the current study, we performed a systematic review and meta-analysis regarding the comparison of accuracy, sensitivity, and specificity of the techniques in diagnosing SSC tendon tears. Also, we performed a systematic review of the classification of SSC tendon tears. English language, peer-reviewed journal publications from the first date available to March 2022 were extracted by searching PubMed and Web of Science databases. A forest plot was used to graphically show the results of pooled sensitivity, specificity, and accuracy of different diagnostic modalities. There were six studies on using MRI to diagnose subscapularis tendon tears, five studies on MRI, four studies on clinical examination, one on ultrasonography, and one on CT arthrography. Pooled sensitivity values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.71 (CI: 0.54; 0.87), 0.83 (0.77; 0.88), 0.49 (0.31; 0.67), 0.39 (0.29; 0.51), and 0.90 (0.72-0.97), respectively. The pooled specificity values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.93 (CI: 0.89; 0.96), 0.86 (0.75; 0.93), 0.89 (0.73; 0.96), 0.93 (0.88; 0.96), and 0.90 (0.69; 0.98), respectively. The pooled diagnostic accuracy values for MRI, MRA, clinical examination, ultrasonography, and CT arthrography were 0.84 (CI: 0.80; 0.88), 0.85 (0.77; 0.90), 0.76 (0.66; 0.84), 0.76 (0.70; 0.81), and 0.90 (0.78; 0.96), respectively. According to our systematic review and meta-analysis, MR arthrography was the most accurate in diagnosing subscapularis tears. MR arthrography was the most sensitive, and MRI and ultrasonography were the most specific in detecting subscapularis tears.

Detection of the glenoid bare spot by non-arthrographic MR imaging, conventional MR arthrography, and 3D high-resolution T1-weighted VIBE MR arthrography: comparison with CT arthrography.

To determine the diagnostic accuracy of non-arthrographic MR imaging, conventional MR arthrography, and 3D T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography sequences as compared with a CT arthrography in the diagnosis of glenoid bare spot. A retrospective study of 216 patients who underwent non-arthrographic MR imaging, conventional MR arthrography, VIBE MRI arthrography, and CT arthrogram between January 2011 and March 2022 was conducted. The diagnostic accuracy of non-arthrographic MR imaging, direct MR arthrography, and VIBE MRI arthrography in the detection of glenoid bare spot was compared with that of CT arthrography. All studies were reviewed by 2 MSK radiologists. Interobserver agreement for MR imaging and MR arthrographic findings was calculated. Sixteen of 216 patients were excluded. Twenty-three of 200 shoulders had glenoid bare spot on CT arthrographic images. The glenoid bare spot was detected in 11 (47.8%) and 7 (30.4%) patients on conventional non-arthrographic MR images and in 18 (78.3%) and 16 (69.6%) patients on conventional MR arthrograms by observers 1 and 2, respectively. Both observers separately described the bare spot in 22 of 23 patients (95.7%) on 3D volumetric MR arthrograms. Interobserver variabilities were fair agreement for conventional non-arthrographic MR imaging (κ = 0.35, p < 0.05), moderate agreement for conventional MR arthrogram (κ = 0.50, p < 0.05), and near-perfect agreement for 3D volumetric MR arthrogram reading (κ = 0.87, p < 0.05). A 3D high-resolution T1-weighted VIBE MR arthrography sequence may yield diagnostic performance that is comparable with that of CT arthrography in the diagnosis of glenoid bare spot. •Glenoid bare spot should not be misdiagnosed as a transchondral defect of the glenoid surface by radiologists. •A 3D high-resolution T1-weighted VIBE MR arthrography sequence may be used as a high-sensitivity imaging technique in the diagnosis of glenoid bare spot.

History of mood and anxiety disorders does not affect the outcomes of arthroscopic rotator cuff repair

BackgroundA pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated. Aim of study and hypothesisThe primary objective of this study was to evaluate how a history of MAD affects the clinical outcomes 1 year after arthroscopic rotator cuff repair (RCR). The secondary objectives were to evaluate how a history of MAD affects tendon healing, analgesic consumption and the occurrence of complications. Materials and methodsThe study population consisted of 219 patients (mean age 54.5±6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD). ResultsThe Constant score was lower preoperatively in patients with history of MAD (−4 points, p=.04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p>.05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p>.05), tendon healing at 1 year (p=.17) or the occurrence of postoperative complications (p=.59). Discussion/conclusionPre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population. Level of evidenceIII; retrospective case-control study.

