Temporomandibular joint: correlation between single-contrast videoarthrography and postmortem morphology

Arthrography of the temporomandibular joint is widely performed in clinical practice. The diagnostic accuracy of this technique has not been systematically evaluated. Therefore, findings from transcranial single-contrast, lower-compartment videoarthrography of 58 temporomandibular joint autopsy specimens were correlated with postmortem morphology. Arthrographic diagnosis of disk position and perforation was confirmed in 47 joints (81%). Misinterpretations were made in 11 joints; nine concerned disk position and two concerned perforation. Analysis of the misinterpretations revealed that inability of arthrography to allow differentiation of lateral from medial resulted in four false-negative diagnoses and one false-positive diagnosis. Variation of joint anatomy with disk deformation resulted in four false-positive diagnoses of anterior disk position. The number of false diagnoses in clinical practice might be reduced if transcranial single-contrast, lower-compartment videoarthrography is followed by multilayer arthrotomography in cases with an unclear diagnosis.     

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.     

Shoulder arthrography: comparison of morbidity after use of various contrast media

This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.     

Ulcerative and granulomatous colitis in children. Comparison of double- and single-contrast studies

The authors reviewed 49 double-contrast and 27 single-contrast barium-enema examinations (BE) in 71 children with suspected inflammatory bowel disease. The diagnosis was proved in 41 patients, of whom 36 underwent proctoscopy and 5 had advanced disease which was treated surgically within 3 to 30 days after BE; the other 30 children served as controls. BE and proctoscopy were compared with regard to sensitivity (detection of disease) and accuracy (categorization as ulcerative or granulomatous colitis). Sensitivity was 93% for double-contrast and 82% for single-contrast BE. Both detected all cases of advanced disease; in early disease, double-contrast BE detected 91% of cases and single-contrast BE 70%. Colitis was correctly categorized as ulcerative or granulomatous in 93% with double-contrast BE and 86% with single-contrast BE. Specificity within the control group was 100% with both techniques. The authors conclude that both types of BE exhibit similar sensitivity in advanced disease, but the double-contrast technique is more accurate in detecting early disease.     

Assessment of patient exposure for barium enema examinations

Methods are described for the assessment of patient exposure during clinical fluoroscopic procedures. Values of the roentgen-area-product (RAP) and their distribution throughout the examination are presented for both single-contrast and double-contrast barium enema studies. The double-contrast procedure was measured to give 50% more radiation to the patient than the single-contrast procedure when the same size optical aperture is used between the intensifier and TV pick-up tube. However, it was possible to decrease the fluoroscopic RAP value by over a factor of two for the double-contrast procedure without an adverse clinical effect by increasing the area of the aperture diaphragm.     

An update on the technique of double-contrast arthrotomography of the shoulder

We review the technique of double-contrast arthrotomography (DCAT) including reference to a new, superficial and bevel-oriented puncture and the use of a special density compensation filter. We have found it possible to demonstrate the varieties, size and exact location of rotator cuff tears in the coronal and sagittal planes. Adaptation of the method to studies of the glenoid labrum also yields excellent results. DCAT is now the best technique of shoulder arthrography.     

Single-contrast vs double-contrast barium enema in the detection of colonic polyps

Radiographic and colonoscopic correlation in 139 patients with 234 colonic polyps compared the sensitivity of single- and double-contrast barium enema. Single-contrast barium enema detected 68 (80%) of polyps, with 72% of polyps under 1 cm and 94% of those 1 cm or over detected. Double-contrast barium enema detected 135 (91%) of 149 polyps, with 88% of polyps under 1 cm and 96% of larger polyps detected. Thus, the double-contrast barium enema was more effective than the single-contrast examination only for detection of polyps under 1 cm. The single-contrast barium enema was more likely performed on patients in poor physical condition and in those over 70 years old. The results suggest that for elderly patients, who may have difficulty in cooperating for a double-contrast enema, a properly performed single-contrast examination is an acceptable option.     

