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1.
Objective The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis.Design and patients We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0–3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis.Results Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7, respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb.Conclusion Enhanced MR imaging of the hand and wrist is a superior technique for detection of tenosynovitis. We observed carpal tunnel flexor tendons to be the most frequently affected tendons of the wrist. The flexor tendons of the second and third digits were the most frequently affected tendons of the hands. Higher contrast-enhancement scores and inflammation were noted in the hand flexor than in the extensor tendons. 相似文献
2.
Gary L. Merhar M.D. Robert A. Clark M.D. Harold J. Schneider M.D. Peter J. Stern M.D. 《Skeletal radiology》1986,15(7):549-552
High resolution computed tomography (CT) was used to scan the wrists of 19 patients with idiopathic carpal tunnel syndrome. Thirteen normal volunteers were used as controls. Measurements obtained from the CT images included the cross-sectional area of the carpal tunnel, the relative amount of synovium within the carpal tunnel, the attenuation coefficient of the carpal tunnel, and the thickness of the transverse carpal ligament. No significant difference in any of these measurements was found when comparing the wrists of symptomatic patients with controls. High resolution CT of the wrist does not appear to be of value in the preoperative evaluation of patients with idiopathic carpal tunnel syndrome. 相似文献
3.
Maha K. Abdel Ghaffar Maha A. El-Shinnawy Hazem Fawzy Soha Eldessouki Ibrahim 《The Egyptian Journal of Radiology and Nuclear Medicine》2012
Purpose
To determine the diagnostic accuracy of gray scale and color Doppler sonography in the diagnosis of patients with carpal tunnel syndrome.Patients and methods
A total of 53 wrists in 41 consecutive patients with clinical suspicion of carpal tunnel syndrome, referred from the Department of Physical medicine, Rheumatology & Rehabilitation were examined with ultrasonography using a 12 MHz linear array transducer. The presence of median nerve edema, swelling, and bowing of the flexor retinaculum was evaluated by gray scale sonography, while intraneural hypervascularity was evaluated by color Doppler sonography. Sensitivity and specificity were calculated for each sonographic feature and compared with electrodiagnostic test (EDT) results.Results
Electrodiagnostic tests confirmed carpal tunnel syndrome in 48 wrists. A median nerve cross sectional area (CSA) of 11 mm2 was calculated as a definition of median nerve swelling. In comparison with electrodiagnostic tests, median nerve swelling showed the highest accuracy (89%) among the gray scale sonographic criteria, and the presence of median nerve hypervascularization showed the highest accuracy (94%) among all sonographic criteria. Median nerve edema and bowing of the flexor retinaculum showed accuracies of 81% and 77% respectively.Conclusion
Median nerve intraneural hypervascularity detected by color Doppler sonography is more accurate in detection of median nerve involvement than gray scale sonography criteria in patients with suspected carpal tunnel syndrome. 相似文献4.
Carpal tunnel syndrome caused by tophaceous gout: CT and MR imaging features in 20 patients 总被引:6,自引:0,他引:6
Chen CK Chung CB Yeh L Pan HB Yang CF Lai PH Liang HL Resnick D 《AJR. American journal of roentgenology》2000,175(3):655-659
OBJECTIVE: The objective of this study is to describe the CT and MR imaging findings of gouty tophi in the wrist and present this entity as a cause of carpal tunnel syndrome. MATERIALS AND METHODS: Retrospective review of the CT (n = 18) and MR imaging (n = 20) studies of the wrist in patients with a documented diagnosis of gout who presented with gout-related carpal tunnel syndrome was performed; images of 24 wrists were collected over a 5-year period. Patient population included 20 men, who ranged in age from 35 to 76 years. All images were reviewed by two musculoskeletal radiologists who reached a consensus opinion. Surgical correlation was available in 12 patients. RESULTS: Tophi were found in the floor of the carpal tunnel (n = 18), carpal bones (n = 17), radiocarpal joint (n = 17), and extensor tendons or tendon sheaths (n = 16) of the wrist. All tophi showed similar signal characteristics (from low to intermediate signal intensity on T1-weighted images with heterogeneous signal intensity on T2-weighted images) with the exception of tophi in the floor of the carpal tunnel (low signal intensity on T2-weighted images). Varying degrees of calcification were noted on CT and MR imaging studies. Gadolinium-enhanced MR studies showed heterogeneous enhancement. CONCLUSION: Gouty tophi should be entertained as a cause of carpal tunnel syndrome in the appropriate patient population. Familiarity with this entity and its imaging characteristics may prove helpful in diagnosis and preoperative planning. 相似文献
5.