The posterior crescent sign on MRI and MR arthrography: is it a marker of hip dysplasia and instability?

To evaluate the prevalence of the 'posterior crescent sign' in symptomatic patients referred for MRI/MR arthrogram of the hip and identify any correlation with imaging features of joint pathology. Retrospective imaging assessment of a cohort of 1462 hips, from 1380 included MR examinations (82 bilateral) retrieved from a search of all examinations in patients 16-50years old from June 2018 to June 2021, with median age 45.8years (range 17.8-50.0) and 936 hips (64%) in women. Radiographic and MR findings related to hip dysplasia, femoroacetabular impingement and osteoarthritis were assessed. Fifty-one hips (3.5%) were positive for the posterior crescent sign, median age of 45.8years (range 17.8-50.0) and 29 (58%) in women. Radiographic findings included the following: mean lateral centre edge angle (LCEA) 22.2° (± 7.8°) with LCEA < 20° in 15 (31%) and LCEA 20-25° in 17 (35%) and mean acetabular index (AI) of 13.1° (± 5.8°) with AI > 13° in 22 (45%). MR findings included the following: mean anterior acetabular sector angle (AASA) 54.3° (± 9.8°), mean posterior acetabular sector angle (PASA) 92.7° (± 7.0°), labral tear at 3-4 o'clock in 20 (39%), high-grade acetabular chondral loss in 42 (83%) and ligamentum teres abnormality in 20 (39%). The posterior crescent sign occurs in 3.5% of symptomatic young and middle-aged adults on MR. It is associated with overt and borderline hip dysplasia and other findings of hip instability. It is also associated with osteoarthritis in some cases and should be interpreted with caution in these patients.

Postoperative Imaging of the Rotator Cuff: A Systematic Review and Meta-Analysis.

BACKGROUND. It is unclear which, MRI or ultrasound (US), is the most useful imaging tool to diagnose rotator cuff retears. OBJECTIVE. The objective of this study was to evaluate MRI and US in terms of diagnosing retear of a repaired rotator cuff tendon using a systematic review and meta-analysis. EVIDENCE ACQUISITION. A comprehensive literature search was performed on the main concepts of MRI (including noncontrast MRI and MR arthrography), US, and rotator cuff repairs. Inclusion criteria consisted of original research studies that assessed the diagnostic accuracy of MRI and US (index tests) for the diagnosis of rotator cuff tendon retear after prior rotator cuff repair using surgical findings as the reference standard. QUADAS-2 was used to assess methodologic quality. Meta-analyses were performed to compare MRI and US studies in the diagnosis of all retears and of full-thickness retears. Study variation was analyzed using the Cochran Q test and I2 statistic. EVIDENCE SYNTHESIS. Eight studies (MRI, n = 6; US, n = 2) satisfied inclusion and exclusion criteria, consisting of 304 total patients (MRI, n = 221; US, n = 83) and 309 shoulders (MRI, n = 226; US, n = 83). Years of publication ranged from 1993 to 2006 for the MRI studies and from 2003 to 2018 for the US studies. Two studies had high risk of bias in terms of applicability to clinical practice because of patient selection. Five studies had potential risk of bias in two categories, whereas two had potential risk of bias in three categories. For all retears, mean sensitivity and specificity for MRI were 81.4% (95% CI, 73.3-87.5%) and 82.6% (95% CI, 76.3-87.5%) and 83.7% (95% CI, 67.4-92.7%) and 90.7% (95% CI, 73.6-97.1%) for US. For full-thickness retears, mean sensitivity and specificity for MRI were 85.9% (95% CI, 80.2-90.2%) and 89.1% (95% CI, 84.6-92.4%) and 89.7% (95% CI, 75.6-96.1%) and 91.0% (95% CI, 75.5-97.1%) for US. There was no significant difference in terms of sensitivity or specificity for either comparison (p = .28-.76). CONCLUSION. Our analyses revealed no significant difference between US and MRI for the diagnosis of rotator cuff tendon tears after prior cuff repair. CLINICAL IMPACT. Either MRI or US can be considered a first-line imaging option to assess suspected rotator cuff retear after prior repair.

