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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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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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Lee MH, Park HJ, Kim JN. [Postoperative Imaging of Rotator Cuff Tear]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1388-1401. [PMID: 36238871 PMCID: PMC9431978 DOI: 10.3348/jksr.2021.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/06/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022]
Abstract
Postoperative imaging of the rotator cuff may be performed routinely, even if pain or disability develops after surgery or if there are no symptoms. Postoperative images are obtained through MRI or US, and the purpose is to confirm the integrity of the restored tendon in general. Postoperative MRI has a relatively poor diagnostic accuracy compared to that of preoperative images because various materials used in surgeries deteriorate the image quality. US can dynamically check the condition of the restored tendon and avoid artifacts from the surgical instruments used for recovery. Although imaging findings are not always consistent with the clinical symptoms or prognosis, sub-deltoid fluid retention is more important for pain and functional recovery than the thickness of the reconstructed tendon. Strain elastography can also be a useful method for predicting the prognosis.
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Li L, Dong J, Li Q, Dong J, Wang B, Zhou D, Liu F. MRA improves sensitivity than MRI for the articular-sided partial-thickness rotator cuff tears. Sci Prog 2021; 104:368504211059976. [PMID: 34939473 PMCID: PMC10364937 DOI: 10.1177/00368504211059976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aims to compare the diagnostic accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) for the articular-sided partial-thickness rotator cuff tear (PTRCT). METHODS Three electronic databases, PubMed/Medline, Embase and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting articular-sided PTRCTs. The pooled statistical indexes included sensitivity, specificity, positive/negative predictive value, diagnostic odds ratio (DOR) and the area under the receiver operating characteristic curve (AUC). RESULTS Eleven studies involving 1703 patients and 1704 shoulders were included. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRA to diagnose articular-sided PTRCTs were 0.81 (95% CI, 0.65-0.90), 0.96 (95% CI, 0.91-0.98), 68.14 (95% CI, 33.20-139.84) and 0.96 (95% CI, 0.94-0.97), respectively. The pooled sensitivity, specificity, DOR and AUC and their 95% CIs of MRI were 0.78 (95% CI, 0.65-0.87) and 0.97 (95% CI, 0.84-0.99), 47.82 (95% CI, 8.29-275.89) and 0.89 (95% CI, 0.86-0.92), respectively. CONCLUSIONS This meta-analysis reveals that MRA has a better diagnostic value than that of MRI for the diagnosis of articular-sided partial-thickness rotator cuff tears because of an improvement of sensitivity.
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Affiliation(s)
- Lianxin Li
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qinghu Li
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinye Dong
- Department of Ultrasound, Weifang People's Hospital, Weifang 261041, Shandong, PR China
| | - Bingzhi Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong, China
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Tsoi C, Tsai CSC, Law EKC, Lee RKL, Ng AWH, Griffith JF. A comparison of ultrasound-guided rotator interval and posterior glenohumeral injection techniques for MR shoulder arthrography. Clin Imaging 2020; 69:255-260. [PMID: 33002752 DOI: 10.1016/j.clinimag.2020.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/31/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this prospective, randomized study was to compare the performance of a rotator interval approach with the posterior glenohumeral approach for ultrasound-guided contrast injection prior to MR shoulder arthrography. METHOD This study was approved by the institutional review board. One hundred and twenty consecutive patients referred for MR shoulder arthrography were randomized into four groups: rotator interval approach in-plane (n = 30); rotator interval approach out-of-plane (n = 30); posterior approach in-plane (n = 30); and posterior approach out-of plane (n = 30). Outcome measures included procedure time, number of injection attempts, patient-reported pain score (0-10), and radiologist-reported technical difficulty (0-10). MR arthrograms were assessed for adequacy of joint distension, diagnostic utility, and extra-capsular contrast leakage. RESULTS All 120 patients had a successful ultrasound-guided injection with adequate joint distension and diagnostic utility for MR arthrography. In-plane needle guidance was less technically demanding, quicker, required fewer injection attempts, and had a lower frequency of contrast leakage than out-of-plane needle guidance. The posterior glenohumeral approach was less technically demanding though had a higher frequency of contrast leakage and caused more patient discomfort than the rotator interval approach. CONCLUSION For ultrasound-guided shoulder joint injection, an in-plane approach is preferable. The posterior glenohumeral approach is less technically demanding though causes more patients discomfort than the rotator interval approach possibly due to the longer needle path.