The role of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome 总被引:7,自引:0,他引:7
Yesildag A Kutluhan S Sengul N Koyuncuoglu HR Oyar O Guler K Gulsoy UK 《Clinical radiology》2004,59(10):910-915
AIM: The aim of study was to assess the usefulness of ultrasonographic measurements of the median nerve in the diagnosis of carpal tunnel syndrome. MATERIALS AND METHODS: Eighty-six patients with carpal tunnel syndrome confirmed by electromyography and 45 asymptomatic controls were included in the study and underwent high-resolution ultrasonography of the wrists. The cross-sectional area and flattening ratio at the level of the pisiform bone of the proximal carpal tunnel were measured. Data from the patient group and control group were compared to determine the statistical significance. The accuracy of the ultrasonographic diagnostic criteria for carpal tunnel syndrome was evaluated using receiver-operating characteristic (ROC) analysis. RESULTS: One hundred and forty-eight wrists of 86 patients with carpal tunnel syndrome and 76 wrists of 45 control patients were examined. All measurements showed significant differences between patients and controls. Increased cross-sectional area of the median nerve was the most predictive measurement of carpal tunnel syndrome. Using the ROC curve, a cut-off value of >10.5 mm2 at the level of pisiform bone provided a diagnostic sensitivity of 89% and specificity of 94.7% CONCLUSION: The ultrasonographic measurement of the median nerve cross-sectional area is a sensitive, specific and useful non-invasive method for the diagnosis of carpal tunnel syndrome. 相似文献
6.
K Monagle G Dai A Chu R S Burnham R E Snyder 《AJR. American journal of roentgenology》1999,172(6):1581-1586
OBJECTIVE: Previous MR imaging studies have produced evidence of changes to structures within the wrist believed to be associated with carpal tunnel syndrome. In an attempt to resolve the conflicting and inconclusive results of these studies, we report here the results of an MR imaging study at a field strength of 3.0 T, which is higher than that previously reported. SUBJECTS AND METHODS: Patients with carpal tunnel syndrome and control groups of asymptomatic subjects were studied using MR imaging. We evaluated electrophysiologically the median nerve function of the affected wrists of all patients. A gradient-recalled echo pulse sequence was used to study 13 3-mm-thick slices within the wrist of each patient or asymptomatic subject. Spatial resolution was approximately 0.3 x 0.3 mm2. The median nerve and other structures associated with the carpal tunnel, which were clearly shown on the MR images, were analyzed to yield structural data. RESULTS: Analysis revealed that the cross-sectional area of the nerve within and proximal to the carpal tunnel was approximately 50% larger in patients with carpal tunnel syndrome than in asymptomatic subjects. We found no significant difference in the area of the nerve within the carpal tunnel compartment compared with the area of the nerve proximal to the carpal tunnel either in patients or in asymptomatic subjects. Also, flattening of the nerve on entering the carpal tunnel was not significantly different in patients than in asymptomatic subjects. In patients an increase in the palmar bowing of the flexor retinaculum was found only at the level of the hamate compared with that found in asymptomatic subjects. The cross-sectional area of the carpal tunnel was of a similar size in patients and in asymptomatic subjects. Comparison of electrodiagnostic results indicated no correlations between the MR parameters and electrophysiologic dysfunction of the median nerve for patients. CONCLUSION: The only statistically significant differences found between patients with carpal tunnel syndrome and asymptomatic subjects were that the median nerve was approximately 50% larger within and proximal to the carpal tunnel in patients with carpal tunnel syndrome and palmar bowing of the flexor retinaculum occurred in patients only at the level of the hamate. 相似文献
7.
