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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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Mailhiot SE, Thompson MA, Eguchi AE, Dinkel SE, Lotz MK, Dowdy SF, June RK. The TAT Protein Transduction Domain as an Intra-Articular Drug Delivery Technology. Cartilage 2021; 13:1637S-1645S. [PMID: 32954793 PMCID: PMC8804766 DOI: 10.1177/1947603520959392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Intra-articular drug delivery holds great promise for the treatment of joint diseases such as osteoarthritis. The objective of this study was to evaluate the TAT peptide transduction domain (TAT-PTD) as a potential intra-articular drug delivery technology for synovial joints. DESIGN Experiments examined the ability of TAT conjugates to associate with primary chondrocytes and alter cellular function both in vitro and in vivo. Further experiments examined the ability of the TAT-PTD to bind to human osteoarthritic cartilage. RESULTS The results show that the TAT-PTD associates with chondrocytes, is capable of delivering siRNA for chondrocyte gene knockdown, and that the recombinant enzyme TAT-Cre is capable of inducing in vivo genetic recombination within the knee joint in a reporter mouse model. Last, binding studies show that osteoarthritic cartilage preferentially uptakes the TAT-PTD from solution. CONCLUSIONS The results suggest that the TAT-PTD is a promising delivery strategy for intra-articular therapeutics.
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Affiliation(s)
| | | | - Akiko E. Eguchi
- Mie University Graduate School of
Medicine Faculty of Medicine, Tsu, Mie, Japan
| | | | | | | | - Ronald K. June
- Montana State University System,
Bozeman, MT, USA,Ronald K. June, Montana State
University System, 220 Roberts Hall, Bozeman, MT 59717, USA.
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Lee SH, Yun SJ, Yoon Y. Diagnostic performance of shoulder magnetic resonance arthrography for labral tears having surgery as reference: comparison of high-resolution isotropic 3D sequence (THRIVE) with standard protocol. Radiol Med 2018; 123:620-630. [PMID: 29582321 DOI: 10.1007/s11547-018-0879-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/20/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare the diagnostic performance of T1 high-resolution isotropic volume excitation (THRIVE) sequence with that of a standard protocol for direct shoulder magnetic resonance arthrography (MRA) for the diagnosis of superior labral anterior-to-posterior (SLAP) and Bankart lesions, using arthroscopy findings as a reference standard. MATERIALS AND METHODS We retrospectively studied 84 patients who underwent direct shoulder 3T MRA using THRIVE and two-dimensional three-plane proton-density fat-suppressed (2D-PD-FS) sequences. One reviewer evaluated the contrast-to-noise ratio (CNR) as a quantitative image quality. Other two reviewers independently evaluated the subjective image noise, image sharpness, and radiologic diagnosis as qualitative image quality. Arthroscopic surgical findings were considered the reference standard. Wilcoxon rank sum, Chi-square/Fisher's exact, and DeLong's tests, as well as intraclass correlation coefficients (ICCs) were used to evaluate differences between THRIVE and 2D-PD-FS images. RESULTS THRIVE images had significantly higher CNR (p < 0.001), and subjective ratings of image noise (p = 0.009) and sharpness (p = 0.039) than 2D-PD-FS images (p < 0.001). THRIVE images had similar (p ≥ 0.18) diagnostic performance (sensitivity, 93.0-97.2%; specificity, 95.8-100%; accuracy, 95.2-97.6%) for the diagnosis of SLAP and Bankart lesions with excellent agreement (ICC = 0.898-0.942) when compared to 2D-PD-FS images (sensitivity, 86.1-91.7%; specificity, 93.8-95.8%; accuracy, 90.5-92.9%; agreement, ICC = 0.782-0.858). The scan time was reduced by 69% for THRIVE sequence compared to 2D-PD-FS sequence (2 min 40 s vs. 8 min 40 s). CONCLUSION The THRIVE sequence may be helpful in the diagnosis of SLAP and Bankart lesions, and may be routinely used during direct shoulder 3T MRA.
