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Oca Pernas R, Fernández Cantón G. Direct MR arthrography without image guidance: a practical guide, joint-by-joint. Skeletal Radiol 2024:10.1007/s00256-024-04709-0. [PMID: 38801542 DOI: 10.1007/s00256-024-04709-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
Direct MR arthrography (dMRA) is a fundamental technique in diagnosing pathology in major peripheral joints, allowing for precise evaluation of intra-articular structures. Although injection guidance is typically performed using imaging techniques such as ultrasound or fluoroscopy, puncture via anatomical landmarks may be useful in certain circumstances where it has been proven to be a safe and effective procedure. This paper describes the indications and injection technique of dMRA, joint by joint, focusing on the different technical details, from the most common locations, like the shoulder or hip, to those with more restricted clinical indications, such as the wrist, knee, elbow, or ankle. The most relevant anatomical landmarks are detailed for each joint, aiding in the intra-articular introduction of diluted contrast, highlighting the most accessible trajectories and structures to avoid when inserting the needle. Additionally, tips are provided to facilitate proper joint distension. With all this information, this paper aims to serve as a suitable reference guide for performing dMRA without image guidance if needed.
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Affiliation(s)
- Roque Oca Pernas
- Osakidetza - Basque Health Service, MRI Department, OSATEK, Osatek Deusto, Luis Power, 18, 48014, Bilbao, Spain.
- Department of Radiology, Mutualia, Bilbao, Spain.
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2
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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Gomes JLE, Soares AF, Bastiani CE, de Castro JV. Anterolateral talar palpation: A complementary test for ankle instability. Foot Ankle Surg 2018; 24:486-489. [PMID: 29409195 DOI: 10.1016/j.fas.2017.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/21/2017] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The anterior drawer test is traditionally used to assess ankle instability, but we believe that there is room for a small but effective improvement by adding digital palpation of the talus. We aimed to determine the accuracy of anterolateral talar palpation (ATP) in the diagnosis of ankle instability by comparing it with the traditional anterior drawer test. METHODS Fourteen symptomatic and 10 asymptomatic patients were examined for excessive mobility through comparison of both ankles by two blinded orthopedic surgeons, each one using one of the above-mentioned tests. Symptomatic patients were also referred for stress radiography and magnetic resonance imaging (MRI). RESULTS ATP was the most sensitive test, but also the least specific, yielding more positive results than the other tests, including tests with negative MRI. ATP and radiography had the highest accuracy and highest level of agreement with MRI. CONCLUSIONS ATP significantly improved diagnostic accuracy in detecting ankle instability. LEVEL OF EVIDENCE IV: cross-sectional study.
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Affiliation(s)
- João L Ellera Gomes
- Graduate Program in Surgical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFGRS), Rua Desembargador Esperidião de Lima Medeiros, 81, Porto Alegre, RS, 91330-020, Brazil.
| | - Arthur F Soares
- Resident in Orthopaedics and Traumatology, Hospital de Clínicas de Porto Alegre (HCPA), Rua Garibaldi, 894/403, Porto Alegre, RS 90035-051, Brazil.
| | - Carlos E Bastiani
- Resident in Orthopaedics and Traumatology, HCPA, Rua Conde de Porto Alegre, 577/01, Porto Alegre, RS 90220-211, Brazil.
| | - Jacqueline Vieira de Castro
- Graduate Program in Surgical Sciences, School of Medicine, UFRGS, Rua Afonso Taunay, 115/401, Porto Alegre, RS 90520-540, Brazil.
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Abstract
Ankle impingement and instability are well-recognized complications of ankle sprain. Ankle impingement is an important cause of chronic ankle pain in active populations, particularly in the professional athlete. Depending on anatomical location and the structures involved, impingement syndromes are classified into anterolateral, anterior, posterior, posteromedial, and anteromedial types. Clinically, impingement syndromes are characterized by painful limitation of full-ankle movement. Ankle impingement results from repetitive subclinical trauma due to overuse injuries, which, in the subacute or chronic situation, lead to abnormal osseous and soft-tissue thickening within the ankle joint. Various imaging techniques can be used in the diagnosis of ankle impingement. Usually, radiography is the initial imaging technique performed to rule out bony trauma and identify potential anatomical bony abnormalities. Use of computed tomography and isotope bone scanning is largely superseded by magnetic resonance imaging, although with variable sensitivity and specificity. Arthrographic techniques, using computed tomography or magnetic resonance, are useful for exquisite demonstration of capsular recesses and synovial abnormalities. Imaging-guided injection techniques can be used in the management of impingement for pain ablation and to aid clinical diagnosis, especially in hind foot pain.