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Affiliation(s)
- Carita Tsoi
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chris S C Tsai
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Eric K C Law
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ryan K L Lee
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex W H Ng
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Liu F, Dong J, Shen WJ, Kang Q, Zhou D, Xiong F. Detecting Rotator Cuff Tears: A Network Meta-analysis of 144 Diagnostic Studies. Orthop J Sports Med 2020; 8:2325967119900356. [PMID: 32076627 PMCID: PMC7003181 DOI: 10.1177/2325967119900356] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Many imaging techniques have been developed for the detection of rotator cuff tears (RCTs). Despite numerous quantitative diagnostic studies, their relative accuracy remains inconclusive. PURPOSE To determine which of 3 commonly used imaging modalities is optimal for the diagnosis of RCTs. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Studies evaluating the performance of magnetic resonance imaging (MRI), magnetic resonance arthrography (MRA), and ultrasound (US) used in the detection of RCTs were retrieved from the PubMed/MEDLINE and Embase databases. Diagnostic data were extracted from articles that met the inclusion/exclusion criteria. A network meta-analysis was performed using an arm-based model to pool the absolute sensitivity and specificity, relative sensitivity and specificity, and diagnostic odds ratio as well as the superiority index for ranking the probability of these techniques. RESULTS A total of 144 studies involving 14,059 patients (14,212 shoulders) were included in this network meta-analysis. For the detection of full-thickness (FT) tears, partial-thickness (PT) tears, or any tear, MRA had the highest sensitivity, specificity, and superiority index. For the detection of any tear, MRI had better performance than US (sensitivity: 0.84 vs 0.81, specificity: 0.86 vs 0.82, and superiority index: 0.98 vs 0.22, respectively). With regard to FT tears, MRI had a higher sensitivity and superiority index than US (0.91 vs 0.87 and 0.67 vs 0.28, respectively) and a similar specificity (0.88 vs 0.88, respectively). The results for PT tears were similar to the detection of FT tears. A sensitivity analysis was performed by removing studies involving only 1 arm for FT tears, PT tears, or any tear, and the results remained stable. CONCLUSION This network meta-analysis of diagnostic tests revealed that high-field MRA had the highest diagnostic value for detecting any tear, followed by low-field MRA, high-field MRI, high-frequency US, low-field MRI, and low-frequency US. These findings can help guide clinicians in deciding on the appropriate imaging modality.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Jinlei Dong
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Wun-Jer Shen
- Po Cheng Orthopedic Institute, Kaohsiung, Taiwan
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
- Fei Xiong, MD, Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Yishan Road 600, Xuhui District, Shanghai 200233, China ()
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Huang T, Liu J, Ma Y, Zhou D, Chen L, Liu F. Diagnostic accuracy of MRA and MRI for the bursal-sided partial-thickness rotator cuff tears: a meta-analysis. J Orthop Surg Res 2019; 14:436. [PMID: 31831029 PMCID: PMC6909503 DOI: 10.1186/s13018-019-1460-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 11/06/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Numerous quantitatively studies have focused on the diagnosis of bursal-sided partial-thickness rotator cuff tears (RCTs); however, the accuracy of magnetic resonance imaging (MRI) and MR arthrography (MRA) remains inconclusive. This study was performed systematically to compare the diagnostic value of MRA and MRI for the bursal-sided partial-thickness RCTs. METHODS Three electronic databases, PubMed, Embase, and Cochrane Library, were utilized to retrieve articles comparing the diagnostic value of MRA and MRI for detecting bursal-sided partial-thickness RCTs. After screening and diluting out the articles that met the inclusion criteria to be used for statistical analysis, the pooled evaluation indexes include sensitivity, specificity, positive and negative predictive values, diagnostic odds ratio (DOR), and the area under the receiver operating characteristic curve (AUC). RESULTS Twelve studies involving 1740 patients and 1741 shoulders were identified. The pooled sensitivity, specificity, DOR, and AUC of MRA to diagnose bursal-sided partial-thickness RCTs were 0.77 (95% CI, 0.67-0.85), 0.98 (95% CI, 0.95-0.99), 73.01 (95% CI, 35.01-152.26), and 0.88 (95% CI, 0.85-0.91), respectively. The pooled sensitivity, specificity, DOR, and AUC of MRI were 0.77 (95% CI, 0.66-0.86) and 0.96 (95% CI, 0.81-0.99), and 37.12 (95% CI, 8.08-170.64) and 0.82 (95% CI, 0.78-0.85), respectively. CONCLUSIONS This meta-analysis reveals that MRA and MRI have similar diagnostic value for the diagnosis of bursal-sided partial-thickness rotator cuff tears.
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Affiliation(s)
- Tao Huang
- Department of Orthopaedics, Yantai Shan Hospital, Yantai, Shandong Province, China
| | - Jian Liu
- Department of Orthopaedics, Zhangqiu District People's Hospital of Jinan City, Zhangqiu District, Jinan City, Shandong Province, China
| | - Yupeng Ma
- Department of Orthopaedics, Yantai Shan Hospital, Yantai, Shandong Province, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Liang Chen
- Department of Orthopaedics, Shandong Provincial Western Hospital, No. 4, Road Duan Xing Xi, Jinan, 250022, Shandong, China.
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Klaan B, Wuennemann F, Kintzelé L, Gersing AS, Weber MA. [MR and CT arthrography in cartilage imaging : Indications and implementation]. Radiologe 2019; 59:710-721. [PMID: 31286150 DOI: 10.1007/s00117-019-0564-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The imaging of chondral pathologies is an essential part in the work-up of acute and chronic joint diseases. Besides conventional MR imaging, CT and MR arthrography are well-established methods in evaluating articular cartilage. The application of these techniques requires knowledge of indications and safe injection procedures by the performing radiologist. PURPOSE Our goal is to describe the techniques of cross-sectional arthrographies of different joints, give an overview of general and joint-specific considerations for practical application as well as provide typical indications for cartilage imaging. MATERIALS AND METHODS A selective PubMed literature search concerning "arthrography", "CT arthrography", "MR arthrography", "arthrography cartilage", "arthrography wrist", "arthrography elbow", "arthrography shoulder", "arthrography hip", "arthrography knee", "arthrography ankle", "arthrography complications", "arthrography imaging guidance" "osteochondral lesion", "cartilage imaging" and "cartilage lesion" was performed. RESULTS AND CONCLUSION CT and MR arthrography are valuable and safe tools in cartilage imaging. They are useful to verify and specify chondral pathologies, usually after conventional MR imaging, and have an important role in evaluating the stability and therefore in therapeutic decision making of osteochondral lesions. CT arthrography is not only a substitute technique in case of MR contraindications, it can be advantageous in small joints (wrist, elbow, ankle) compared to MR arthrography due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is steadily increasing. Joint traction in MR arthrography is a promising technique to improve cartilage visualization, though it is not yet used in clinical routine imaging.
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Affiliation(s)
- B Klaan
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland.
