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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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Malhotra G, Hansford BG, Felcher C, Wuerfel KA, Yablon CM. Fluoroscopic-guided procedures of the lower extremity. Skeletal Radiol 2023; 52:855-874. [PMID: 35930079 PMCID: PMC9362560 DOI: 10.1007/s00256-022-04139-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/02/2023]
Abstract
This article reviews the literature and the authors' experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.
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Affiliation(s)
- Gunjan Malhotra
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Barry G. Hansford
- grid.5288.70000 0000 9758 5690Department of Radiology, Oregon Health & Science University, 3181 SW Jackson Park Rd., Portland, OR 97239 USA
| | - Cindy Felcher
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Kristie A. Wuerfel
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
| | - Corrie M. Yablon
- grid.214458.e0000000086837370Department of Radiology, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, MI 48109 USA
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Duan N, Chen X, Yin Y, Wang Z, Chen R. Comparison between magnetic resonance hysterosalpingography and conventional hysterosalpingography: direct visualization of the fallopian tubes using a novel MRI contrast agent mixture. Acta Radiol 2020; 61:1001-1007. [PMID: 31684746 DOI: 10.1177/0284185119883712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Magnetic resonance hysterosalpingography (MR-HSG) is a promising technique in the work-up of female infertility. Few existing MR-HSG studies focus on the comparison between MR-HSG with gold standard examination. PURPOSE To compare the diagnostic value of MR-HSG with conventional HSG in patients receiving both exams in one day. MATERIAL AND METHODS This study included 33 infertile women who completed pelvic MR scanning, HSG, and MR-HSG in that order. A traditional HSG contrast agent (iohexol) and a magnetic resonance imaging (MRI) contrast agent (1 mL gadopentetate dimeglumine (Gd-DTPA) blended with 100 mL iohexol) were used to achieve image enhancement. Inter-observer and inter-modality agreements of HSG and MR-HSG exams were assessed. The results were calculated by using the kappa test. Three radiologists who were blinded to the clinical data independently reviewed the MR images. Extratubal abnormalities were analyzed. RESULTS A total of 62 fallopian tubes of 33 women were included in the study. MR-HSG imaging findings to depict tubal patency were similar to these of HSG (AUC 0.911, sensitivity 0.821, specificity 1.000, positive predictive values 1.000, and negative predictive values 0.872). Pairwise inter-observer agreement among three observers and inter-modality agreement of the diagnosis were excellent (mean kappa 0.863 and 0.835, respectively). In addition, 29 extratubal abnormalities in 21 patients were found on pelvic MR scanning. CONCLUSION MR-HSG and HSG demonstrated similar results in assessing tubal patency. Because it offers the comprehensive assessment of female pelvic structures, and avoids ionizing radiation, MR-HSG may be used as an alternative imaging technique for evaluation of female infertility.
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Affiliation(s)
- Na Duan
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, Jiangsu Province, PR China
| | - Xiao Chen
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, Jiangsu Province, PR China
| | - Yanyun Yin
- Department of Gynecology and Reproductive Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, Jiangsu Province, PR China
| | - Zhongqiu Wang
- Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing City, Jiangsu Province, PR China
| | - Rong Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA
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Adams CC, Loewen MJ, Breckenridge IA, Besich-Carter JE, Bush LA. How we do it: shifting MR arthrogram compounding from the fluoroscopy suite to the sterile pharmacy. Skeletal Radiol 2019; 48:445-448. [PMID: 29846755 DOI: 10.1007/s00256-018-2980-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/02/2018] [Accepted: 05/14/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the impact of shifting arthrogram injectate compounding from the fluoroscopy suite to the main hospital sterile pharmacy on cost, examination delays, and infection rates. MATERIALS AND METHODS All arthrograms from the 12 months before (629 in total) and the 12 months after (699 in total) the change in arthrogram preparation procedure were compared to identify differences in examination delays and infection rate. The arthrogram formulation was sent to the Compounder's International Analytical Laboratory for stability testing. Finally, cost per injection analysis was performed to compare fluoroscopy suite with sterile pharmacy compounding. RESULTS In the 699 arthrograms performed in the 12 months following transfer of arthrogram preparation to the main hospital pharmacy, there were 0 reported examination delays, 0 reported infections, and a 53% decrease in the material cost per arthrogram. There were three recorded instances of fluoroscopy suite preparation of arthrogram injectate due to unexpected add-on patients. Outside stability testing determined that the arthrogram injectate retained at least 90% potency 30 h post-preparation. CONCLUSION Shifting the compounding of the arthrogram injectate from the fluoroscopy room to the main hospital sterile pharmacy provides a modest cost saving and can be accomplished without examination delays or any increase in infection rate. It brought our practice into compliance with USP797, which is the current guideline for compounding practitioners, by transferring the compounding preparation of the arthrogram injectate from a procedure room to the sterile pharmacy.