Andrea Kleindienst Bernd Hamm Wolfgang R. Lanksch 《Journal of magnetic resonance imaging : JMRI》1998,8(5):1119-1125
The purpose of this prospective study was to determine the potential of MR imaging to depict morphologic alterations of the median nerve correlating with the stage of carpal tunnel syndrome (CTS). Eighteen wrists of normal subjects and 81 wrists of patients with CTS were examined. MR imaging was performed with proton-density- and T2-weighted spin-echo sequences. Staging of CTS was done on the basis of clinical and electrophysiological testing, including evaluation of the number of previous steroid infiltrations in conservative treatment. Median nerve flattening, cross-sectional area, and signal intensity were measured from the distal radius to the end of the carpal tunnel. Delineation and structure of the median nerve were recorded qualitatively by two experienced radiologists in consensus. Three major MR imaging criteria of early CTS were (a) isolated prestenotic and intracarpal swelling of the median nerve (P < .01), (b) the absence of significant flattening, and (c) a generalized increase in signal intensity retrograde to the distal radius (P < .01). The nerve showed sharply delineated contours and a homogeneous signal pattern. Advanced CTS was characterized by retrograde swelling of the median nerve to the distal radius (P < .01) and decreased signal intensity (P < .05). Demarcation of the nerve became poorer, and its signal pattern appeared fasciculated. After steroid infiltration, the median nerve was difficult to delineate, showed an inhomogeneous structure, and swelling was less pronounced than without steroid infiltration (P < .05). MR imaging yields typical morphologic findings that correlate with the duration and severity of median nerve compression. Hence, MR imaging allows staging of median nerve compression in CTS and thus may contribute to therapeutic decision-making. 相似文献
8.
W Buchberger W Judmaier G Birbamer M Lener C Schmidauer 《AJR. American journal of roentgenology》1992,159(4):793-798
OBJECTIVE. Carpal tunnel syndrome is characterized by typical anatomic changes that can be shown with high-resolution sonography. To determine whether these findings are reliable and can be used to establish the diagnosis, sonograms of patients with the disease were compared with sonograms obtained in patients with normal wrists. Also compared were sonograms and MR images obtained in the patients with carpal tunnel syndrome. SUBJECTS AND METHODS. Twenty wrists in 18 consecutive patients with clinical symptoms of carpal tunnel syndrome and with abnormal nerve conduction studies were examined with real-time sonography and MR imaging. The sonograms and MR images were evaluated quantitatively by two unbiased observers with regard to the size and shape of the median nerve and the palmar bowing of the flexor retinaculum. A t test was used to compare these data with those from previous sonographic studies of 28 normal wrists. Correlation coefficients for the measurements obtained with sonography and with MR were calculated. The relative accuracies of different diagnostic criteria for the diagnosis of carpal tunnel syndrome were assessed by using receiver-operating-characteristic analytical techniques. RESULTS. Characteristic findings on both MR and CT scans of the 20 wrists with carpal tunnel syndrome included swelling of the median nerve in the proximal part of the carpal tunnel in 16 wrists, flattening of the median nerve in the distal part of the carpal tunnel in 13 wrists, and increased palmar bowing of the flexor retinaculum in nine wrists. Comparison with the data of 28 normal wrists proved that these findings were significant (p less than .01 to p less than .001). Receiver-operating-characteristic analysis showed that the discrimination between wrists in normal subjects and in patients with carpal tunnel syndrome achieved with each of the three diagnostic criteria was not significantly different. Measurements of the size and flattening of the median nerve obtained from sonograms were similar to those on MR images, whereas sonography was less accurate for measuring the palmar bowing of the flexor retinaculum. CONCLUSION. We conclude that the results of sonography are reliable, and that the diagnosis of carpal tunnel syndrome can be established on the basis of sonographic findings. 相似文献
9.
Objective To describe the magnetic resonance (MR) imaging and gross anatomic appearance of the scaphocapitate (SC) ligament and triquetrohamocapitate
(THC) ligament, which are the radial and ulnar limbs of the composite arcuate ligament, a critical volar midcarpal stabilizing
ligament.