| | - F Wuennemann
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - L Kintzelé
- Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A S Gersing
- Institut für Diagnostische und Interventionelle Radiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - M-A Weber
- Institut für Diagnostische und Interventionelle Radiologie, Kinder- und Neuroradiologie, Universitätsmedizin Rostock, Ernst-Heydemann-Straße 6, 18057, Rostock, Deutschland
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Raythatha M, Spitz D, Tang JY. Fluoroscopically-guided Joint and Bursa Injection Techniques: A Comprehensive Primer. Semin Roentgenol 2019; 54:124-148. [PMID: 31128737 DOI: 10.1053/j.ro.2018.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manisha Raythatha
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Tufts University School of Medicine, New England Baptist Hospital, Boston, MA
| | - Damon Spitz
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Tufts University School of Medicine, New England Baptist Hospital, Boston, MA
| | - Joseph Y Tang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Tufts University School of Medicine, New England Baptist Hospital, Boston, MA; Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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do Nascimento PCX, Amaral AM, de Almeida JRM. Magnetic resonance arthrography of the shoulder: a painful procedure? Radiol Bras 2018; 51:81-86. [PMID: 29743734 PMCID: PMC5935400 DOI: 10.1590/0100-3984.2016.0226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the pain expected to that effectively caused by magnetic resonance
arthrography of the shoulder and, secondarily, to describe a simplified
approach to the technique for articular access. Materials and Methods We prospectively evaluated 40 participants who used a visual analog scale and
a simplified categorical scale to indicate the level of pain expected and
that experienced after the procedure, comparing the two with the Wilcoxon
matched-pairs test. We also determined gender-related differences in pain
conditions using the Mann-Whitney U test. In addition, we described a
modified technique involving radiographic localization and the use of
standard puncture needles for articular access. Results Analysis of the visual analog scales showed that the pain experienced was
less than had been expected, with median scores of 1.75 and 3.75,
respectively (p < 0.001). The level of pain expected was
higher among women than among men, with median scores of 8.0 and 3.0,
respectively (p = 0.014), as was the level of pain
experienced, with median scores of 3.0 and 1.5, respectively
(p = 0.139). The overall categorical evaluation
corroborated that difference (p = 0.03). Articular access
with the modified technique was successful in all patients. Conclusion Magnetic resonance arthrography of the shoulder is less painful than patients
expect. In addition, digital radiographic guidance combined with the use of
standard puncture needles appears to improve the efficiency of the method.
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Affiliation(s)
| | - André Maltez Amaral
- MD, Radiologist at the Clínica de Assistência à Mulher - CAM, Salvador, BA, Brazil
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Affiliation(s)
- Guinel Hernandez Filho
- MD, Radiologist for the Grupo Musculoesquelético da Teleimagem/HCor, Grupo Alta/DASA, Attending Physician at Santa Casa de São Paulo, São Paulo, SP, Brazil. E-mail:
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Lee SH, Yun SJ, Jin W, Park SY, Park JS, Ryu KN. Comparison between 3D isotropic and 2D conventional MR arthrography for diagnosing rotator cuff tear and labral lesions: A meta-analysis. J Magn Reson Imaging 2018; 48:1034-1045. [DOI: 10.1002/jmri.26024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/20/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine; Sanggye Paik Hospital, Inje University College of Medicine; Seoul Republic of Korea
| | - Seong Jong Yun
- Department of Radiology; Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul Republic of Korea
| | - Wook Jin
- Department of Radiology; Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul Republic of Korea
| | - So Young Park
- Department of Radiology; Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Seoul Republic of Korea
| | - Ji Seon Park
- Department of Radiology; Kyung Hee University Hospital; Seoul Republic of Korea
| | - Kyung Nam Ryu
- Department of Radiology; Kyung Hee University Hospital; Seoul Republic of Korea
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Kim DY, Lee SS, Nomkhondorj O, Cho MG, Lee JJ, Hwang JT, Hong MS. Comparison Between Anterior and Posterior Approaches for Ultrasound-Guided Glenohumeral Steroid Injection in Primary Adhesive Capsulitis: A Randomized Controlled Trial. J Clin Rheumatol 2017; 23:51-57. [PMID: 28002160 DOI: 10.1097/rhu.0000000000000475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Do-Young Kim
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Anesthesiology and Pain Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea Department of Diagnostic Radiology, Chuncheon Sacred Heart Hospital, Hallym University Medical College, Chuncheon, Gangwon, Republic of Korea
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Correlation of Joint Volume and Passive Range of Motion With Capsulo-Synovial Thickness Measured by Contrast-Enhanced Magnetic Resonance Imaging in Adhesive Capsulitis. PM R 2017; 10:137-145. [PMID: 28729060 DOI: 10.1016/j.pmrj.2017.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 06/13/2017] [Accepted: 06/30/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND No study has investigated the relationship between the findings of contrast-enhanced magnetic resonance imaging (CE-MRI) and the joint volume of the shoulder, which has been considered the standard reference for diagnosis of adhesive capsulitis (AC). OBJECTIVE To investigate the relationships among the capsulo-synovial thickness measured by CE-MRI, joint volume, and passive range of motion (ROM) in patients with AC. DESIGN This was a retrospective study. SETTING The study took place at an institutional practice. PATIENTS Medical record of 103 patients (46 male and 57 female), who were treated with sonographically guided intra-articular injection with diagnosis of AC and underwent CE-MRI to rule out other concomitant shoulder disease, were retrospectively reviewed. METHODS Passive ROM and glenohumeral joint (GHJ) volume were measured before and during sonographically guided injection. The thickness of the enhancing portion of the capsulo-synovium was measured at the axillary recess and rotator interval on CE-MRI. MAIN OUTCOME MEASUREMENTS The relationship among the thickness of the enhancing portion on CE-MRI, GHJ volume, and passive ROM was analyzed using the Pearson correlation coefficient. RESULTS Capsulo-synovial thickness measured by CE-MRI at the enhancing portion of the axillary recess inversely correlated with GHJ volume (ρ = -0.444, P < .001), whereas at the rotator interval, this finding was not observed. At the axillary recess, the capsulo-synovial thickness inversely correlated with abduction (ρ = -0.400, P < .001), forward elevation (ρ = -0.378, P < .001), and external rotation (ρ = -0.297, P < .01), but at the rotator interval, such statistically significant correlations were not shown. CONCLUSION The capsulo-synovial thickness measured by CE-MRI at the enhancing portion of the axillary recess could represent obliterated joint capacity and clinical impairment (restricted passive ROM), which could help in diagnosing AC and in differentiating other shoulder diseases that may mimic this condition. LEVEL OF EVIDENCE III.