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Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul, 01757, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
| | - Youngno Yoon
- Department of Radiology, Gangnam Severance Hospital, College of Medicine, Yonsei University, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
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Lee SH, Yun SJ, Jo HH, Kim DH, Song JG, Park YS. Direct shoulder magnetic resonance arthrography for superior labral anterior-to-posterior (SLAP) and Bankart lesions: investigation into the appropriate dose and level of local anesthesia. Br J Radiol 2017; 90:20170345. [PMID: 28749175 DOI: 10.1259/bjr.20170345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To compare contrast leakage, pain score, image quality and diagnostic performance at different doses and levels of local anaesthesia for direct shoulder magnetic resonance arthrography. METHODS Patients (n = 157) were prospectively enrolled and allocated to Group 1 (no local anaesthetic), Group 2 (local anaesthesia to subcutaneous fat level; lidocaine 1-2 ml), Group 3 (to deltoid muscle level; 3-5 ml), or Group 4 (to subscapularis muscle level; 6-8 ml). We evaluated the frequency of contrast leakage, periprocedural/postprocedural pain, contrast-to-noise ratio of the intra-articular signal, and subjective image noise/image sharpness. Radiological diagnoses of superior anterior-to-posterior (SLAP) and Bankart lesions were assessed. All data were analysed by one-way analysis of variance/Kruskal-Wall, Χ2/Fisher's exact and DeLong's tests. RESULTS The frequency of contrast leakage from the injection path and subjective image noise were significantly lower in Groups 1 and 2 than in Groups 3 and 4 (p = 0.001-0.04). Periprocedural/postprocedural pain scores among Groups 2-4 were similar and lower than those of Group 1. The contrast-to-noise ratio (p = 0.11-0.97) and image sharpness (p = 0.12-0.43) were similar among Groups 2-4 and significantly lower than those of Group 1 (p = 0.001-0.02). The diagnostic performance for the assessment of superior anterior-to-posterior and Bankart lesions was better in Groups 2-4 than in Group 1, although there were no significant differences (p = 0.23-0.99). CONCLUSION Local anaesthesia with 1-2 ml lidocaine at subcutaneous fat level reduced pain and provided optimal image quality in direct shoulder magnetic resonance arthrography. Advances in knowledge: This method can increase image quality, reduce periprocedural/postprocedural pain and potentially reduce the need for re-examination.
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Affiliation(s)
- Sun Hwa Lee
- 1 Department of Emergency Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Seong Jong Yun
- 2 Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Chungcheongbuk-do, Republic of Korea
| | - Hyeon Hwan Jo
- 2 Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Chungcheongbuk-do, Republic of Korea
| | - Dong Hyeon Kim
- 2 Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Chungcheongbuk-do, Republic of Korea
| | - Jae Gwang Song
- 3 Department of Orthopedic Surgery, Aerospace Medical Center, Republic of Korea Air Force, Chungcheongbuk-do, Republic of Korea
| | - Yong Sung Park
- 4 Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea
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Mailhiot SE, Zignego DL, Prigge JR, Wardwell ER, Schmidt EE, June RK. Non-Invasive Quantification of Cartilage Using a Novel In Vivo Bioluminescent Reporter Mouse. PLoS One 2015; 10:e0130564. [PMID: 26151638 PMCID: PMC4495059 DOI: 10.1371/journal.pone.0130564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/21/2015] [Indexed: 11/18/2022] Open
Abstract
Mouse models are common tools for examining post-traumatic osteoarthritis (OA), which involves cartilage deterioration following injury or stress. One challenge to current mouse models is longitudinal monitoring of the cartilage deterioration in vivo in the same mouse during an experiment. The objective of this study was to assess the feasibility for using a novel transgenic mouse for non-invasive quantification of cartilage. Chondrocytes are defined by expression of the matrix protein aggrecan, and we developed a novel mouse containing a reporter luciferase cassette under the inducible control of the endogenous aggrecan promoter. We generated these mice by crossing a Cre-dependent luciferase reporter allele with an aggrecan creERT2 knockin allele. The advantage of this design is that the targeted knockin retains the intact endogenous aggrecan locus and expresses the tamoxifen-inducible CreERT2 protein from a second IRES-driven open reading frame. These mice display bioluminescence in the joints, tail, and trachea, consistent with patterns of aggrecan expression. To evaluate this mouse as a technology for non-invasive quantification of cartilage loss, we characterized the relationship between loss of bioluminescence and loss of cartilage after induction with (i) ex vivo collagenase digestion, (ii) an in vivo OA model utilizing treadmill running, and (iii) age. Ex vivo experiments revealed that collagenase digestion of the femur reduced both luciferase signal intensity and pixel area, demonstrating a link between cartilage degradation and bioluminescence. In an in vivo model of experimental OA, we found decreased bioluminescent signal and pixel area, which correlated with pathological disease. We detected a decrease in both bioluminescent signal intensity and area with natural aging from 2 to 13 months of age. These results indicate that the bioluminescent signal from this mouse may be used as a non-invasive quantitative measure of cartilage. Future studies may use this reporter mouse to advance basic and preclinical studies of murine experimental OA with applications in synovial joint biology, disease pathogenesis, and drug delivery.