Design T1 spin-echo and 3D gradient-echo MR imaging in the standard, coronal oblique, and axial oblique planes were performed both
before and following midcarpal arthrography in seven cadaveric wrists. The seven specimens were then sectioned in selected
planes to optimally visualize the SC and THC ligaments. These specimens were analyzed and correlated with their corresponding
MR images.
Results The SC and THC ligaments can be visualized in MR images as structures of low signal intensity that form an inverted “V” joining
the proximal and distal carpal rows. The entire ligamentous complex is best visualized with coronal and axial oblique MR imaging
but can also be seen in standard imaging planes.
Conclusion SC and THC ligaments together form the arcuate ligament of the wrist. Their function is crucial to the normal functioning
of the wrist. Palmar midcarpal instability (PMCI) is a resulting condition when abnormalities of these ligaments occur. Dedicated
MR imaging in the coronal and axial imaging planes can be performed in patients suspected of having PCMI. 相似文献
10.
Objective Enlargement of the median nerve is an objective potential imaging sign of carpal tunnel syndrome. Diffusion tensor MRI (DTI)
may provide additional structural information that may prove useful in characterizing median neuropathy. This study further
examines normal values for median nerve cross-sectional area (CSA), apparent diffusion coefficient (ADC), and fractional anisotropy
(FA).
Materials and methods Twenty-three wrists in 17 healthy volunteers underwent MRI of the wrist at 3 T. In 13 subjects, DTI was performed at a B value of 600 mm2/s. Median nerve CSA, ADC, and FA were analyzed at standardized anatomic levels.
Results Mean (SD) median nerve CSA within the proximal carpal tunnel was 10.0 (3.4) mm2. The mean (SD) FA of the median nerve was 0.71 (0.06) and 0.70 (0.13) proximal to and within the carpal tunnel, respectively.
There was a significant difference between nerve CSA and ADC, but not FA, at the distal forearm and proximal carpal tunnel.
Nerve CSA, ADC, and FA did not differ between men and women or between dominant and non-dominant wrists. Nerve CSA at the
proximal carpal tunnel was positively correlated with subject age and body mass index.
Conclusion Our results suggest a 90% upper confidence limit for normal median nerve CSA of 14.4 mm2 at the proximal carpal tunnel, higher than normal limits reported by many ultrasound studies. We observed a difference between
the CSA and ADC, but not the FA, of the median nerve at the distal forearm and proximal carpal tunnel levels. 相似文献
11.
Alex Wing Hung Ng James Francis Griffith Carita Tsoi Raymond Chun Wing Fong Michael Chu Kay Mak Wing Lim Tse Pak Cheong Ho 《Korean journal of radiology》2021,22(7):1132
ObjectiveTo investigate changes in the median nerve, retinaculum, and carpal tunnel on ultrasound after successful endoscopic carpal tunnel release (ECTR).Materials and MethodsThis prospective study involved 37 wrists in 35 patients (5 male, 30 female; mean age ± standard deviation [SD], 56.9 ± 6.7 years) with primary carpal tunnel syndrome (CTS). An in-house developed scoring system (0–3) was used to gauge the clinical improvement after ECTR. Ultrasound was performed before ECTR, and at 1, 3, and 12 months post-ECTR. Changes in the median nerve, flexor retinaculum, and carpal tunnel morphology on ultrasound after ECTR were analyzed. Ultrasound parameters for different clinical improvement groups were compared.ResultsAll patients improved clinically after ECTR. The average clinical improvement score ± SD at 12 months post-ECTR was 2.2 ± 0.7. The median nerve cross-sectional area proximal and distal to the tunnel decreased at all time intervals post-ECTR but remained swollen compared to normal values. Serial changes in the median nerve caliber and retinacular bowing after ECTR were more pronounced at the tunnel outlet than at the tunnel inlet. The flexor retinaculum had reformed in 25 (68%) of 37 wrists after 12 months.ConclusionPostoperative changes in median nerve and retinaculum parameters were most pronounced at the tunnel outlet. Even in patients with clinical improvement after ECTR, nearly all ultrasound parameters remain abnormal at one year post-ECTR. These ultrasound parameters should not necessarily be relied upon to diagnose persistent CTS after ECTR. 相似文献
12.