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A prospective randomized study comparing three different approaches to fluoroscopy-guided shoulder arthrography according to the experience of practitioners. Skeletal Radiol 2017; 46:925-933. [PMID: 28365852 DOI: 10.1007/s00256-017-2637-2] [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: 05/17/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare three approaches via the anterior and posterior glenohumeral joints, and the rotator interval in fluoroscopy-guided shoulder arthrography according to the experience of the practitioners. MATERIALS AND METHODS This prospective randomized study was originally designed to have 34 subjects for each approach, and finally evaluated 98 patients (mean age: 51.5 years; 55 men) from July to December 2014, who had shoulder arthrography via the anterior (n = 41) or posterior glenohumeral joint (n = 27) approaches, or via the rotator interval approach (n = 30) by residents (n=76) or fellows (n=22). The success rate, number of punctures, fluoroscopy time, radiation dose, and complications of the three methods were compared, and according to the practitioners. RESULTS The success rate was 100% for the anterior glenohumeral joint approach (34 out of 34), 90.0% for the posterior glenohumeral joint approach (23 out of 30), and 88.2% for the rotator interval approach (30 out of 34; p = 0.013). There was no difference in the success rate according to the practitioners' experience. Fluoroscopy time was longest for the posterior glenohumeral joint approach (mean: 95.44 s) and shortest for the rotator interval approach (mean: 31.57 s, p = 0.006). Radiation dose was larger by 1st- or 2nd-year residents (p = 0.014), with no difference among the three approaches. Only one patient who underwent arthrography using the posterior glenohumeral joint approach complained about post-procedural pain. CONCLUSION Fluoroscopy-guided shoulder arthrography via the posterior glenohumeral joint or rotator interval approach may be difficult for trainees, and the posterior glenohumeral joint approach may need a long fluoroscopy time.
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Simoni P, Grumolato M, Malaise O, Preziosi M, Pasleau F, de Lemos Esteves F. Are blind injections of gleno-humeral joint (GHJ) really less accurate imaging-guided injections? A narrative systematic review considering multiple anatomical approaches. Radiol Med 2017; 122:656-675. [DOI: 10.1007/s11547-017-0772-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/01/2017] [Indexed: 01/08/2023]
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Wybranski C, Adamchic I, Röhl FW, Ricke J, Fischbach F, Fischbach K. Freehand direct arthrography of the shoulder using near real-time guidance in an open 1.0-T MRI scanner. Skeletal Radiol 2017; 46:51-58. [PMID: 27771753 DOI: 10.1007/s00256-016-2507-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 09/17/2016] [Accepted: 09/29/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the technical success and duration of magnetic resonance imaging (MRI)-guided freehand direct shoulder arthrography (FDSA) with near real-time imaging implemented in a routine shoulder MRI examination on an open 1.0-T MRI scanner, and to assess the learning curve of residents new to this technique. METHODS An experienced MRI interventionalist (the expert) performed 125 MRI-guided FDSA procedures, and 75 patients were treated by one of three residents without previous experience in MRI-guided FDSA. Technical success rate and duration of MRI-guided FDSA of the expert and the residents were compared. The residents' learning curves were assessed. The occurrence of extra-articular deposition and leakage of contrast media from the puncture site and the subsequent impairment of image interpretation were retrospectively analyzed. RESULTS Overall technical success was 97.5 %. The expert needed overall fewer puncture needle readjustments and was faster at puncture needle positioning (p < 0.01). The learning curve of the residents, however, was steep. They leveled with the performance of the expert after ≈ 15 interventions. With a minimal amount of training all steps of MRI-guided FDSA can be performed in ≤10 min. CONCLUSION Magnetic resonance-guided FDSA in an open 1.0-T MRI scanner can be performed with high technical success in a reasonably short amount of time. Only a short learning curve is necessary to achieve expert level.
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Affiliation(s)
- Christian Wybranski
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
| | - Ilya Adamchic
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Friedrich-Wilhelm Röhl
- Institute of Biometry and Medical Informatics, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Frank Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Medical School, Magdeburg, Germany
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Gupton TB, Delgado J, Jaramillo D, Cahill AM, Chauvin NA. Comparative analysis of anterior and posterior contrast injection approaches for shoulder MR arthrograms in adolescents. Pediatr Radiol 2016; 46:1848-1855. [PMID: 27587064 DOI: 10.1007/s00247-016-3691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/07/2016] [Accepted: 08/12/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is no consensus in the literature concerning the optimal approach for performing a fluoroscopically guided shoulder arthrogram injection in a pediatric population. OBJECTIVE To compare adequacy of capsular injection and radiation doses between fluoroscopically guided anterior and posterior glenohumeral joint contrast injections in adolescents. MATERIALS AND METHODS We evaluated imaging in 67 adolescents (39 boys, 28 girls; mean age 16.0 years; range 11.7-19.1 years) who underwent an anterior approach glenohumeral contrast injection with subsequent MR imaging, and 67 age- and gender-matched subjects (39 boys, 28 girls; mean age 16.0 years; range 11.1-19.2 years) who underwent a posterior approach injection during the period June 2010 to September 2015. Two pediatric radiologists independently evaluated all MR shoulder arthrograms to assess adequacy of capsular distention and degree of contrast extravasation. We recorded total fluoroscopic time, dose-area product (DAP) and cumulative air kerma (CAK). RESULTS There were no significant differences in age, gender, height, weight or body mass index between the populations (P-values > 0.6). The amount of contrast extravasation between the groups was not significantly different (P = 0.27). Three anterior injections (4.5%) and one posterior (1.5%) were suboptimal (P = 0.62). Fluoroscopy time was not different: 1.1 min anterior and 1.3 min posterior (P = 0.14). There was a significant difference in CAK (0.7 mGy anterior and 1.1 mGy posterior; P = 0.007) and DAP (5.3 μGym2 anterior and 9.4 μGym2 posterior; P = 0.008). Inter-rater agreement was excellent (Cohen kappa >0.81). CONCLUSION Both techniques were technically successful. There was no difference in the fluoroscopy time for either approach. The radiation dose was higher with the posterior approach but this is of questionable clinical significance.
