Accuracy of double-contrast arthrography and arthroscopy of the knee joint

Only in the diagnosis of medial meniscal lesions is double contrast arthrography superior to arthroscopy, provided that arthroscopy is carried out only from the anterolateral side (94% against 81% positive correlations). The rates in diagnosing lateral meniscal lesions are respectively 90% and 94.5%, in patellar chondropathy 55% and 99.5% respectively, and in diagnosing cruciate ligament lesions 69% and 97% respectively.     

Meniscal tears on knee arthrography: Patterns of arthrographic abnormalities

The presence or absence of a meniscal tear was established in 340 out of 475 consecutive patients who had double contrast knee arthrograms. The accuracy in these 340 cases was 95% for both the medial and lateral menisci although the specificity for lateral tears was only 0.64. Analysis of the pattern of arthrographic abnormalities revealed that both medial and lateral tears usually involved the posterior horn of the meniscus. Posterior horn abnormalities rarely caused a false positive diagnosis of a meniscal tear. In contrast, isolated blunting of the anterior horn of either the lateral or medial meniscus was an unreliable sign of a tear and accounted for many of the false positive diagnoses. It is concluded that careful attention to the posterior horn of each meniscus is essential for accurate arthrographic diagnosis of a meniscal tear.     

Diagnosis of popliteal cyst: double-contrast arthrography and sonography

One hundred consecutive patients who had trauma to the knee were examined by sonography and double-contrast arthrography to evaluate the presence or absence of popliteal cyst. In 58 cases both tests were negative, while in 15 both were positive. Each of those 15 patients had pain and/or a palpable mass behind the knee. In 27 remaining patients the arthrogram demonstrated a popliteal cyst that was not detected on the sonogram. None of the 27 patients complained of pain in the popliteal fossa or had a palpable mass in the area. The sonographic findings, however, showed good correlation with these clinical symptoms. This paper attempts to analyze these discrepancies and to evaluate the advantages and disadvantages of each method.     

Temporomandibular joint: comparison of single- and double-contrast arthrography

Lower-space, single-contrast arthrography and dual-space, double-contrast arthrotomography were sequentially applied to 58 fresh temporomandibular joint (TMJ) autopsy specimens, and the findings were compared with observations in corresponding cryosections. Both modalities had high accuracy rates (greater than or equal to 84%) and no statistically significant differences between the two techniques were found. A side-by-side comparison of the two types of arthrograms, however, revealed that video tape recording of lower-space, single-contrast arthrography was superior in demonstrating joint dynamics and that dual-space, double-contrast arthrotomography was superior in demonstrating the soft-tissue anatomic features of the joint. It appears that lower-space, single-contrast arthrography can be recommended for examination of patients with clicking, catching, and intermittent locking, and that dual-space, double-contrast arthrotomography is preferable when information about morphologic alterations is clinically more important than information about joint dynamics.     

Elbow joint: assessment with double-contrast CT arthrography

The elbow joint was evaluated by means of computed tomography (CT) immediately following double-contrast arthrography. Normal baseline anatomy and representative abnormal studies are illustrated. Intraarticular abnormalities, such as osteocartilaginous bodies, hyperplastic synovium, fracture fragments, and osteophytes, were identified and precisely located on postarthrography CT scans. This technique, which enabled such abnormalities to be seen, has provided an anatomic and mechanical basis for seemingly idiopathic instances of limited elbow motion.     

Rotator cuff tears: evaluation using double-contrast shoulder arthrography

To determine the accuracy of double-contrast arthrography in complete rotator cuff tears, we studied 805 patients thought to have a complete rotator cuff tear who had undergone double-contrast shoulder arthrography (DCSA) between 1978 and 1983. The results of this study indicate that DCSA is exquisitely sensitive and as accurate as the single-contrast examination. The site of disruption was directly visualized in 93% of cases, and the size of the defect and status of the torn tendon edges were reliably predicted. Such information may influence the surgeon in patient selection for operative repair as well as surgical approach.     

Prone and supine views in double-contrast knee arthrography

The addition of supine views to the standard double-contrast (DC) knee arthrogram with the patient prone can be useful (a) to diagnose meniscal tears not seen otherwise, (b) to provide a second look at an equivocal meniscal lesion, and (c) to enhance subject contrast in the presence of residual joint effusion, or when opaque medium has not adequately coated the interior surfaces of a large joint. In a prospective study of 137 patients, 30 meniscal tears were diagnosed, two of which were visible only on the supine films.     

The carpal ligaments in MR arthrography of the wrist: correlation with standard MRI and wrist arthroscopy

We assessed the value of three-compartment magnetic resonance (MR) wrist arthrography in comparison with non-enhanced magnetic resonance imaging (MRI) for the evaluation of 13 individual wrist ligaments in 35 patients with refractory wrist pain. In 20 of these patients MR findings were correlated with the findings from multiportal wrist arthroscopy. For MR imaging (1.5-T magnet) a three-dimensional volume acquisition with a gradient-recalled echo sequence and 0.6-1.0 mm effective slice thickness was used. The delineation of individual wrist ligaments was rated as "good" in 10% of non-enhanced MR and 90% of MR arthrography images. Ligament evaluation was possible with high diagnostic confidence in 11% by non-enhanced MR imaging and 90% by MR arthrography. With wrist arthroscopy as the standard of reference, average sensitivities/specificities/accuracies for the diagnosis of full-thickness ligamentous defects were 0.81/0.75/0.77 for non-enhanced MR imaging and 0.97/0.96/0.96 for MR arthrography. Our findings suggest that MR arthrography is more accurate than standard MRI in delineating and evaluating the ligaments of the wrist.     