Mäurer J Bleschkowski A Tempka A Felix R 《Acta radiologica (Stockholm, Sweden : 1987)》2000,41(1):78-83
Purpose:
To make a comparative analysis of transversal tomograms obtained by high-resolution MR imaging with frozen cross-sections of an anatomical forearm specimen. Twenty-two healthy volunteers were also examined using the same coil system to test for a range of possible clinical applications and for the depiction of morphological and morphometrical values of normal anatomy in vivo.
Material and Methods:
MR images of the carpal tunnel of 22 healthy volunteers were obtained with a 1.5-T whole-body system with a 5-cm surface coil. Measurements were recorded with a field-of-view between 50×50 mm2 and 60×60 mm2 in a 256×256 pixel matrix for the T1 sequence. A slice thickness of 2 mm was used. The images were acquired using a T1-weighted SE sequence (TR/TE 500/38 ms) and a T2-weighted SE sequence (TR/TE 2000/70 ms). Additionally, a formalin-fixed anatomical forearm specimen was imaged for anatomic correlation. The imaged transversal cross-section levels in the specimen were subsequently freeze-sectioned. The anatomical structures of the MR findings were identified and compared with the macroscopical sections of the specimen.
Results:
Based on the good depiction of details at this coil system with a pixel size in T1 of 0.195×0.195 mm, high-resolution MR imaging enabled identification of the interior structures of the carpal tunnel, as well as delineation of connective tissue. The clinical value of high-resolution MR includes the diagnosis of carpal tunnel syndrome and inflammatory disorders of the wrist.
Conclusion:
Our results support the feasibility of high-resolution MR imaging of the carpal tunnel and the wrist using small surface coils. 相似文献
To make a comparative analysis of transversal tomograms obtained by high-resolution MR imaging with frozen cross-sections of an anatomical forearm specimen. Twenty-two healthy volunteers were also examined using the same coil system to test for a range of possible clinical applications and for the depiction of morphological and morphometrical values of normal anatomy in vivo.
Material and Methods:
MR images of the carpal tunnel of 22 healthy volunteers were obtained with a 1.5-T whole-body system with a 5-cm surface coil. Measurements were recorded with a field-of-view between 50×50 mm2 and 60×60 mm2 in a 256×256 pixel matrix for the T1 sequence. A slice thickness of 2 mm was used. The images were acquired using a T1-weighted SE sequence (TR/TE 500/38 ms) and a T2-weighted SE sequence (TR/TE 2000/70 ms). Additionally, a formalin-fixed anatomical forearm specimen was imaged for anatomic correlation. The imaged transversal cross-section levels in the specimen were subsequently freeze-sectioned. The anatomical structures of the MR findings were identified and compared with the macroscopical sections of the specimen.
Results:
Based on the good depiction of details at this coil system with a pixel size in T1 of 0.195×0.195 mm, high-resolution MR imaging enabled identification of the interior structures of the carpal tunnel, as well as delineation of connective tissue. The clinical value of high-resolution MR includes the diagnosis of carpal tunnel syndrome and inflammatory disorders of the wrist.
Conclusion:
Our results support the feasibility of high-resolution MR imaging of the carpal tunnel and the wrist using small surface coils. 相似文献
13.
Sernik RA Abicalaf CA Pimentel BF Braga-Baiak A Braga L Cerri GG 《Skeletal radiology》2008,37(1):49-53
Purpose The purpose of the study was to examine the most adequate cut-off point for median nerve cross-sectional area and additional
ultrasound features supporting the diagnosis of carpal tunnel syndrome (CTS).