Acellular Matrix-Induced Chondrogenesis Technique Improves the Results of Chondral Lesions Associated With Femoroacetabular Impingement

The study's main objective was to evaluate, in the short-term, the result of the autologous acellular matrix-induced chondrogenesis (AMIC) technique in a selected group of patients with 2-4 cm2 full-thickness chondral lesions, undergoing hip arthroscopy for femoroacetabular impingement (FAI). A retrospective single-center Level IV case series of 25 patients (28 hips) who underwent an arthroscopic hip surgery with a liquid acellular collagen matrix. Inclusion criteria for implantation were FAI diagnosis (cam or pincer type), grade IV chondral lesions (Outerbridge size 2-4 cm2); Tönnis stage 0-II, minimum follow-up of 24 months, and 1 year (12-15 months) evaluation with very high field 3-T MRI arthrography. Exclusion criteria were Tönnis III, joint space <2 mm, center-edge angle <20°, and <24 months of follow-up. Clinical assessments involved symptoms duration until surgery, changes in physical and work activity and range of motion, modified Harris Hip Score, reporting percentages of patient acceptable symptomatic state (PASS) and minimal clinically important difference (MCID), pain with a VAS, and level of satisfaction. Radiological assessments: Tönnis stage, articular space, alpha and lateral center edge angle (Wiberg), and generated tissue characteristics at 1 year (based on the MOCART score), through 3-T MRI. 25 patients (28 hips) treated; 19 men and 6 women (mean age: 40.5 years; range: 25-55). Two women underwent joint replacement surgery. Thus, 23 patients (26 hips) were analyzed. At 29 months following surgery (range: 24-48), a significant improvement was obtained in all parameters assessed, focusing on the characteristics of the generated tissue in the MRI (MOCART scores). 95% of the patients met the MCID (improvement >12 points in the modified Harris Hip Score), and 100% scored >74 points, achieving the PASS. Patients' satisfaction was 86.6% (SD 16.4). All patients who practiced sports resumed them. The liquid AMIC is a safe technique that shows good clinical and radiological outcomes in a 2-year follow-up in patients with femoroacetabular impingement and grade IV acetabular 2-4 cm2 chondral defects. Level IV, retrospective case series.

Responsiveness of five shoulder outcome measures at follow-ups from 3 to 24\u2009months

BackgroundTo assess responsiveness of five outcome measures at four different follow-ups in patients with SLAP II lesions of the shoulder.Methods119 patients with symptoms and signs, MRI arthrography and arthroscopic findings were included. The Western Ontario Shoulder Instability Index (WOSI), Oxford Instability Shoulder Score (OISS), EuroQol (EQ-5D3L), Rowe Score and Constant-Murley Score (CMS) were assessed at baseline, 3, 6, 12 and 24 months. The analysis contains both anchor-based and distribution-based methods, and hypothesis testing.ResultsConfidence intervals for ROC cut-off values, representing MID, for OISS, CMS and EQ-5D3L crossed zero at 3 months. Cut-off values were stable between 6- and 24-months follow-up. At 24-months ROC cut-off values (95% CI) were: Rowe 18 (13 to 24); WOSI 331 (289 to 442); OISS 9 (5 to 14); CMS 11 (9 to 15) and EQ-5D3L 0.123 (0.035 to 0.222). MID95%limit estimates were substantially higher than ROC cut-off values and MIDMEAN at all follow-ups for all instruments. The reliable change proportion (RCP) values in the improved group were highest for WOSI and the Rowe Score (ranging from 68 to 87%) and significantly lower for CMS. EQ-5D3L had the lowest values (13 to 16%). We found a moderate correlation between mean change scores of the outcome measures and the anchor, except for the EQ-5D3L.ConclusionsIn patients with SLAP II-lesions the patient reported OISS and WOSI and the clinical Rowe score had best responsiveness. Our results suggest that 3 months follow-up is too early for outcome evaluation.

Non-surgical and surgical treatments for rotator cuff disease: a pragmatic randomised clinical trial with 2-year follow-up after initial rehabilitation

BackgroundRotator cuff disease (RCD) causes prolonged shoulder pain and disability in adults. RCD is a continuum ranging from tendinopathy to full-thickness tendon tear. Recent studies have shown that subacromial decompression...