Comparison of conventional and computed arthrotomography with MR imaging in the evaluation of the shoulder

To compare conventional arthrography and computed arthrotomography (CAT) with magnetic resonance (MR) imaging in the evaluation of the shoulder, we studied 18 patients who underwent conventional double contrast arthrography and CAT, and T1-, balanced, and T2-weighted MR imaging. The arthrograms were independently reviewed by two of the authors and the MR images were independently reviewed by three other authors in a systematic fashion with the aid of a prewritten evaluation form. The findings were compared among reviewers and between imaging methods. We found MR comparable to conventional arthrography in the evaluation of the rotator cuff; however, MR also enabled evaluation of tendonitis, which could not be accomplished with conventional arthrography. Because of MR's superior soft tissue imaging capability, we were able to stage the impingement syndrome. Magnetic resonance also allowed evaluation of the glenoid labrum and capsuloligamentous structures and assessment of instability in a fashion similar to CAT. In most cases, information obtained from MR equaled or exceeded that obtained from conventional arthrography and CAT. With refinement in technique and increased experience, we believe that MR may replace arthrography in the evaluation of the shoulder.     

Arthrography of the glenohumeral joint: experience with a non-ionic dimeric contrast agent and future perspectives

The role of conventional arthrography versus computed tomography (CT) arthrography of the glenohumeral joint using iotrolan was evaluated in patients with different shoulder problems. In addition, a diagnostic combination of conventional and CT arthrography was compared with magnetic resonance (MR) arthrography of the glenohumeral joint. Two diagnostic protocols were used. Protocol 1: conventional followed after 30 min by CT arthrography of 37 joints using a double contrast technique with iotrolan 300. Protocol 2: conventional followed after 90–180 min by MR arthrography in 20 patients using a single-contrast technique with 10 ml iotrolan 300 and 1 ml gedopentetate dimeglumine 500 mM. Ten patients also underwent CT arthrography. Neither patient group experienced contrast-related complications. Image quality was good for all conventional arthrograms, excellent in 45/47 CT arthrograms and good in 20 MR arthrograms. CT and MR arthrography were diagnostically valuable in many patients. We conclude that glenohumeral joint evaluation should be perfomed first using conventional or CT arthrography. Iotrolan has proven to be highly reliable and safe in these applications. Iotrolan in combination with gadopentetate dimeglumine, permits MR arthrography following completion of the standard examinations if necessary.     

Hypertrophy of Hoffa's fat pad - an arthrographic diagnosis? (author's transl)]

The wide spectrum of conditions, ranging from normal variants over early posttraumatic swelling to Hoffa's classical syndrome with hypertrophy of the fat pad can be demonstrated in double-contrast arthrography with high reliability, demonstrated after review of 1566 arthrographies in comparison with results of surgery and histology. Following post-mortem studies in 50 knee joints statements are made about normal size and shape, physiological variants and pathological enlargement of Hoffa's fat pad in arthrography. Since post-traumatic changes of menisci, cartilage and Hoffa body often cannot be differentiated by clinical examination, double-contrast arthrography should be performed routinely before surgery, since this technique provides the surgeon with a maximum of preoperative information about the internal structures of the knee joint and may modify the planned surgical procedure considerably.     

Arthrography of the glenohumeral joint: experience with a non-ionic dimeric contrast agent and future perspectives

The role of conventional arthrography versus computed tomography (CT) arthrography of the glenohumeral joint using iotrolan was evaluated in patients with different shoulder problems. In addition, a diagnostic combination of conventional and CT arthrography was compared with magnetic resonance (MR) arthrography of the glenohumeral joint. Two diagnostic protocols were used. Protocol 1: conventional followed after 30 min by CT arthrography of 37 joints using a double contrast technique with iotrolan 300. Protocol 2: conventional followed after 90–180 min by MR arthrography in 20 patients using a single-contrast technique with 10 ml iotrolan 300 and 1 ml gedopentetate dimeglumine 500 mM. Ten patients also underwent CT arthrography. Neither patient group experienced contrast-related complications. Image quality was good for all conventional arthrograms, excellent in 45/47 CT arthrograms and good in 20 MR arthrograms. CT and MR arthrography were diagnostically valuable in many patients. We conclude that glenohumeral joint evaluation should be perfomed first using conventional or CT arthrography. Iotrolan has proven to be highly reliable and safe in these applications. Iotrolan in combination with gadopentetate dimeglumine, permits MR arthrography following completion of the standard examinations if necessary.     