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Affiliation(s)
- Chad C Adams
- Madigan Army Medical Center, 405 6th Ave Apt 403, Tacoma, WA, 98402, USA.
| | - Matthew J Loewen
- Madigan Army Medical Center, 405 6th Ave Apt 403, Tacoma, WA, 98402, USA
| | - Ian A Breckenridge
- Madigan Army Medical Center, 405 6th Ave Apt 403, Tacoma, WA, 98402, USA
| | | | - Lisabeth A Bush
- Madigan Army Medical Center, 405 6th Ave Apt 403, Tacoma, WA, 98402, USA
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Lungu E, Moser TP. A practical guide for performing arthrography under fluoroscopic or ultrasound guidance. Insights Imaging 2015; 6:601-10. [PMID: 26493836 PMCID: PMC4656236 DOI: 10.1007/s13244-015-0442-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/24/2015] [Accepted: 10/07/2015] [Indexed: 11/25/2022] Open
Abstract
Abstract We propose a practical approach for performing arthrography with fluoroscopic or ultrasound guidance. Different approaches to the principal joints of the upper limb (shoulder, elbow, wrist and fingers), lower limb (hip, knee, ankle and foot) as well as the facet joints of the spine are discussed and illustrated with numerous drawings. Whenever possible, we emphasise the concept of targeting articular recesses, which offers many advantages over traditional techniques aiming at the joint space. Teaching Points • Arthrography remains a foremost technique in musculoskeletal radiology • Most joints can be successfully accessed by targeting the articular recess • Targeting the recess offers several advantages over traditional approaches • Ultrasound-guidance is now favoured over fluoroscopy and targeting the recess is equally applicable
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Affiliation(s)
- Eugen Lungu
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada.,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, 1560 rue Sherbrooke Est, Montréal, QC, H2L 4M1, Canada
| | - Thomas P Moser
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada. .,Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame, 1560 rue Sherbrooke Est, Montréal, QC, H2L 4M1, Canada.
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De Rycke L, van Bree H, Van Caelenberg A, Polis I, Duchateau L, Gielen I. Epinephrine-enhanced computed tomographic arthrography of the canine shoulder. Res Vet Sci 2015; 102:15-21. [PMID: 26412512 DOI: 10.1016/j.rvsc.2015.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/06/2015] [Accepted: 06/21/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the effect of epinephrine-enhanced computed tomographic arthrography (CTA) on the image sharpness of the lateral and medial glenohumeral ligaments (LGHL and MGHL, respectively), biceps tendon (BT) and joint cartilage (JC) in the canine shoulder. The shoulders of eight normal dogs were examined using a 4-slice helical CT scanner. The right shoulders were injected with Iohexol and the left shoulders with a mixture of Iohexol and epinephrine. CTA images were obtained after 1, 3, 5, 9, 13, 20 and 30 min and the image sharpness of the intra-articular structures in both shoulders was graded for visibility. The attenuation values were measured to examine the persistence of contrast appearance. Admixture of epinephrine and Iohexol significantly improved the image sharpness of the LGHL and the BT, especially on delayed CTA images. The use of epinephrine did not negatively affect post-CTA recovery.