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Affiliation(s)
- Sarah E. Mailhiot
- Molecular Biosciences Program, Montana State University, Bozeman, MT, United States of America
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, United States of America
| | - Donald L. Zignego
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, United States of America
| | - Justin R. Prigge
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, United States of America
| | - Ella R. Wardwell
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, United States of America
| | - Edward E. Schmidt
- Molecular Biosciences Program, Montana State University, Bozeman, MT, United States of America
- Department of Microbiology and Immunology, Montana State University, Bozeman, MT, United States of America
| | - Ronald K. June
- Molecular Biosciences Program, Montana State University, Bozeman, MT, United States of America
- Department of Mechanical and Industrial Engineering, Montana State University, Bozeman, MT, United States of America
- Department of Cell Biology and Neuroscience, Affiliate Faculty, Montana State University, Bozeman, MT, United States of America
- * E-mail:
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Garmer M, Grönemeyer D. Magnetic resonance-guided interventions of large and small joints. Top Magn Reson Imaging 2011; 22:153-169. [PMID: 23514923 DOI: 10.1097/rmr.0b013e31827db35f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Magnetic resonance (MR)-guided interventions of large and small joints are feasible and safe procedures offering several advantages compared with standard guiding techniques. Nevertheless, MR-guided interventions are not routinely performed in daily practice apart from a few centers. Accurate injections are crucial for clinical outcome in diagnostic arthrography as well as therapeutic joint injections. In particular, palpatory joint puncture was shown to be inaccurate or uncertain in a substantial percentage of injections of the shoulder, the hip, and the knee. Magnetic resonance imaging offers respective merits of a cross-sectional technique with high soft-tissue contrast. Exact depiction of structures, which should be preserved, such as the labrum, should be aimed for. Areas with complex anatomy can be approached by adapting the right imaging plane(s) because of multiplanar capacity. Lack of ionizing radiation for patients is of growing interest particularly in young patients with repeated interventions. Magnetic resonance guidance alone allows an "all-in-one" MR arthrography combining precise targeting with high-field-strength imaging. Modern short-bore and open-bore high-field-strength systems offer a good comfort for patients as well as clinicians and enhance patient positioning options such as supine or prone position. Thus, a tailored approach such as a posterior technique for suspected anterior lesions in shoulder MR arthrography is possible.In this article, we describe the advantages and limitations of MR guidance in joint interventions with focus on shoulder and hip interventions. We review the requirements for needle material and MR sequences, discuss several different techniques developed to date, and present current results in clinical outcome.
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Omoumi P, Teixeira P, Lecouvet F, Chung CB. Glenohumeral joint instability. J Magn Reson Imaging 2011; 33:2-16. [PMID: 21182115 DOI: 10.1002/jmri.22343] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Due to the configuration of its bony elements, the glenohumeral joint is the most mobile joint of the body, but also an inherently unstable articulation. Stabilization of the joint is linked to a complex balance between static and dynamic soft tissue stabilizers. Because of complex biomechanics, and the existence of numerous classifications and acronyms to describe shoulder instability lesions, this remains a daunting topic for most radiologists. In this article we provide a brief review of the anatomy of the glenohumeral joint, as well as the classifications and the pathogenesis of shoulder instability. Technical aspects related to the available imaging techniques (including computed tomography [CT] arthrography, magnetic resonance imaging [MRI], and MR arthrography) are reviewed. We then describe the imaging findings related to shoulder instability, focusing on those elements that are important to the clinician.