Arthrotomography of the temporomandibular joint: new technique and preliminary observations.

A technique for arthrography of the temporomandibular joint using multidirectional tomography is described that greatly simplifies interpretation. In 21 attempts, 20 successful arthrograms were obtained in patients complaining of pain, tenderness, and clicking and locking of the joint who had not responded to conservative therapy. Abnormalities demonstrated were perforation of the meniscus, anterior dislocation and subluxation of the meniscus; and redundancy of the bilaminar zone. In all 11 patients who underwent surgical meniscoplasty, disc abnormalities included thinning, perforation, flaccidity, and bilaminar redundancy. No permanent complications of the arthrographic procedure occurred, but temporary postprocedure discomfort was frequent. This preliminary experience with temporomandibular joint arthrotomography suggests this easily performed procedure offers reliable information about disc function and integrity that may assist in a selection of patients for meniscoplasty and other surgical treatment.     

Diagnostic accuracy of double-contrast arthrotomography of the temporomandibular joint: correlation with postmortem morphology

The diagnostic accuracy of double-contrast arthrotomography in the evaluation of internal derangement of the temporomandibular joint is unknown. Therefore, findings from double-contrast arthrotomograms of 48 temporomandibular joint autopsy specimens were correlated with postmortem morphology seen from dissections or cryosections. Arthrotomographic diagnosis was confirmed in 41 joints, signifying a diagnostic accuracy of 85%. Misinterpretations were made in seven joints (three concerning the configuration, three concerning the position, and one concerning the configuration and position of the disk). False-positive reports due to observation errors can be avoided with improved knowledge of the joint anatomy as well as with increased experience in the technique. False-negative examinations were due to limitation of the tomographic reproduction of the lateral part of the joint.     

Barium pharyngography: comparison of single and double contrast

In 119 patients referred for barium pharyngography, both single- and double-contrast examinations were performed. The air-contrast examinations were easier to perform and yielded fewer suboptimal studies than the single-contrast examinations. Neither technique proved to be sensitive in the detection of lesions in the oral cavity, but for lesions in the pharynx, the air-contrast technique had a higher sensitivity (87% vs. 33%) and overall accuracy (94% vs. 84%) than the combination of single-contrast radiography and videotaped fluoroscopy. Single-contrast films provided no further information than the combination of the air-contrast views and the videotaped fluoroscopy. The air-contrast examination was clinically helpful in those patients in whom indirect laryngoscopy was difficult.     

Computed tomography of the cruciate ligaments.

Computed tomography was used to delineate the cruciate ligaments of the knee joint in 31 patients. Optimal positioning for demonstrating the length and body of the anterior and posterior cruciate ligaments is described and the CT, arthrographic, surgical, and clinical findings are correlated. The potential and limitations of CT and its role in combination with double-contrast arthrography in the clinical setting are discussed.     

Cryptic vascular malformations involving the brainstem

Sixty-seven patients with endoscopically proved esophagitis and 25 patients who had no esophageal disease were examined by double-contrast esophagography, followed by a single-contrast examination. The radiographs were evaluated separately and as a combined examination technique by three independent radiologists in a blind analysis. The respective sensitivities were 77% for the single-contrast examination, 80% for the double-contrast examination, and 88% for the combined examination method with no significant statistical difference (P = 0.05). The sensitivity increased for all methods with an increased severity of esophagitis. False positives more frequently occurred with double-contrast radiography, leading to similar accuracy rates for all methods (74% to 77%). The double-contrast examination technique showed an advantage over single-contrast radiography only if a granular pattern and erosions were the only radiographically detectible features of esophagitis. The use of the combined examination technique is recommended.     