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Affiliation(s)
- Lieve De Rycke
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium.
| | - Henri van Bree
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Annemie Van Caelenberg
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Ingeborgh Polis
- Department of Medicine and Clinical Biology of Small Animals, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Luc Duchateau
- Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Ingrid Gielen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
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da Silva YLP, Costa RZV, Pinho KEP, Ferreira RR, Schuindt SM. Effects of iodinated contrast agent, xylocaine and gadolinium concentration on the signal emitted in magnetic resonance arthrography: a samples study. Radiol Bras 2015; 48:69-73. [PMID: 25987746 PMCID: PMC4433294 DOI: 10.1590/0100-3984.2013.0002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 09/03/2014] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the effects of dilution of paramagnetic contrast agent with
iodinated contrast and xylocaine on the signal intensity during magnetic resonance
arthrography, and to improve the paramagnetic contrast agent concentration
utilized in this imaging modality. Materials and Methods Samples specially prepared for the study with three different concentrations of
paramagnetic contrast agent diluted in saline, iodinated contrast agent and
xylocaine were imaged with fast spin echo T1-weighted sequences with fat
saturation. The samples were placed into flasks and graphical analysis of the
signal intensity was performed as a function of the paramagnetic contrast
concentration. Results As compared with samples of equal concentrations diluted only with saline, the
authors have observed an average signal intensity decrease of 20.67% for iodinated
contrast agent, and of 28.34% for xylocaine. However, the increased gadolinium
concentration in the samples caused decrease in signal intensity with all the
dilutions. Conclusion Minimizing the use of iodinated contrast media and xylocaine and/or the use of a
gadolinium concentration of 2.5 mmol/L diluted in saline will improve the
sensitivity of magnetic resonance arthrography.
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Affiliation(s)
| | | | - Kátia Elisa Prus Pinho
- Fellow PhD degree in Sciences, Professor at Universidade Tecnológica Federal do Paraná (UTFPR), Curitiba, PR, Brazil
| | - Ricardo Rabello Ferreira
- MD, Radiology and Ultrasonography Specialist at Centro Diagnóstico Água Verde (Cedav), Curitiba, PR, Brazil
| | - Sueliton Miyamoto Schuindt
- Radiology Technologist, Graduate Student of Medicine, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Kirchgesner T, Pesquer L, Larbi A, Meyer P, Moreau-Durieux MH, Silvestre A, Dallaudière B. Axial traction in magnetic resonance arthrography of the wrist: How to do? Diagn Interv Imaging 2015; 96:519-22. [DOI: 10.1016/j.diii.2014.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ugas MA, Huynh BH, Fox MG, Patrie JT, Gaskin CM. MR Arthrography: Impact of Steroids, Local Anesthetics, and Iodinated Contrast Material on Gadolinium Signal Intensity in Phantoms at 1.5 and 3.0 T. Radiology 2014; 272:475-83. [DOI: 10.1148/radiol.14132352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Khedr SA, Kassem HM, Azab MA. Comparative study of direct MR arthrography and CT arthrography with arthroscopic correlation in preoperative evaluation of anterior shoulder instability. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hingorani DV, Gonzalez SI, Li JF, Pagel MD. Sensing lanthanide metal content in biological tissues with magnetic resonance spectroscopy. SENSORS (BASEL, SWITZERLAND) 2013; 13:13732-43. [PMID: 24152931 PMCID: PMC3859089 DOI: 10.3390/s131013732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 09/22/2013] [Accepted: 09/27/2013] [Indexed: 11/17/2022]
Abstract
The development and validation of MRI contrast agents consisting of a lanthanide chelate often requires a determination of the concentration of the agent in ex vivo tissue. We have developed a protocol that uses 70% nitric acid to completely digest tissue samples that contain Gd(III), Dy(III), Tm(III), Eu(III), or Yb(III) ions, or the MRI contrast agent gadodiamide. NMR spectroscopy of coaxial tubes containing a digested sample and a separate control solution of nitric acid was used to rapidly and easily measure the bulk magnetic susceptibility (BMS) shift caused by each lanthanide ion and gadodiamide. Each BMS shift was shown to be linearly correlated with the concentration of each lanthanide ion and gadodiamide in the 70% nitric acid solution and in digested rat kidney and liver tissues. These concentration measurements had outstanding precision, and also had good accuracy for concentrations ≥10 mM for Tm(III) Eu(III), and Yb(III), and ≥3 mM for Gd(III), gadodiamide, and Dy(III). Improved sample handling methods are needed to improve measurement accuracy for samples with lower concentrations.