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Affiliation(s)
- Theodore B Gupton
- Division of Interventional Radiology, Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
| | - Jorge Delgado
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diego Jaramillo
- Diagnostic Radiology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Anne M Cahill
- Division of Interventional Radiology, Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA
| | - Nancy A Chauvin
- Musculoskeletal Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Diagnostic Performance of MR Arthrography with Anterior Trans-Subscapularis versus Posterior Injection Approach for Subscapularis Tendon Tears at 3.0T. Eur Radiol 2016; 27:1303-1311. [PMID: 27311539 DOI: 10.1007/s00330-016-4467-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To compare the diagnostic performance of shoulder magnetic resonance arthrography (MRA) with the anterior trans-subscapularis versus posterior injection approach to diagnose subscapularis tendon (SCT) tears. METHODS One hundred and sixty-seven arthroscopically confirmed patients (84 anterior and 83 posterior approaches) were included. Two readers retrospectively scored SCT tears. Proportions of correctly graded tears between MR arthrography and arthroscopy were calculated. Retrospective error analysis was performed. RESULTS The sensitivity and specificity were 80 % (24/30) and 72 % (39/54) by reader 1, 73 % (22/30) and 76 % (41/54) by reader 2 in the anterior approach, and 86 % (30/35) and 79 % (38/48) by reader 1, 80 % (28/35) and 88 % (42/48) by reader 2 in the posterior approach, respectively. There were no significant differences in sensitivity and specificity between the two groups. Proportions of correctly graded tears of both readers were 48 % and 36 % in the anterior approach, and 70 % and 68 % in the posterior approach, respectively. The intratendinous collection of contrast material was not statistically significantly different between anterior (n = 8) and posterior (n = 3) approach group. CONCLUSIONS For the MRA diagnosis of SCT tears, there was no significant difference between the anterior trans-subscapularis and the posterior approach. KEY POINTS • Anterior trans-subscapularis and posterior approaches showed no significant difference for SCT tears • Intratendinous collection of gadolinium is more frequent in anterior trans-subscapularis approach • Extent of SCT tears tends to be overestimated in anterior trans-subscapularis approach • Posterior approach should be considered for diagnosing SCT tear.
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Roy EA, Cheyne I, Andrews GT, Forster BB. Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder. Radiology 2016; 278:316-32. [PMID: 26789600 DOI: 10.1148/radiol.2015150364] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.
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Affiliation(s)
- Elizabeth A Roy
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Ian Cheyne
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Gordon T Andrews
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
| | - Bruce B Forster
- From the Department of Radiology, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
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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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Ogul H, Bayraktutan U, Yildirim OS, Suma S, Ozgokce M, Okur A, Kantarci M. Magnetic resonance arthrography of the glenohumeral joint: ultrasonography-guided technique using a posterior approach. Eurasian J Med 2015; 44:73-8. [PMID: 25610213 DOI: 10.5152/eajm.2012.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 04/25/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the efficacy and feasibility of ultrasound (US)-guided magnetic resonance (MR) arthrography of the glenohumeral joint via a posterior approach. MATERIALS AND METHODS Thirty-four patients (18 males and 16 females) who were suspected to have glenohumeral joint pathology were examined using MR arthrography. The patients ranged in age from 21 to 85 years, and the average age was 45±15.9 years. A Toshiba Xario US unit was utilized. Ultrasonography examinations were conducted using a broad-band 5-12 MHz linear array transducer. Gadolinium was injected into the shoulder joint using an 18-20 gauge needle. MR imaging was performed within the first 30 min after the injection. RESULTS The injection of gadolinium into the shoulder joint was successfully accomplished in all 34 patients. Major contrast media extravasation outside the joint was depicted in only two patients (5.9%). No major complications were encountered. CONCLUSION Ultrasonography is an effective alternate guidance technique for the injection of gadolinium into the glenohumeral joint for MR arthrography. US-guided arthrography via a posterior approach to the glenohumeral joint is safe, accurate, well tolerated by patients and easy to perform with minimal training.
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Affiliation(s)
- Hayri Ogul
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | | | - Omer Selim Yildirim
- Department of Orthopedic, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Selami Suma
- Department of Radiology, Faculty of Medicine, Baskent University, Istanbul, Turkey
| | - Mesut Ozgokce
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Adnan Okur
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Amber KT, Landy DC, Amber I, Knopf D, Guerra J. Comparing the accuracy of ultrasound versus fluoroscopy in glenohumeral injections: a systematic review and meta-analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:411-416. [PMID: 24668738 DOI: 10.1002/jcu.22154] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 11/06/2013] [Accepted: 03/04/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE We performed a systematic review with meta-analysis to compare the accuracy of fluoroscopic-guided glenohumeral injections with that of ultrasound-guided glenohumeral injections as reported in prior studies. METHODS We reviewed the databases of MEDLINE, PubMed, and Google Scholar using combinations of the keywords "ultrasound," "fluoroscopy," "injection," and "shoulder" for articles reporting the injection accuracy, confirmed by imaging, of the first attempt under either fluoroscopic or ultrasound guidance. A meta-analysis was performed to assess the accuracy of fluoroscopic-guided glenohumeral injections versus ultrasound-guided glenohumeral injections. RESULTS Five of 42 pertinent studies met our inclusion criteria for a total of 406 glenohumeral injections, of which 115 were fluoroscopy-guided and 291 were ultrasound-guided. The meta-effect estimates for the proportion of joints successfully injected with ultrasound and fluoroscopic guidance were 93% (95% CI, 86% to 98%) and 80% (95% CI, 63% to 93%), respectively, which did not reach statistical significance (Q[df] = 2.55 [1], p = 0.11). CONCLUSIONS Our meta-analysis indicates that glenohumeral injections guided by ultrasound are more accurate than injections guided by fluoroscopy but this difference did not reach statistical significance. As the use of ultrasound does not expose the patient or practitioner to radiation, its similar accuracy may make it the preferred modality for image-guided glenohumeral joint injections. Limitations to our analysis include the retrospective nature, limited number of studies included, and the potential generalizability of our findings to regions outside of those included in our study.