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Affiliation(s)
- Abhijit Datir
- Department of Radiology, Royal National Orthopaedic Hospital NHS Trust, London, UK
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7
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Abstract
MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography permits more sensitive imaging of suspected intra-articular pathology in cases in which conventional MR imaging is either insufficient or inadequate for diagnosis or treatment planning. The main indications for MR arthrography are the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography can be a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in those cases in which an invasive procedure is contraindicated or image guidance is not available.
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Introduction to diagnostic musculoskeletal ultrasound: part 2: examination of the lower limb. Am J Phys Med Rehabil 2008; 87:238-48. [PMID: 18174843 DOI: 10.1097/phm.0b013e31816198c2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This is the second of two articles focusing on ultrasound examination of musculoskeletal components of the upper and lower limbs. Treatment of musculoskeletal injuries is based on establishing an accurate diagnosis. No one would dispute that a good history and physical examination by a competent clinician can help achieve that in the majority of cases. However, musculoskeletal imaging is also an essential adjunct in the work-up of many musculoskeletal disorders. This article describes the ultrasound examination of the lower limb in terms of anatomic structure. Normal and pathologic ultrasound features of these structures, including muscles, tendons, ligaments, bursae, and other soft tissues of the lower limb, will be described by reviewing several representative pathologies commonly seen in musculoskeletal medicine.
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Robinson P. Impingement syndromes of the ankle. Eur Radiol 2007; 17:3056-65. [PMID: 17503050 DOI: 10.1007/s00330-007-0675-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 03/09/2007] [Accepted: 04/20/2007] [Indexed: 01/29/2023]
Abstract
Ankle impingement syndromes are categorised according to their anatomical site around the tibiotalar joint. Anterolateral, anterior and posterior ankle impingement has been extensively described in the orthopaedic and radiology literature with more recent studies describing posteromedial and anteromedial impingement. This article aims to demonstrate the potential spectrum of imaging findings for each ankle impingement syndrome as well as the relative contributions of ultrasound and MR imaging for diagnosis and image-guided treatment.
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Affiliation(s)
- Philip Robinson
- Musculoskeletal Centre X-Ray Department, Chapel Allerton Hospital, Leeds, LS7 4SA, UK.
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Cerezal L, Abascal F, Canga A, García-Valtuille R, Rolón A. Técnica e indicaciones de la resonancia magnética artrografía. Extremidad inferior (II). RADIOLOGIA 2006; 48:357-68. [PMID: 17323893 DOI: 10.1016/s0033-8338(06)75151-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Magnetic resonance (MR) is the imaging technique of election in the evaluation of the articular pathology. MR arthrography (MRA) consists of the direct punction of the joint with intraarticular injection of diluted gadolinium or saline solution. MRA produces distention of the capsular recess, delineates the intraarticular structures and separates annexed structures of difficult evaluation, with which it is able to improve the reliability diagnoses of the articular and periarticular pathology. MRA allows to solve some of the diagnostic problems of conventional MR imaging in the evaluation of the articular pathology, avoiding to make unnecessary diagnostic arthroscopy and allowing a better therapeutic plan. In the greater joints of the inferior extremity (hip, knee and ankle) MRA has established indications standing out the evaluation of the injuries of the acetabular labrum of the hip, the operated meniscus of the knee and the study of the "impingement" syndromes of the ankle. This article reviews the present utility of the MRA in the hip, knee and ankle joints. The more relevant anatomical aspects, the technique and the applications are reviewed. Finally, the value of this technique in pathologies that can affect any joint of the organism such as osteochondral injuries, loose intraarticular bodies and synovial pathology is reviewed.
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Affiliation(s)
- L Cerezal
- Instituto Radiológico Cántabro, Clínica Mompía,. Santander, España.
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McBride DJ, Ramamurthy C. Chronic ankle instability: management of chronic lateral ligamentous dysfunction and the varus tibiotalar joint. Foot Ankle Clin 2006; 11:607-23. [PMID: 16971252 DOI: 10.1016/j.fcl.2006.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Many techniques have been described in acute and chronic lateral ligament insufficiency in the ankle. At present, the Bostrom-Gould and Chrisman-Snook procedures and their variations remain the "gold standard". Recent assessment of important etiologic factors has shed some light on the relationship between the original injury or injuries and the subsequent development of the varus tibiotalar joint with or without secondary osteoarthritis. The development of Taylor Spatial Frame may well revolutionize its management. In the meantime, further consideration should be given to well-designed and evaluated randomized controlled trials, improved understanding of the biomechanics, and function of the ligaments, for example, proprioceptive function and their healing. Newer and less invasive arthroscopic and percutaneous techniques are being developed.