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Affiliation(s)
- Dina V. Hingorani
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721, USA; E-Mail:
- University of Arizona Cancer Center, Tucson, AZ 85724-5013, USA; E-Mail:
| | - Sandra I. Gonzalez
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA; E-Mail:
| | - Jessica F. Li
- University of Arizona Cancer Center, Tucson, AZ 85724-5013, USA; E-Mail:
| | - Mark D. Pagel
- Department of Chemistry and Biochemistry, University of Arizona, Tucson, AZ 85721, USA; E-Mail:
- University of Arizona Cancer Center, Tucson, AZ 85724-5013, USA; E-Mail:
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ 85721, USA; E-Mail:
- Department of Medical Imaging, University of Arizona, Tucson, AZ 85721, USA
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El Habnouni S, Nottelet B, Darcos V, Porsio B, Lemaire L, Franconi F, Garric X, Coudane J. MRI-Visible Poly(ε-caprolactone) with Controlled Contrast Agent Ratios for Enhanced Visualization in Temporary Imaging Applications. Biomacromolecules 2013; 14:3626-34. [DOI: 10.1021/bm400978a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | | | | | | | - Laurent Lemaire
- Micro
et Nanomédecines Biomimétiques (MINT), UMR-S 1066, Université d’Angers, 4 rue Larrey, 49933 Angers Cedex9, France
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Guermazi A, Hayashi D, Eckstein F, Hunter DJ, Duryea J, Roemer FW. Imaging of Osteoarthritis. Rheum Dis Clin North Am 2013; 39:67-105. [DOI: 10.1016/j.rdc.2012.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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[Combined use of contrast media containing iodine and gadolinium for imaging and intervention : A hitherto widely ignored topic in radiological practice]. Radiologe 2012; 52:167-72. [PMID: 22271324 DOI: 10.1007/s00117-011-2279-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The synchronous use of chemically different contrast media in the same body compartment is a challenge for the radiologist, whether it is scheduled or unexpected. However, to inject contrast media containing iodine and gadolinium at the same time can be a prerequisite for the examination of several organs or organ systems. Unlike other topics of contrast-enhanced imaging procedures, the difficulties encountered with double contrast injections have been widely ignored in the literature. In the absence of reliable data from experimental and clinical studies the radiologist is dependent on case reports, information provided by the contrast media manufacturers, personal communications, mostly scanty personal experiences and a skilful time management, in order to overcome the situation. Only the combination of X-ray, computed tomography and magnetic resonance arthrography can be performed without another thought. However, the more or less synchronous vascular application of contrast media containing iodine and gadolinium requires vigilance. The more seriously ill the patient is, the more caution is advised even if the decision on the combined administration has to be reached urgently. The following overview gives a description of the properties of contrast media containing iodine and gadolinium as far as interactions following simultaneous administration are concerned. Subsequently, the clinically relevant situations and constellations are outlined and analyzed.