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Affiliation(s)
- Kyle T Amber
- University of Miami, Miller School of Medicine, 1600 NW 10th Ave, Miami, FL, 33156
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Beltran LS, Bencardino JT, Steinbach LS. Postoperative MRI of the shoulder. J Magn Reson Imaging 2014; 40:1280-97. [DOI: 10.1002/jmri.24570] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 12/09/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Luis S. Beltran
- NYU Langone Medical Center and Hospital for Joint Diseases; Department of Radiology; New York, New York USA
| | - Jenny T. Bencardino
- NYU Langone Medical Center and Hospital for Joint Diseases; Department of Radiology; New York, New York USA
| | - Lynne S. Steinbach
- Department of Radiology; UCSF Medical Center; San Francisco, California USA
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Sidon E, Velkes S, Shemesh S, Levy J, Glaser E, Kosashvili Y. Accuracy of non assisted glenohumeral joint injection in the office setting. Eur J Radiol 2013; 82:e829-31. [DOI: 10.1016/j.ejrad.2013.08.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 11/29/2022]
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Ogul H, Bayraktutan U, Ozgokce M, Tuncer K, Yuce I, Yalcin A, Pirimoglu B, Sagsoz E, Kantarci M. Ultrasound-guided shoulder MR arthrography: comparison of rotator interval and posterior approach. Clin Imaging 2013; 38:11-7. [PMID: 24119385 DOI: 10.1016/j.clinimag.2013.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/02/2013] [Accepted: 07/05/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to prospectively evaluate the two different ultrasound-guided injection techniques for magnetic resonance (MR) arthrography of the shoulder. METHODS AND MATERIALS This study included 100 patients [50 rotator interval group (n=50) vs. 50 posterior approach group (n=50)]. All procedures were performed by the same radiologist. The two injection techniques were compared. The discomfort during and after arthrography was evaluated. Extraarticular contrast media extravasation was graded according to the MRI findings. The number of injection attempts, effect of contrast media extravasation rate on diagnostic quality and procedure times were recorded. RESULTS There were no significant difference between the posterior and rotator interval puncture groups with regard to pain (P=.915), procedure times (P=.401) or attempt scores (P=.182). There were significantly more contrast media extravasations with rotator interval approach than posterior approach (P<.05). CONCLUSION Both techniques were successful and well tolerated by patients. Posterior injection technique provided a more effective route with decreased extravasation rate and easier approach compared to the rotator interval approach.
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Affiliation(s)
- Hayri Ogul
- Atatürk University, School of Medicine, Department of Radiology, Erzurum, Turkey
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Ng AW, Hung EH, Griffith JF, Tong CS, Cho CC. Comparison of ultrasound versus fluorcoscopic guided rotator cuff interval approach for MR arthrography. Clin Imaging 2013; 37:548-53. [DOI: 10.1016/j.clinimag.2012.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 08/01/2012] [Indexed: 11/27/2022]
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Grasso RF, Faiella E, Cimini P, Cazzato RL, Luppi G, Martina F, Del Vescovo R, Beomonte Zobel B. Direct magnetic resonance (MR) shoulder arthrography: posterior approach under ultrasonographic guidance and abduction (PAUGA). Radiol Med 2012; 118:806-15. [DOI: 10.1007/s11547-012-0879-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
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Ramirez Ruiz FA, Baranski Kaniak BC, Haghighi P, Trudell D, Resnick DL. High origin of the anterior band of the inferior glenohumeral ligament: MR arthrography with anatomic and histologic correlation in cadavers. Skeletal Radiol 2012; 41:525-30. [PMID: 21603871 DOI: 10.1007/s00256-011-1201-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/02/2011] [Accepted: 05/03/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The anterior band of the inferior glenohumeral ligament has been described to arise from the anteroinferior labrum, but we have observed that in some persons its origin is from the anterior or anterosuperior labrum, creating diagnostic difficulties. MATERIALS AND METHODS Ten fresh unembalmed cadaveric shoulders underwent magnetic resonance arthrography (MRA) using a posterior approach with a 1.5 T GE magnet, with the following sequences: T1-weighted fast spin-echo in axial, coronal and sagittal planes, and T1 fat-suppressed spin-echo in the axial plane (TR/TE 600/20, section thickness 2.5 mm, 0.5 mm interslice space, number of signals acquired, two, field of view 12 × 12 cm, and matrix 512 × 256 pixels). Following imaging, the shoulders were frozen and later sectioned using a band saw into 3-mm sections corresponding to the axial imaging plane. Histological analysis was also performed to determine the origin of the anterior band. RESULTS Four of the ten shoulders had an origin of the anterior band above or at the 3 o'clock position: one at the 1 o'clock position, two at the 2 o'clock position, and one at the 3 o'clock position. In another shoulder, the anterior band of the inferior glenohumeral ligament originated from the middle glenohumeral ligament, and in five other shoulders, the anterior band originated from the anteroinferior labrum as has been described in the literature. CONCLUSIONS This finding is of clinical significance as a high origin of the anterior band of the inferior glenohumeral ligament leads to MR arthrographic finding that can simulate those of labral tears or detachments.
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Affiliation(s)
- Francisco Alejandro Ramirez Ruiz
- Department of Radiology, Musculoskeletal Division, University of California and VA Healthcare System, 3350 La Jolla Village Dr., San Diego, CA 92161, USA.
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La Rocca Vieira R, Rybak LD, Recht M. Technical update on magnetic resonance imaging of the shoulder. Magn Reson Imaging Clin N Am 2012; 20:149-61, ix. [PMID: 22469396 DOI: 10.1016/j.mric.2012.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improvement in both hardware and software has opened up new opportunities in magnetic resonance (MR) imaging of the shoulder. MR imaging at 3-T has become a reality, with the prospect of 7-T imaging on the horizon. The art of MR arthrography continues to improve, aided by the use of novel imaging positions. New techniques for three-dimensional imaging, the reduction of metal artifact, and biochemical imaging of cartilage hold great promise.
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Affiliation(s)
- Renata La Rocca Vieira
- Department of Radiology, New York University School of Medicine, 301 East 17th Street, New York, NY 10003, USA.
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Goh CK, Peh WCG. Pictorial essay: pitfalls in magnetic resonance imaging of the shoulder. Can Assoc Radiol J 2011; 63:247-59. [PMID: 22054700 DOI: 10.1016/j.carj.2011.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Revised: 02/27/2011] [Accepted: 02/28/2011] [Indexed: 10/15/2022] Open
Abstract
Numerous imaging pitfalls of normal variants due to imaging technique and artifacts can be seen on routine magnetic resonance imaging of the shoulder. Familiarity with these pitfalls is crucial to avoiding diagnostic errors. Understanding of the common causes of shoulder imaging artifacts will enable the radiologist to make rational changes in imaging technique to eliminate or reduce the effects of artifacts on magnetic resonance images. This pictorial essay highlights possible pitfalls that arise from imaging techniques, imaging artifacts, and normal variations, and how they may be recognized.