Indirect Magnetic Resonance Arthrography May Help Avoid Second Look Arthroscopy for Assessment of Healing After Bucket Handle Medial Meniscus Repairs: A Prospective Clinico-Radiological Observational Study

The objectives were: (1) to analyze the MRI healing rates of bucket-handle meniscus repair; (2) to compare the accuracy of assessment ofmeniscus healing for conventional MRI and Indirect Magnetic Resonance Arthrography (IMRA); and (3) to identify patients who may requiresecond-look arthroscopy after meniscus repair. This is a prospective observational case series of thirty-seven patients with repaired bucket-handle medial meniscus tear with a minimum one year follow-up. Meniscus healing rates were assessed on direct MRI and IMRA using Henning's criteria. At the same time, patients' symptoms were evaluated according to Barrett's criteria and functional outcomes were recorded using International Knee Documentation Committee (IKDC) score, Knee Osteoarthritis and Outcomes Score (KOOS) and Tegner-Lysholm scores. A further clinical review was performed 18months after the imaging to assess the evolution of symptoms. At a mean of 22.3 ± 7.8months after the meniscus repair, 56.7% patients showed complete healing and 40.5% patients demonstrated incomplete repair healing on IMRA. 52% patients with complete healing and 40% patients with incomplete healing demonstrated meniscus symptoms. At the second clinical review, 19% patients with complete healing and 20% patients with incomplete healing had meniscus symptoms. There was no co-relation between symptoms, PROMs and healing on MRI. Indirect MR arthrography offers distinct advantages over direct MRIfor assessment of meniscus healing, especially in symptomatic patients. Patient-reported outcome measures and symptomatology are not co-related with the healing status of the meniscus and they resolve in the majority on longer follow-up. A more conservative approach guided by IMRA to assess meniscus healing will avoid early re-operations.

Proposal of a new CT arthrographic classification system of osteochondral lesions of the talus

BackgroundSurgical treatment of osteochondral lesions of the talus (OLT) is warranted if medical treatments fail, achieving good results in around 85% of cases. Numerous classification systems, based on all possible imaging modalities (radiography, MRI, CT scan, scintigraphy, and CT arthrography), have been proposed to guide surgical treatments, but none has proven to be superior. A recent study demonstrated the prognostic value of CT arthrography by accurately describing the subchondral bone plate. A systematic review of the literature has brought new criteria to predict good outcome following bone marrow stimulation surgical techniques: lesions should measure less than 1 centimeter in size and 5 millimeters in depth. Based on these data, we are proposing a new simple, 3-stage CT arthrographic classification system of OLT. Materials and methodsAfter a brief overview of the classification, 60 CT-arthrographies of ankles with OLT were organized according to this new CT arthrographic classification system by four surgeons (two juniors and two seniors). Two imaging assessments were performed one month apart. Statistical analysis was performed using the Fleiss’ kappa coefficient to determine the inter- and intraobserver agreement. ResultsAn excellent inter- and intraobserver agreement was found with overall Fleiss’ kappa coefficients of 0.897 and 0.847, respectively. ConclusionThe results of our study showed an excellent inter- and intraobserver agreement for this new CT arthrographic classification system of OLT. The principal advantage of this new classification system, based on the latest data in the literature, is its ability to easily distinguish lesions that are more amenable to bone marrow stimulation techniques. Level of evidenceII.

Best Practices: Hip Femoroacetabular Impingement.

OBJECTIVE. Imaging plays a critical role in the assessment of patients with femoroacetabular impingement (FAI). With better understanding of the underlying pathomechanics and advances in joint-preserving surgery, there is an increasing need to define the most appropriate imaging workup. The purpose of this article is to provide guidance on best practices for imaging of patients with FAI in light of recent advances in corrective FAI surgery. CONCLUSION. Pelvic radiography with dedicated hip projections is the basis of the diagnostic workup of patients with suspected FAI to assess arthritic changes and acetabular coverage and to screen for cam deformities. Chondrolabral lesions should be evaluated with unenhanced MRI or MR arthrography. The protocol should include a large-FOV fluid-sensitive sequence to exclude conditions that can mimic or coexist with FAI, radial imaging to accurately determine the presence of a cam deformity, and imaging of the distal femoral condyles for measurement of femoral torsion. CT remains a valuable tool for planning of complex surgical corrections. Advanced imaging, such as 3D simulation, biochemical MRI, and MR arthrography with application of leg traction, has great potential to improve surgical decision-making. Further research is needed to assess the added clinical value of these techniques.