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Preoperative Imaging of Anterior Shoulder Instability: Diagnostic Effectiveness of MDCT Arthrography and Comparison With MR Arthrography and Arthroscopy. AJR Am J Roentgenol 2012; 198:661-7. [DOI: 10.2214/ajr.11.7251] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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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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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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Shang Y, Zheng ZZ, Li X. Direct MR arthrography of the shoulder at 3 tesla: Optimization of gadolinium concentration. J Magn Reson Imaging 2009; 30:229-35. [DOI: 10.1002/jmri.21828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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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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Yücesoy C, Oztürk E, Ozer Y, Edgüer T, Hekimoglu B. Conventional galactography and MR contrast galactography for diagnosing nipple discharge: preliminary results. Korean J Radiol 2009; 9:426-31. [PMID: 18838852 PMCID: PMC2627215 DOI: 10.3348/kjr.2008.9.5.426] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective We wanted to compare the clinical usefulness of conventional galactography and MR contrast galactography for diagnosing patients with nipple discharge. Materials and Methods Both conventional galactography and MR contrast galactography were performed prospectively in 16 patients. Gadopentate dimeglumine (0.1 ml) was mixed with non-ionic contrast medium (0.9 ml) to obtain a resultant volume of 1 ml and this was used for both examinations. Following conventional galactography, MR contrast galactography was performed after direct injection of contrast media into the duct. Results Conventional galactography and MR contrast galactography were concordant in 13 (81%) of 16 patients; the results were normal in five, ductal dilatation was noted in four and intraductal filling defects were noted in four. The remaining three (19%) patients demonstrated discordant findings on the two examinations. While conventional galactography revealed filling defects, the MR contrast galactography results were normal in two patients. The third patient had kinks-stricture on conventional galactography and MR contrast galactography showed ductal dilatation. This suggested there were false positive results for the three patients' conventional galactography, and all the three patients with discordant results underwent surgery and the histopathologic evaluation showed fibrocystic changes. Conclusion MR contrast galactography may be used as an alternative imaging modality for making the diagnosis of pathologic nipple discharge. However, statistically supported studies with large pools of subjects for comparing the galactography and MR contrast galactography results are needed to confirm our findings.
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Affiliation(s)
- Cüneyt Yücesoy
- Department of Radiology, S.B. Ankara Diskapi Training and Research Hospital, Ankara, Turkey.
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Multidetector spiral CT arthrography of the shoulder. Eur J Radiol 2008; 68:120-36. [DOI: 10.1016/j.ejrad.2008.02.025] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 02/09/2008] [Accepted: 02/19/2008] [Indexed: 11/20/2022]
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25
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Andreisek G, Froehlich JM, Hodler J, Weishaupt D, Beutler V, Pfirrmann CWA, Boesch C, Nanz D. Direct MR arthrography at 1.5 and 3.0 T: signal dependence on gadolinium and iodine concentrations--phantom study. Radiology 2008; 247:706-16. [PMID: 18403628 DOI: 10.1148/radiol.2473071013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively quantify in vitro the influence of gadopentetate dimeglumine and ioversol on the magnetic resonance (MR) imaging signal observed with a variety of musculoskeletal pulse sequences to predict optimum gadolinium concentrations for direct MR arthrography at 1.5 and 3.0 T. MATERIALS AND METHODS In an in vitro study, T1 and T2 relaxation times of three dilution series of gadopentetate dimeglumine (concentration, 0-20.0 mmol gadolinium per liter) at ioversol concentrations with iodine concentration of 0, 236.4, and 1182 mmol iodine per liter (corresponding to 0, 30, and 150 mg of iodine per milliliter) were measured at 1.5 and 3.0 T. The relaxation rate dependence on concentrations of gadolinium and iodine was analytically modeled, and continuous profiles of signal versus gadolinium concentration were calculated for 10 pulse sequences used in current musculoskeletal imaging. After fitting to experimental discrete profiles, maximum signal-to-noise ratio (SNR), gadolinium concentration with maximum SNR, and range of gadolinium concentration with 90% of maximum SNR were derived. The overall influence of field strength and iodine concentration on these parameters was assessed by using t tests. The deviation of simulated from experimental signal-response profiles was assessed with the autocorrelation of the residuals. RESULTS The model reproduced relaxation rates of 0.37-38.24 sec(-1), with a mean error of 4.5%. Calculated SNR profiles matched the discrete experimental profiles, with autocorrelation of the residuals divided by the mean of less than 5.0. Admixture of ioversol consistently reduced T1 and T2, narrowed optimum gadolinium concentration ranges (P = .004-.006), and reduced maximum SNR (P < .001 to not significant). Optimum gadolinium concentration was 0.7-3.4 mmol/L at both field strengths. At 3.0 T, maximum SNR was up to 75% higher than at 1.5 T. CONCLUSION Admixture of ioversol to gadopentetate dimeglumine solutions results in a consistent additional relaxation enhancement, which can be analytically modeled to allow a near-quantitative a priori optimized match of contrast media concentrations and imaging protocol for a broad variety of pulse sequences.