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Affiliation(s)
- Chin K Goh
- Department of Diagnostic Radiology, Changi General Hospital, Singapore, Republic of Singapore
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Jana M, Gamanagatti S. Magnetic resonance imaging in glenohumeral instability. World J Radiol 2011; 3:224-32. [PMID: 22007285 PMCID: PMC3194043 DOI: 10.4329/wjr.v3.i9.224] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 07/28/2011] [Accepted: 08/04/2011] [Indexed: 02/06/2023] Open
Abstract
The glenohumeral joint is the most commonly dislocated joint of the body and anterior instability is the most common type of shoulder instability. Magnetic resonance (MR) imaging, and more recently, MR arthrography, have become the essential investigation modalities of glenohumeral instability, especially for pre-procedure evaluation before arthroscopic surgery. Injuries associated with glenohumeral instability are variable, and can involve the bones, the labor-ligamentous components, or the rotator cuff. Anterior instability is associated with injuries of the anterior labrum and the anterior band of the inferior glenohumeral ligament, in the form of Bankart lesion and its variants; whereas posterior instability is associated with reverse Bankart and reverse Hill-Sachs lesion. Multidirectional instability often has no labral pathology on imaging but shows specific osseous changes such as increased chondrolabral retroversion. This article reviews the relevant anatomy in brief, the MR imaging technique and the arthrographic technique, and describes the MR findings in each type of instability as well as common imaging pitfalls.
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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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Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach. Skeletal Radiol 2010; 39:575-9. [PMID: 19784644 DOI: 10.1007/s00256-009-0793-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 08/09/2009] [Accepted: 08/20/2009] [Indexed: 02/02/2023]
Abstract
AIM Shoulder MR arthrography has an important role in the assessment of rotator cuff lesions, labral tears, glenohumeral ligaments, rotator interval lesions, and postoperative shoulder status. Injection in direct MR arthrography can be performed with palpation, fluoroscopy, ultrasonography (US), or MRI. Recently, the posterior approach is the preferred method due to the presence of fewer stabilizers, absence of important articular structures and less extravasation, has been advocated. Our aim was to assess the efficacy of US-guided MR arthrography via a posterior approach on the glenohumeral joint. MATERIALS AND METHODS Thirty MR arthrographies were performed on 29 patients. Ultrasonography (Xario, Toshiba) examinations were conducted by a wide-band 5-12 Mhz linear array transducer set to muscle-skeleton. Diluted contrast medium (1 ml gadolinium chelate and 100 ml saline, approximately 15 ml) was delivered into the glenohumeral joint space from between the humeral head and posterior labrum with a 20-gauge spinal needle. MRI examination was conducted by a 1.5 T scanner. Fat-saturated T1-weighted spin echo was applied on coronal, axial, and sagittal planes within the first 30 min after contrast material injection. RESULTS One (3.3%) arthrography was not successful due to technical reasons associated with obesity. Contrast extravasation around the infraspinatus and teres minör muscles was depicted in twelve examinations. One (3.3%) patient developed vasovagal collapse. CONCLUSION Ultrasonography-guided posterior approach is an easy, reliable, fast, and comfortable method in experienced hands. It may be an alternative for fluoroscopy-guided shoulder MR arthrography.
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Souza PME, Aguiar ROCD, Marchiori E, Bardoe SAW. Arthrography of the shoulder: A modified ultrasound guided technique of joint injection at the rotator interval. Eur J Radiol 2010; 74:e29-32. [DOI: 10.1016/j.ejrad.2009.03.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 03/11/2009] [Accepted: 03/12/2009] [Indexed: 11/24/2022]
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Esenyel CZ, Ozturk K, Demirhan M, Sonmez M, Kahraman S, Esenyel M, Ozbaydar MU, Senel B. Accuracy of anterior glenohumeral injections: a cadaver study. Arch Orthop Trauma Surg 2010; 130:297-300. [PMID: 19139912 DOI: 10.1007/s00402-008-0811-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Indexed: 02/09/2023]
Abstract
PURPOSE Intra-articular glenohumeral injections have an important role for therapeutic benefit and diagnostic information. Therefore, it is very important that the injected material should reach its desired target. This study assessed the accuracy of an anterior intra-articular injection in fresh cadavers. METHODS A total of 50 shoulders of 25 fresh cadavers were included in the study. Anterior placement of a spinal needle using a location just 1 cm lateral to the coracoid, without radiographic assistance were performed. After the needle was placed and estimated to be intra-articular 1 cc of acrylic dye was injected into the joint to determine accuracy of position. RESULTS Ninety-six percent of injections were accurately administered into the glenohumeral joint and 4% in the surrounding soft tissues and capsule. CONCLUSION Based on our cadaveric study, an unassisted anterior injection to the glenohumeral joint could be accurately placed.
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Affiliation(s)
- Cem Zeki Esenyel
- Department of Orthopaedics and Traumatology, Vakif Gureba Training Hospital, Capa, Istanbul, Turkey.
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Abstract
Athletes who partake in overhead or throwing activities frequently suffer from shoulder pain. Glenohumeral instability plays an important role in sports-related shoulder pain. Shoulder instability can be traumatic, atraumatic, or microtraumatic in origin. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement and chronic damage to intra-articular structures. MR arthrography is the modality of choice for assessing glenohumeral instability and diagnosing labroligamentous injuries. This article reviews imaging of instability-related injuries in athletes, with special emphasis on MR imaging.
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Affiliation(s)
- Diane Bergin
- Department of Radiology, Galway University Hospital, Galway, Ireland.
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Abstract
Magnetic resonance arthrography is widely used throughout the world for joint imaging. It extends the capabilities of conventional MR imaging because contrast solution distends the joint capsule, outlines intraarticular structures, and extends into soft tissue tears and defects. MR arthrography exploits the natural advantages gained from a joint effusion and can be performed on any joint.