Evaluation of glenoid labrum by double-contrast shoulder arthrography.

Double-contrast shoulder arthrography was used to define the normal and abnormal arthrographic anatomy of the glenoid labrum. A retrospective study of 12 patients suspected of having labral abnormalities or who had unexplained shoulder disability consistent with capsular laxity was undertaken. In four of the nine patients with abnormal arthrograms, the study revealed critical anatomic alterations not detectable on physical examination or pain radiographs.     

Air aspiration after double-contrast knee arthrography: a worthwhile exercise?

A prospective study following double-contrast knee arthrography was undertaken to compare pain and discomfort experienced at the conclusion of the procedure and for 7 days afterwards. The patients were divided into two groups. Half had the air aspirated at the end of the examination and the other half did not. Twice as many patients in the aspirated group were totally asymptomatic (48% compared with 22%); however, by 7 days after the procedure the numbers of asymptomatic patients were similar in the two groups (64% and 63%, respectively). Thus our conclusion is that air aspiration after double-contrast knee arthrography does reduce short-term morbidity.     

The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy

 Objective. To compare three-compartment MR wrist arthrography with non-enhanced MRI in correlation with wrist arthroscopy, and to evaluate the potential of MR arthrography for consistently visualizing all parts of the scapholunate interosseous ligament of the wrist (SLIL) and exactly diagnosing the site and extent of SLIL defects. Design and Patients. In 41 patients with wrist pain (34 patients with wrist pain for more than 6 months) plain radiographs, stress views, non-enhanced MRI and three-compartment MR arthrography were done within 2 h of each other, using three-dimensional volume acquisition (0.6–1.0 mm effective slice thickness) with a gradient-recalled echo sequence and a 1.5-T magnet. The MR arthrography findings were compared with the findings from non-enhanced MRI and correlated with the arthroscopic findings in all patients. Results. The dorsal, central and palmar segments of the SLIL could be delineated exactly by MR arthrography in 95% of the patients; with non-enhanced MRI only 28% of SLIL segments were seen consistently. Demonstration of SLIL defects was possible with high diagnostic confidence in 42% of SLIL segments by non-enhanced MRI and in 94% by MR arthrography. With wrist arthroscopy as the standard of reference, sensitivity and specificity values for SLIL perforations were 52%/34% for non-enhanced MRI and 90%/87% for MR arthrography. Conclusions. MR arthrography, using three-dimensional volume acquisition with thin slices (0.6–1.0 mm), combines the advantages of three-compartment arthrography and non-enhanced MRI. It shows the precise location and magnitude of ligamentous defects of all parts of the SLIL, correlates well with wrist arthroscopy and has potential implications for diagnosis and treatment planning.     

Meniscal tears diagnosed with MR imaging versus arthroscopy: how reliable a standard is arthroscopy?

Arthroscopy of the menisci is considered the standard by which all noninvasive imaging procedures of the knee are measured. To better recognize the accuracy and relevance of arthroscopic correlation, a study was done in 254 consecutive patients who underwent both magnetic resonance (MR) imaging of the knee and arthroscopy. If interpretation of arthroscopic findings disagreed with MR findings, the arthroscopic videotapes were reviewed. Seventeen errors occurred in interpretation, resulting in false-positive MR images. Nine of these errors (53%) were associated with lines of high signal intensity that reached the articular surface of the posterior horn, an area incompletely seen on the arthroscopic videotapes. Two errors (12%) occurred in postmenisectomy abnormalities that the arthroscopist believed were not clinically significant; the six other errors (35%) occurred in high-signal-intensity alterations in either the free edge or the entire meniscal substance that did not correlate with clinically significant tears. Thirty-two errors occurred in interpretation, resulting in false-negative MR images. Fifteen of these errors (47%) occurred in small tears that did not require meniscectomy.     

A prospective comparison study of double contrast computed tomography (CT) arthrography and arthroscopy of the shoulder

Thirty consecutive patients who underwent double contrast CT arthrography prior to shoulder arthroscopy were prospectively studied. Results from both studies were recorded with the radiologist blinded to the arthroscopic findings when making the final CT reading. The sensitivity, specificity, and accuracy, respectively, of CT arthrography findings compared to arthroscopy were 50%, 100%, 96% for rotator cuff; 66%, 100% 96% for bicipital labral complex; 100%, 100%, 100% for loose bodies; 50%, 100% 93% for Hill-Sachs lesions; 90%, 73%, 83% for anterior labral defects; and 100%, 100%, 100% for posterior labral defects. We conclude that shoulder arthroscopy accurately delineates abnormalities of the anterior and posterior labrum, bicipital labral complex, rotator cuff, joint synovium, and humeral head. CT arthrography accurately delineates capsular redundancy, loose bodies, hardware around joints, and bony glenoid rim abnormalities.     

Meniscal tears of the knee: evaluation by high-resolution CT combined with arthrography

The knees of 27 patients with evidence of meniscal tears were examined with high-resolution computed tomography (HRCT) immediately following double-contrast arthrography. The arthrograms and postarthrogram HRCT scans were compared for their display of anatomic and pathologic detail. The anatomy of the semilunar cartilage and surrounding structures was more clearly outlined on the HRCT scans. The HRCT scans also enabled differentiation of the menisci from the surrounding anatomic parts (popliteal tendon sleeve and popliteal cyst) and good visualization of the relationship of torn meniscal fragments. Postarthrography HRCT should be used as a complement to arthrography. With this additional information, arthroscopists can plan the most appropriate surgical treatment.