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Affiliation(s)
- Donald J McBride
- Orthopaedic and Trauma Departments, University Hospital of North Staffordshire, Princes Road, Stoke-on-Trent, Staffordshire St4 7LN, United Kingdom.
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12
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Abstract
For decades, fluoroscopic arthrography was the only method available to image a joint with contrast enhancement. Advances in CT led to the natural development of CT arthrography. Development of MRI and its capability for multiplanar imaging led to direct magnetic resonance arthrography (MRA). This technique has been performed since 1987 and has surpassed CT arthrography in popularity in the United States. Indirect MRA developed subsequently to offer a less invasive alternative. This article presents an overview of direct MRA and addresses joint-specific issues regarding direct MRA. An overview of indirect MRA also is provided.
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Affiliation(s)
- Todd Osinski
- Department of Radiology, University of California San Francisco, 505 Parnassus, Suite M392, San Francisco, CA 94143-0628, USA
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Sahin G, Demirtaş M. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips. Eur J Radiol 2006; 58:416-30. [PMID: 16464555 DOI: 10.1016/j.ejrad.2006.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2005] [Revised: 12/29/2005] [Accepted: 01/04/2006] [Indexed: 12/15/2022]
Abstract
Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however, direct MR arthrography using diluted gadolinium as the contrast agent is the most commonly used technique and is the most reliable of all. MR arthrography is useful for demonstrating labrocapsular-ligamentous abnormalities and distinguishing partial thickness rotator cuff tears from focal full thickness tears in the shoulder, identifying or excluding recurrent tears following meniscal operations in the knee, demonstrating perforations of the triangular fibrocartilage complex (TFCC) and ligaments in the wrist, showing labral tears in the hip, diagnosing ligament tears in the ankle and identifying osteochondral lesions or loose bodies in any of the aforementioned joints. In this article, an overview of techniques of MR arthrography is provided with emphasis on direct MR arthrography using diluted gadolinium as the contrast agent. The current applications of the technique in major peripheral joints are reviewed, with emphasis given to the shoulder joint where the role of this technique has become well established.
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Affiliation(s)
- Gülden Sahin
- Department of Radiology, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara, Turkey.
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Cerezal L, Abascal F, García-Valtuille R, Canga A. Ankle MR Arthrography: How, Why, When. Radiol Clin North Am 2005; 43:693-707, viii. [PMID: 15893532 DOI: 10.1016/j.rcl.2005.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
MR arthrography has become an important tool for the assessment of a variety of ankle disorders. MR arthrography may facilitate the evaluation of patients with suspected intra-articular pathology in whom conventional MR imaging is not sufficient for an adequate diagnosis and be useful for therapy planning. MR arthrography is valuable in the evaluation of ligamentous injuries, impingement syndromes, cartilage lesions, osteochondral lesions of the talus, loose bodies, and several synovial joint disorders. Indirect MR arthrography is a useful adjunct to conventional MR imaging and may be preferable to direct MR arthrography in cases in which an invasive procedure is contraindicated or when fluoroscopy is not available.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Instituto Radiológico Cántabro, Clínica Mompía, Mompía, 39109 Cantabria, Spain.
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15
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Abstract
Directed injections of the foot and ankle performed under fluoroscopic guidance have both considerable diagnostic value and the potential for targeted therapy by accurately delivering corticosteroid and/or anesthetic to the source of pain. Both large and small joints in the foot and ankle are readily accessed, offering precise information to the foot and ankle surgeon who may be contemplating arthrodesis or other intervention. In addition to its role in pain management, ankle arthrography may be performed in conjunction with MRI or CT, with improved evaluation of articular cartilage and capsular abnormalities.