Intra- and Periarticular Ganglia (Synovial Cysts) of the Hip with Compression of the Obturator Nerve, Concomitant with Lesions of the Ligamentum Teres—A Report of 3 Cases

Background: Synovial cysts of the hip are commonly found in patients with intra- or extraarticular pathologies of the joint. Symptoms are mostly unspecific. To date there are no guidelines for a gold standard of treatment. Aim of this article is to show up how lesions of the ligamentum teres (LT) might possibly lead to a specific formation of synovial cysts of the hip joint and how this can be treated arthroscopically. Methods: This case series included 3 patients with ganglia of the hip. All patients had impingement symptoms, combined with untypical location of pain. All patients qualified for joint preserving surgery and underwent hip arthroscopy with pre- and postoperative MRI imaging. The mean follow-up time was 22 months. Results: MRI imaging showed extensive ganglia, presumably originating from the pelvic root of LT, extending to the obturator lodge. In 2 of 3 cases MRI showed lesions of the LT. Hip arthroscopy revealed damage of the LT in all cases, caused by chronic instability of the joint. The postoperative MRI showed a complete regression of the ganglia in all patients after offset correction. After follow-up, 2 of 3 patients were mostly symptom free. One patient was still suffering from a chronic weakness of the gluteus medius muscle. Conclusion: Whenever unspecific radiating pain of surrounding areas of the hip is encountered and cannot be explained by common pathologies of the hip, possible compression of nerves by ganglion cysts should be excluded. This should be done by MRI arthrography. A partial rupture of the LT can occur during FAI with consecutive formation of ganglia in the obturator canal, compressing the obturator nerve. Primarily the articular pathology needs to be repaired. In our cases, this was feasible by hip arthroscopy, as a minimally invasive and safe technique.

Role of MRI Arthrography Compared to Conventional MRI in Assessment of Shoulder Joint Disorders

Abstract Glenohumeral joint instability is extremely common. With regard to primary anterior shoulder dislocations, the incidence is between 8.2 and 23.9 per 100 000 person-years, with an estimated prevalence of 1.7%. Many imaging methods, including arthrography, CT arthrography, MR arthrography, have been used to image the glenoid labrum and the associated structures of the capsular mechanism. The aim of the study is to prove MR arthrography is the preferred imaging technique for the investigation of patients with shoulder instability. MR arthrography reliably shows subtle lesions of the labroligamentous complex, providing information essential to the surgeon concerning the surgery or arthroscopic repair .Thirty Patients with clinically evident or suspected shoulder impingemint or glenohumeral instability.of both sexes were included , conventional MRI was performed for all patients followed by CT guided intraarticular contrast injection then MRI Arthrography images taken within thirty minutes. Data were collected, revised, coded and entered to the Statistical Package for Social Science (IBM SPSS) version 20.

MRI of the Normal Elbow and Common Pathologic Conditions.

Anatomic and biomechanical knowledge of the supporting structures that provide stability to the medial and lateral elbow is essential to correctly interpret pathologic findings.

Identification of Naturally Occurring Cartilage Damage in the Equine Distal Interphalangeal Joint Using Low-Field Magnetic Resonance Imaging and Magnetic Resonance Arthrography.

Objectives: To describe detectable and non-detectable naturally occurring cartilage damage of the equine distal interphalangeal (DIP) joint using plain magnetic resonance (MR) imaging and gadolinium and saline MR arthrography. The second objective was to quantify the sensitivity, specificity and accuracy in detection of cartilage damage.Methods: In a pilot study, the distal limbs of two horses with confirmed osteoarthritis of the DIP joint were imaged with low-field MR. Magnetic resonance images were assessed in consensus by three observers and compared to gross pathological findings. Subsequently, a prospective analytical cross-sectional study design was created to compare pre-contrast MR imaging and saline and gadolinium MR arthrography of isolated equine distal limbs to gross observation findings. Hallmarq® low-field MR (0.27T) scans were performed prior to DIP joint injection, saline/gadolinium post-injection scans were performed at 15 min intervals for 2 h. Joints were inspected and the articular cartilage graded subjectively for cartilage damage (0–3). The presence of detectable or non-detectable cartilage damage on MR images was identified, characterized and recorded in consensus by three observers. Sensitivity, specificity and accuracy in detection of cartilage damage related to gross pathology were calculated.Results: The two clinical cases from the pilot study with confirmed osteoarthritis had full thickness cartilage defects; however, only one of these was correctly identified using low-field MRI. In the prospective study, the majority of naturally occurring cartilage damage could not be identified on plain MR or MR arthrography including extensive partial thickness cartilage erosions. Saline and gadolinium MR arthrography did not improve the detection of cartilage damage. The accuracy of cartilage damage detection was 0.63 with a sensitivity of 0.14 and specificity of 0.92.Clinical Relevance: Both, plain low-field MRI and MR arthrography are not sensitive in detection of naturally occurring cartilage damage of the DIP joint. However, if an abnormal contour is seen in the articular cartilage, cartilage damage is likely to be present.