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Affiliation(s)
- Gustav Andreisek
- Institute for Diagnostic Radiology and Department of Medical Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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Ganguly A, Gold GE, Butts Pauly K, Mayer D, Moseley MM, Pelc NJ, Fahrig R. Quantitative evaluation of the relaxivity effects of iodine on GD-DTPA enhanced MR arthrography. J Magn Reson Imaging 2007; 25:1219-25. [PMID: 17520728 DOI: 10.1002/jmri.20934] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To quantify the effect of iodine on the gadolinium (Gd) contrast-enhanced signal in MR arthrography. MATERIALS AND METHODS Saline solutions of Gd contrast agent (0-1 mmol/liter) were mixed with iodinated contrast agent (0-185 mmol/liter). The T1 and T2 relaxation constants of these solutions were measured at 1.5T. Different types of commonly used iodinated contrast agents as well as sodium iodide (NaI) solutions were also analyzed. RESULTS Iodine caused significant T2 shortening and some T1 shortening in Gd contrast solutions. Both contrast agents independently obeyed the standard relaxation relation, and their mixture obeyed a modified version of this relation. The side chains in various iodine molecules and their viscosities affected the relaxation properties differently. For various spin-echo (SE) sequences, the signal from synovial fluid containing different concentrations of the two contrast agents was calculated. The T2-weighted signal appeared to be most affected by the increase in iodine concentrations. In the absence of Gd contrast, all SE sequences showed an initial increase in signal from iodine contrast. CONCLUSION A generalized relation for the relaxivities of Gd contrast in the presence of iodine was established. The side chains of iodine contrast were found to alter the relaxivities of Gd contrast. Imaging with proton density (PD)-weighted SE with only iodine contrast agent was found to be feasible.
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Affiliation(s)
- Arundhuti Ganguly
- Lucas MRS Center, Department of Radiology, Stanford University, 1201 Welch Road, Stanford, CA 94305, USA.
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Cerezal L, García-Valtuille R, Canga A, Rolón A, Abascal F. Técnica e indicaciones de la resonancia magnética artrografía. Extremidad superior (I). RADIOLOGIA 2006; 48:341-56. [PMID: 17323892 DOI: 10.1016/s0033-8338(06)75150-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic resonance (MR) is the most effective imaging technique in the diagnosis of articular pathology. MR arthrography (MRA), with intra-articular injection of diluted gadolinium or physiological saline solution has become more common in recent years. The intra-articular fluid facilitates the detection of articular pathology by delineating the articular structures, separating adjacent anatomic structures, and filling potential spaces that originate in or communicate with the joint. MRA provides additional information about the integrity of the articular structures, especially cartilage, fibrocartilage, and ligaments. MRA has proven especially useful in the shoulder, where most of the studies have been centered. The detection of subtle lesions of the capsule/labrum complex is fundamental for presurgical evaluation. MRA can be used to complement conventional MR imaging in some cases and in others it is the initial technique of choice. Indirect MRA with intravenous gadolinium administration is based on the enhancement of articular fluid caused by diffusion from the synovial space to the articular space. This technique offers better results in articulations with less capacity for distension, such as the wrist, ankle, hand, and foot. This first part of two-part article reviews the current role of MRA in the upper limb. Special emphasis is placed on the shoulder joint, where its usefulness has been most clearly established. The usefulness of this technique in other joints is also described, reviewing the most important anatomic aspects, techniques and applications.
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Affiliation(s)
- L Cerezal
- Instituto Radiológico Cántabro, Clínica Mompía, Santander, España.