Elbow arthrography: a reassessment of the technique

Twenty-six elbow arthrograms were retrospectively reviewed. Each arthrogram consisted of conventional radiography, conventional tomography, standard double-contrast arthrography, and arthrotomography. Each of these four components was independently interpreted in a blinded fashion by six radiologists, each working alone. The four components were evaluated for presence or absence of intraarticular bodies, cartilage loss, or fractures. The results showed that conventional tomography was the most accurate single study. Arthrotomography rarely improved the diagnostic accuracy of noncontrast methods. It was useful in those few patients where detection of purely cartilaginous bodies, precise position of mineralized densities, or status of articular cartilage was desired. It may be possible to reduce the number of elbow arthrograms, thereby reducing time, cost, and radiation dose factors.     

Rotator cuff lesions of the shoulder: evaluation by direct sagittal CT arthrography

Direct sagittal computed tomographic scanning (DSCT) of the shoulder was performed in 42 symptomatic patients, six healthy volunteers, and two cadaver shoulders. Axial CT scanning and double-contrast arthrography with plain radiographs were performed in 41 patients for comparison. DSCT enabled correct identification of 27 of 29 lesions in 24 patients. Seventeen patients had normal shoulders. Axial CT scanning and DSCT together enabled correct identification of all lesions and were markedly superior to plain-film arthrography. DSCT enabled diagnosis of all cases of complete rotator cuff tear plus three cases of incomplete tear and three of rotator cuff atrophy not identified by the other techniques. Axial CT scanning was better than DSCT for diagnosis of Bankart lesions.     

Performance of barium examinations after acute myocardial infarction: report of a survey

A survey of members of the Society of Gastrointestinal Radiologists was conducted to ascertain the standards of practice and timing for elective barium studies of the gastrointestinal tract in patients recovering from acute myocardial infarction. Sixty-two percent of respondents do not have cardiac monitoring apparatus readily available in the fluoroscopy suite. When readily available, such equipment is rarely (42%) or never (58%) used during routine barium examinations. Twenty-four percent of respondents take special precautions when performing examinations on these patients by reducing patient movement, the length of the examination, and the number of radiographs exposed, and by employing cardiac monitoring. Seventy-two (89%) of 81 respondents noted at least one adverse cardiovascular reaction. This was most often chest pain, but there were 10 deaths from cardiac causes. Two-thirds of respondents delay elective barium examinations of any kind for at least 4 weeks after acute myocardial infarction. The remaining one-third perform these studies earlier than 4 weeks. The latter typically limit their studies to the upper gastrointestinal tract (82%), 42% of which are single-contrast; the rest are equally divided between double-contrast and biphasic studies. This minority of radiologists is twice as likely to perform a single-contrast barium enema than a double-contrast barium enema during this period. No such preference for single-contrast (47%) over double-contrast (53%) barium enema is revealed by the majority who delay their elective barium enemas 4 or more weeks. The data indicate a strong preference to defer elective barium examinations a minimum of 4 weeks after acute myocardial infarction. A sizable minority (one-third) of radiologists, however, feel comfortable performing a single-contrast upper gastrointestinal examination at an earlier time.     

Pain in knee arthrography: comparison of air vs. CO2 and reaspiration vs. no reaspiration

A prospective study of 255 patients undergoing double-contrast arthrography of the knee was performed to evaluate postexamination knee pain after two procedural modifications: (1) intraarticular carbon dioxide versus room air and (2) postprocedural joint reaspiration versus no reaspiration. A moderate or severe increase in pain during the 24 hr after the examination was experienced by 20% of patients. Carbon dioxide resulted in slightly greater patient pain immediately after the procedure than did room air. However, there was no difference in morbidity in these two groups at 24 hr. Aspiration of the knee joint had no immediate or delayed effect on patient pain. Older patients, women, and patients with abnormal arthrograms, reported more baseline discomfort but, allowing for this, they tolerated the procedure as well as younger patients, men, and patients with normal arthrograms. It is recommended that double contrast arthrography of the knee be performed using intraarticular air without reaspiration of the joint.