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Affiliation(s)
- Joel S Newman
- Department of Rediology, New England Baptist Bone and Joint Institute, 125 Parker Hill Avenue, Boston, MA 02120 USA
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Sizer PS, Phelps V, Dedrick G, James R, Matthijs O. Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management. Pain Pract 2003; 3:343-74. [PMID: 17166130 DOI: 10.1111/j.1530-7085.2003.03038.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, School of Allied Health, Doctorate of Science Program in Physical Therapy, Lubbock, Texas 79430, USA
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Robinson P, White LM. Soft-tissue and osseous impingement syndromes of the ankle: role of imaging in diagnosis and management. Radiographics 2002; 22:1457-69; discussion 1470-1. [PMID: 12432115 DOI: 10.1148/rg.226025034] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Soft-tissue and osseous impingement syndromes of the ankle can be an important cause of chronic pain, particularly in the professional athlete. The main impingement syndromes are anterolateral, anterior, anteromedial, and posterior impingement. These conditions arise from initial ankle injuries, which, in the subacute or chronic situation, lead to development of abnormal osseous and soft-tissue thickening within the ankle joint. The relative contributions of the osseous and soft-tissue abnormalities are variable, but whatever component is dominant there is physical impingement and painful limitation of ankle movement. Conventional radiography is usually the first imaging technique performed and allows assessment of any potential bone abnormality, particularly in anterior and posterior impingement. Computed tomography (CT) and isotope bone scanning have been largely superseded by magnetic resonance (MR) imaging, but the accuracy and role of MR imaging in assessment of possible ankle impingement have not been clearly established. MR imaging can demonstrate osseous and soft-tissue edema in anterior or posterior impingement. Studies of conventional MR imaging have produced conflicting sensitivities and specificities in assessment of anterolateral impingement. CT and MR arthrographic techniques allow the most accurate assessment of the capsular recesses, albeit with important limitations in diagnosis of clinical impingement syndromes.
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Affiliation(s)
- Philip Robinson
- Department of Radiology, St James University Hospital, Beckett St, Leeds LS9 7TF, England.
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Abstract
MR arthrography by virtue of its ability accurately to demonstrate intra-articular structures and abnormalities of these structures has become an important tool for the evaluation of a variety of articular disorders. Although not necessary in all patients, MR arthrography may facilitate the evaluation of patients with suspected intra-articular pathology in whom conventional MRI is not sufficient for an adequate therapy planning. MR arthrography combines the advantages of arthrography, like joint distention and delineation of intra-articular structures, with the superior spatial resolution of MRI. This technique improves diagnostic confidence, particularly in the assessment of subtle lesions and of complex anatomic structures. MR arthrography is of high value in the evaluation of osteochondral defects, loose bodies, previously operated menisci, and acetabular labral lesions.
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Affiliation(s)
- Josef Kramer
- Institut für CT and MRI Diagnostik am Schillerpark Rainerstrasse 6-8, 4020 Linz, Austria.
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Robinson P, White LM, Salonen DC, Daniels TR, Ogilvie-Harris D. Anterolateral ankle impingement: mr arthrographic assessment of the anterolateral recess. Radiology 2001; 221:186-90. [PMID: 11568338 DOI: 10.1148/radiol.2211001666] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the accuracy of magnetic resonance (MR) arthrography in assessing the anterolateral recess of the ankle. MATERIALS AND METHODS Thirty-two patients with chronic ankle pain prospectively underwent gadolinium-enhanced MR arthrography of the tibiotalar joint. All underwent clinical examination and were included if anterolateral impingement (n = 13) or a control condition (n = 19; suspected osteochondral defect, intraarticular bodies, instability, osteoarthritis) was diagnosed. MR imaging included transverse and coronal T1-weighted and sagittal T2-weighted imaging sequences. Images were prospectively analyzed by two readers blinded to the clinical diagnosis. The anterolateral gutter contour was assessed. MR arthrographic findings were correlated with subsequent arthroscopic appearances. RESULTS MR arthrographic assessment of the anterolateral soft tissues had an accuracy of 97%, sensitivity of 96%, specificity of 100%, negative predictive value of 89%, and positive predictive value of 100%. Accuracy was 100% with clinical anterolateral impingement, with an arthroscopically confirmed abnormality in 12 cases and a normal appearance in one. Anterolateral soft-tissue thickening was identified at MR arthrography in 11 control cases, with arthroscopic confirmation in all. The remaining cases had normal appearances, with an arthroscopic soft-tissue abnormality in one case and a normal appearance in seven. CONCLUSION MR arthrography of the tibiotalar joint is accurate in assessing the anterolateral recess of the ankle.
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Affiliation(s)
- P Robinson
- Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, University of Toronto, 600 University Ave, Toronto, Ontario, Canada M5G 1X5
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Grainger AJ, Elliott JM, Campbell RS, Tirman PF, Steinbach LS, Genant HK. Direct MR arthrography: a review of current use. Clin Radiol 2000; 55:163-76. [PMID: 10708607 DOI: 10.1053/crad.1999.0374] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A J Grainger
- Department of Radiology, University of California, San Francisco, California, USA
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Abstract
Sonography of the foot and ankle offers many advantages. Currently, sonographic evaluation rivals or exceeds MR imaging for evaluation of tendons, joint and bursal pathology, and specific soft tissue pathology. The advantages of sonographic evaluation provide a strong impetus for applying this modality to imaging of foot and ankle pathology. Those who accept the challenge will have an expanded repertoire to offer in the pursuit of efficient and effective patient care.
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Affiliation(s)
- D P Fessell
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA
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