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28
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Affiliation(s)
- Kimberly K Amrami
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Theumann NH, Etechami G, Duvoisin B, Wintermark M, Schnyder P, Favarger N, Gilula LA. Association between Extrinsic and Intrinsic Carpal Ligament Injuries at MR Arthrography and Carpal Instability at Radiography: Initial Observations. Radiology 2006; 238:950-7. [PMID: 16424247 DOI: 10.1148/radiol.2383050013] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively compare the presence or absence of carpal instability on radiographs with the findings of magnetic resonance (MR) arthrographic evaluation of intrinsic and extrinsic ligament tears in patients with chronic wrist pain. MATERIALS AND METHODS The institutional review board approved this study and did not require informed consent. Signs of carpal instability were assessed on static and dynamic radiographs of the wrist obtained in 72 patients (24 female, 48 male; mean age, 36 years; age range, 14-59 years) with posttraumatic wrist pain. MR arthrography was subsequently performed. Two musculoskeletal radiologists independently analyzed the radiographs and MR images. Each intrinsic and extrinsic ligament was individually evaluated for the presence of a ligament tear. The extent of the tear also was recorded. Interobserver agreement regarding MR arthrographic findings was tested by calculating kappa statistics. Statistical comparison between radiography and MR arthrography was performed by using the Fisher exact test. RESULTS Twenty-five triangular fibrocartilage complex, 18 (five partial, 13 complete) scapholunate ligament, and 25 (10 partial, 15 complete) lunotriquetral ligament tears were visualized. Twenty-two (all complete) extrinsic ligament tears were detected: two radial collateral ligament, 10 radioscaphocapitate ligament, and 10 radiolunotriquetral ligament tears. Interobserver agreement regarding intrinsic and extrinsic ligament tear detection at MR arthrography was excellent (kappa = 0.80). Nineteen patients had evidence of carpal instability on radiographs. Fourteen (52%) of 27 patients with at least one complete intrinsic lesion had no sign of carpal instability. On the other hand, the association of scapholunate ligament and/or lunotriquetral ligament and extrinsic ligament tears was significantly correlated (P < .001) with carpal instability at radiography. CONCLUSION The presence or absence of carpal instability on radiographs depends on the association between intrinsic and extrinsic ligament tears-even partial ones-rather than on the presence of intrinsic ligament tears alone, even when the tears are complete.
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Affiliation(s)
- Nicolas H Theumann
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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30
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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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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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Masi JN, Newitt D, Sell CA, Daldrup-Link H, Steinbach L, Majumdar S, Link TM. Optimization of gadodiamide concentration for MR arthrography at 3 T. AJR Am J Roentgenol 2005; 184:1754-61. [PMID: 15908526 DOI: 10.2214/ajr.184.6.01841754] [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: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to determine the optimal concentration of a gadolinium-based contrast agent (gadodiamide) for direct MR arthrography at 3 T compared with 1.5 T in an in vitro study. CONCLUSION Optimized concentrations of gadolinium-based contrast agents for MR arthrography are similar at 3 and 1.5 T, although a slightly greater dilution may be useful at 3 T. Signal-to-noise ratio peak levels are significantly reduced by adding an iodinated contrast agent, relatively significantly more at 3 T than at 1.5 T.
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Affiliation(s)
- Jeffrey N Masi
- Department of Radiology, University of California, San Francisco, 400 Parnassus Ave., A 367, Box 0628, San Francisco, CA 94143-0628, USA
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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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Cerezal L, Abascal F, García-Valtuille R, Del Piñal F. Wrist MR Arthrography: How, Why, When. Radiol Clin North Am 2005; 43:709-31, viii. [PMID: 15893533 DOI: 10.1016/j.rcl.2005.02.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
MR imaging of the wrist frequently represents a diagnostic challenge for radiologists because of the complex anatomy of this joint, small size of its components, and little known pathologic conditions. MR arthrography combines the advantages of conventional MR imaging and arthrography by improving the visualization of small intra-articular abnormalities. This article reviews the current role of MR arthrography in the evaluation of wrist joint disorders considering the relevant aspects of anatomy, techniques, and applications.
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Affiliation(s)
- Luis Cerezal
- Department of Radiology, Instituto Radiológico Cántabro, Clínica Mompía, Mompía, Cantabria 39109, Spain.
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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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