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Affiliation(s)
- Patrick Omoumi
- Department of Radiology, Cliniques Universitaires Saint Luc, Académie Universitaire de Louvain, Brussels, Belgium
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Aubry S, Bélanger D, Giguère C, Lavigne M. Magnetic resonance arthrography of the hip: technique and spectrum of findings in younger patients. Insights Imaging 2010; 1:72-82. [PMID: 22347907 PMCID: PMC3259340 DOI: 10.1007/s13244-010-0023-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/26/2010] [Accepted: 04/28/2010] [Indexed: 11/26/2022] Open
Abstract
Magnetic resonance(MR) imaging is the reference imaging technique in the evaluation of hip abnormalities. However, in some pathological conditions-such as lesions of the labrum, cartilaginous lesions, femoroacetabular impingement, intra-articular foreign bodies, or in the pre-operative work-up of developmental dysplasia of the hip-intra-articular injection of a contrast medium is required to obtain a precise diagnosis. This article reviews the technical aspects, contraindications, normal appearance and potential pitfalls of MR arthrography, and illustrates the radiological appearance of commonly encountered conditions.
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Affiliation(s)
- Sébastien Aubry
- Service de Radiologie A., CHU Jean Minjoz, Boulevard Flemming, 25000 Besançon Cedex, France
- Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Danny Bélanger
- Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Caroline Giguère
- Département de Radiologie, Université de Sherbrooke, Sherbrooke, QC Canada
| | - Martin Lavigne
- Département d’Orthopédie, Hôpital Maisonneuve Rosemont, Montréal, QC Canada
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10
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Abstract
CT arthrography and MR arthrography are accurate methods for the study of surface cartilage lesions and cartilage loss. They also provide information on subchondral bone and marrow changes, and ligaments and meniscal lesions that can be associated with osteoarthritis. Nuclear medicine also offers new insights in the assessment of the disease. This article discusses the strengths and limitations of CT arthrography and MR arthrography. It also highlights nuclear medicine methods that may be relevant to the study of osteoarthritis in research and clinical practice.
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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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12
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Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis. Eur J Radiol 2009; 69:331-8. [DOI: 10.1016/j.ejrad.2007.08.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/16/2007] [Accepted: 08/31/2007] [Indexed: 11/21/2022]
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Hodler J. Technical errors in MR arthrography. Skeletal Radiol 2008; 37:9-18. [PMID: 17530246 DOI: 10.1007/s00256-007-0329-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 04/16/2007] [Accepted: 04/18/2007] [Indexed: 02/02/2023]
Abstract
This article discusses potential technical problems of MR arthrography. It starts with contraindications, followed by problems relating to injection technique, contrast material and MR imaging technique. For some of the aspects discussed, there is only little published evidence. Therefore, the article is based on the personal experience of the author and on local standards of procedures. Such standards, as well as medico-legal considerations, may vary from country to country. Contraindications for MR arthrography include pre-existing infection, reflex sympathetic dystrophy and possibly bleeding disorders, avascular necrosis and known allergy to contrast media. Errors in injection technique may lead to extra-articular collection of contrast agent or to contrast agent leaking from the joint space, which may cause diagnostic difficulties. Incorrect concentrations of contrast material influence image quality and may also lead to non-diagnostic examinations. Errors relating to MR imaging include delays between injection and imaging and inadequate choice of sequences. Potential solutions to the various possible errors are presented.
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Affiliation(s)
- Juerg Hodler
- Radiology, Orthopaedic University Hospital of Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland.