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Affiliation(s)
- Usha Chundru
- Insight Imaging San Francisco, San Francisco, CA 94109, USA
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The posterior transtriceps approach for elbow arthrography: a forgotten technique? Skeletal Radiol 2009; 38:513-6. [PMID: 19183992 DOI: 10.1007/s00256-008-0634-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2008] [Revised: 12/08/2008] [Accepted: 12/09/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the technical feasibility of performing elbow MR arthrography via a posterior approach through the triceps. MATERIALS AND METHODS The images of 19 patients with elbow MR arthrography via a posterior transtriceps approach were retrospectively studied. The injections were performed by four musculoskeletal radiologists, using fluoroscopic guidance and a 22- or 25-gauge needle. The fluoroscopic and subsequent MR images were reviewed by two musculoskeletal radiologists and evaluated for adequacy of joint capsular distention, degree and location of contrast leakage, and presence of gas bubbles. RESULTS The injection was diagnostic in all 19 patients, with a sufficient amount of contrast agent seen in the elbow joint. No significant contrast leakage occurred in 12 patients who received injections of 8 cc or less of contrast agent, but moderate contrast leakage occurred in 6/7 patients who received injections of greater than 8 cc. Contrast leakage generally occurred within the triceps myotendinous junction. No gas bubbles were identified in the injected joints. CONCLUSION Patients often present for MR arthrography of the elbow with medial or lateral elbow pain. Contrast leakage during a radiocapitellar approach may complicate evaluation of the lateral collateral ligament or the common extensor tendon origin. Transtriceps MR arthrography offers an alternative to the more commonly used radiocapitellar approach. With injected volumes not exceeding 8 cc, the risk of significant contrast leakage is small. An advantage of the transtriceps injection is that contrast leakage through the posterior needle tract does not interfere with evaluation of the lateral structures.
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Campos P, Redondo M, Berná-Serna J, Reus M, Martínez F. Optimización de las dosis de radiación en la artrografía de hombro. RADIOLOGIA 2009; 51:282-6. [DOI: 10.1016/j.rx.2008.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Accepted: 11/23/2008] [Indexed: 11/17/2022]
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MR Arthrography of the Shoulder Using an Anterior Approach: Optimal Injection Site. AJR Am J Roentgenol 2008; 191:1397-400. [DOI: 10.2214/ajr.08.1014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rutten MJCM, Collins JMP, Maresch BJ, Smeets JHJM, Janssen CMM, Kiemeney LALM, Jager GJ. Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography. Eur Radiol 2008; 19:722-30. [PMID: 18958474 PMCID: PMC2816243 DOI: 10.1007/s00330-008-1200-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 09/19/2008] [Indexed: 01/31/2023]
Abstract
To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and posterior approach (USp), fluoroscopic-guided anterior (FLa) and posterior (FLp) approach were used. Number of injection attempts, effect of contrast leakage on diagnostic quality, and total room, radiologist and procedure times were measured. Pain was documented with a visual analogue scale (VAS) pain score. Access to the joint was achieved in all patients. A successful first attempt significantly occurred more often with US (94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US guidance mean room, procedure and radiologist times were significantly shorter (p < 0.001). The USa approach was rated with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of contrast material into the glenohumeral joint. US-guided injections and especially the anterior approach are significantly less time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and iodine contrast.
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45
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46
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MRI of shoulder instability. Eur J Radiol 2008; 68:57-71. [PMID: 18406556 DOI: 10.1016/j.ejrad.2008.02.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 02/09/2008] [Accepted: 02/19/2008] [Indexed: 01/02/2023]
Abstract
The most unstable joint in the body, the glenohumeral joint is subject to many insults including microinstability, subluxation and dislocation. During the last two decades, MRI has allowed for direct visualization of many of the lesions related to instability, aiding in diagnosis as well as therapeutic planning and follow-up. This article reviews the use of MRI for shoulder instability and describes the different types of lesions associated with this disorder. Topics include technical considerations, the use of MR arthrography, normal anatomy and variants, labral and glenohumeral ligament pathology, and osseous lesions related to instability.
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Lim JB, Kim YK, Kim SW, Sung KW, Jung I, Lee C. Ultrasound Guided Shoulder Joint Injection through Rotator Cuff Interval. Korean J Pain 2008. [DOI: 10.3344/kjp.2008.21.1.57] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Jong Bum Lim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Young Ki Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Sung Woo Kim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Kyu Wan Sung
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Il Jung
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, College of Medicine, Ulsan University, Gangneung, Korea
| | - Chung Lee
- Department of Anesthesiology and Pain Medicine, Eulji Hospital, College of Medicine, Eulji University, Daejeon, Korea
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Catalano OA, Manfredi R, Vanzulli A, Tomei E, Napolitano M, Esposito A, Resnick D. MR Arthrography of the Glenohumeral Joint: Modified Posterior Approach without Imaging Guidance. Radiology 2007; 242:550-4. [PMID: 17255424 DOI: 10.1148/radiol.2422051964] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [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. The purpose of the study was to prospectively perform magnetic resonance (MR) arthrography of the glenohumeral joint by using modified posterior approach without ultrasonographic or fluoroscopic guidance. A solution containing 0.1 mL of gadolinium chelate, 15 mL of saline, and 5 mL of 2% lidocaine was subsequently injected into the glenohumeral joint in 147 patients (81 men, 66 women; age range, 20-79 years). A 21-gauge needle was advanced along a trajectory connecting a skin mark 3-4 cm below and 2 cm medially to the posterolateral margin of the acromion and the coracoid process, as assessed with palpation, proceeding in posteroanterior direction. The joint was successfully entered at first attempt in 125 (85%) patients, at second attempt in 19 (13%), and at third attempt in three (2%). Contrast material-enhanced images were evaluated for presence, site, and maximal extent of contrast material extravasation; route of diffusion of the extravasation; compromised or noncompromised diagnostic quality; and presence of gas bubbles. Extravasation occurred in seven patients: at the interval between the teres minor muscle and infraspinatus muscle in five and within the infraspinatus muscle belly in two; extravasation had diffused along the teres minor muscle and infraspinatus muscle in five (71%) and along the teres minor muscle in two (29%). The mean extension of extravasation was 15 mm. Image quality was not compromised, and no gas bubbles were detected. The procedure was successful in all patients, with no complications.
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Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, AO G Rummo, Via Provinciale 93, Beltiglio, BN, 82010, Italy.
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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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