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Andreisek G, Duc SR, Froehlich JM, Hodler J, Weishaupt D. MR arthrography of the shoulder, hip, and wrist: evaluation of contrast dynamics and image quality with increasing injection-to-imaging time. AJR Am J Roentgenol 2007; 188:1081-8. [PMID: 17377051 DOI: 10.2214/ajr.06.0719] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to investigate the contrast dynamics and the relationship between visualization of intraarticular structures and time elapsed between intraarticular injection of contrast agent and MRI in symptomatic patients referred for MR arthrography of the shoulder, hip, and wrist. SUBJECTS AND METHODS Our local ethics committees and the national drug administration approved this multicentric study. We prospectively studied 11 shoulders, 11 hips, and 10 wrists. After the intraarticular gadolinium injection, patients underwent a baseline MR arthrography protocol (time point [TP] 1) and subsequent MRI at another four time points (TP 2-TP 5) up to 240 minutes. The course of contrast-to-noise ratio (CNR) over time was calculated. Three observers assessed the degree of visualization of different intraarticular structures and the overall image quality at each time point using a 3-point scale and a 5-point scale, respectively. RESULTS For all joints, CNR measurements showed peak CNR at TP 1 (21 minutes) and TP 2 (45 minutes) with a subsequent, near-logarithmic decline of CNR values over time. Visualization of different anatomic structures decreased over time. Overall image quality was insufficient for diagnostic purposes at TP 3 (96 minutes) in three (27%) of 11 shoulders and in three (27%) of 11 hips. In two (20%) of 10 wrists, image quality was insufficient at TP 2 (45 minutes). CONCLUSION For MR arthrography, the degree of visualization of intraarticular structures depends on the time elapsed between contrast injection and MRI. MR arthrography of the shoulder and hip should be performed within 90 minutes, and MR arthrography of the wrist should be performed within 45 minutes, after intraarticular injection.
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Affiliation(s)
- Gustav Andreisek
- Institute for Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
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Sundberg TP, Toomayan GA, Major NM. Evaluation of the Acetabular Labrum at 3.0-T MR Imaging Compared with 1.5-T MR Arthrography: Preliminary Experience. Radiology 2006; 238:706-11. [PMID: 16436825 DOI: 10.1148/radiol.2382050165] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Institutional review board approval and informed consent were obtained for this HIPAA-compliant study. The purpose of this study was to prospectively compare imaging of the acetabular labrum with 3.0-T magnetic resonance (MR) imaging and 1.5-T MR arthrography. Eight patients (four male, four female; mean age, 38 years) with hip pain suspicious for labral disease were examined at both MR arthrography and MR imaging. Presence of labral lesions, paralabral cysts, articular cartilage lesions, subchondral cysts, osteophytes, and synovial herniation pits was recorded. There was arthroscopic correlation of findings in five patients. MR imaging depicted four surgically confirmed labral tears that were identified at MR arthrography, as well as one that was not visualized at MR arthrography. MR imaging helped identify all other pathologic conditions that were diagnosed at MR arthrography and helped identify one additional surgically confirmed focal articular cartilage lesion. These results provide encouraging support for evaluation with 3.0-T MR imaging over 1.5-T MR arthrography.
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Affiliation(s)
- Thorsten P Sundberg
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
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Chung CB, Isaza IL, Angulo M, Boucher R, Hughes T. MR Arthrography of the Knee: How, Why, When. Radiol Clin North Am 2005; 43:733-46, viii-ix. [PMID: 15893534 DOI: 10.1016/j.rcl.2005.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
MR arthrography combines the techniques of arthrography with MR imaging to benefit from the added imaging information afforded by intra-articular distention. This article reviews technical considerations for MR arthrography, potential complications, indications, pitfalls in imaging diagnosis, and commonly encountered pathology. It is an elegant study that can offer precise diagnostic information in the appropriate clinical setting.
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Affiliation(s)
- Christine B Chung
- Department of Radiology, University of California San Diego and Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161, USA.
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Affiliation(s)
- Christine B Chung
- University of California-San Diego and Veterans Affairs Health Care Services-San Diego, 3350 La Jolla Village Drive, La Jolla, CA 92161, USA.
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Abstract
Hip arthroscopy is being used increasingly for the diagnosis and treatment of hip disorders. MR imaging performed with appropriate technical considerations may aid not only in preoperative planning but in the appropriate selection of patients, which tends to lead to better postoperative results. Although the painful hip is imaged most commonly by radiography, MR imaging is considered the next imaging test of choice for evaluation of most common hip abnormalities in athletes, including labral injuries, ligament injuries, osteochondral injuries, fractures, bursitis, and musculotendinous injuries. MR arthrography can be a particularly useful technique for dedicated assessment of hip joint internal derangements.
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Affiliation(s)
- Robert D Boutin
- Med-Tel International, 3713 Lillard Drive, Davis, CA 95616, USA
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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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