Material and methods Forty wrists from 31 CTS patients and 63 wrists from 37 asymptomatic volunteers were evaluated by ultrasound. All patients
were women. The mean age was 49.1 years (range: 29–78) in the symptomatic and 45.1 years (range 24–82) in the asymptomatic
group. Median nerve cross-sectional area was obtained using direct (DT) and indirect (IT) techniques. Median nerve echogenicity,
mobility, flexor retinaculum measurement and the anteroposterior (AP) carpal tunnel distance were assessed. This study was
IRB-approved and all patients gave informed consent prior to examination.
Results In CTS the median nerve cross-sectional area was increased compared with the control group. Median nerve cross-sectional area
of 10 mm2 (DT) and 9 mm2 (IT) had high sensitivity (85% and 88.5%, respectively), specificity (92.1% and 82.5%) and accuracy (89.3% and 82.5%) in
the diagnosis of CTS. CTS patients had an increased carpal tunnel AP diameter, flexor retinaculum thickening, reduced median
nerve mobility and decreased median nerve echogenicity.
Conclusion Ultrasound assists in the diagnosis of CTS using the median nerve diameter cut-off point of 10 mm2 (DT) and 9 mm2 (IT) and several additional findings. 相似文献
14.
N. Nakahara M. Uetani K. Hayashi Y. Kawahara T. Matsumoto J. Oda 《Skeletal radiology》1996,25(7):639-647
Objective. To determine the usefulness of fat-suppressed gadolinium (Gd)-enhanced MR imaging of the wrist in patients with rheumatoid
arthritis (RA). Design and patients. Fat-suppressed Gd-enhanced T1-weighted spin-echo (SE) images were obtained and compared with other standard techniques in
38 wrists of 27 patients (22–77 years) with RA. Scoring based on the degree of synovial enhancement of each joint was developed
and the total scores (J-score) were correlated with radiographic stage, C-reactive protein (CRP), erythrocyte sedimentation
rate (ESR), and symptomatic change in the follow-up study. Results. Synovial proliferations showed marked enhancement in all the wrists. In addition, contrast enhancement in the bone marrow
and tenosynovium was seen in 36 and eight wrists respectively. Fat-suppressed Gd-enhanced T1-weighted images demonstrated
these abnormalities better than other techniques. The J-scores correlated well with values of CRP (P=0.0034), but not with radiographic stages and ESR. Conclusion. Fat-suppressed Gd-enhanced T1-weighted SE images can clearly demonstrate most of the essential lesions in RA including the
proliferative synovium, bone erosion, bone marrow inflammatory change, and tenosynovitis. Scoring based on the extent of Gd-enhancement
of synovium can be useful in the assessment of the inflammatory status. 相似文献
15.
Objective The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists
of patients with psoriatic arthritis (PsA).
Materials and methods We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of
PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow
edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists
reviewed all images independently. Differences were resolved during a subsequent joint session.
Results The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the
13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands
(31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present
in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%)
and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue
involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue
involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement
was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists).
The “rheumatoid” type of distribution of bony lesions was common in our study. Interobserver agreement for various findings
ranged from 83% to 100%.
Conclusion Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve
involvement, with good interobserver reliability in patients with PsA of the hands and wrists. Disease was more extensive
in the wrists than in the hands. 相似文献
16.
High-field MR surface-coil imaging of the hand and wrist. Part II. Pathologic correlations and clinical relevance 总被引:3,自引:0,他引:3
High-resolution magnetic resonance (MR) images of the hands and wrists of 12 patients with a variety of suspected pathologic conditions were obtained at 1.5 T using a prototype surface coil. Lesions included ganglions, rheumatoid arthritis, carpal fractures, carpal tunnel syndrome, and arteriovenous malformations. In the selected cases studied, MR images provided potentially relevant information. Surgical, pathologic, and radiographic correlations were obtained. MR imaging affords delineation of soft-tissue structure that is unmatched by other imaging methods, including computed tomography. It is anticipated that MR imaging of the hand and wrist will afford sufficient valuable clinical information in certain conditions to justify its expense outside a research setting. Further clinical testing, however, is warranted. 相似文献
17.
Objective To describe magnetic resonance (MR) imaging findings in the wrists of asymptomatic subjects that might be confused with pathologic findings.Design MR examination of the dominant wrist was performed in 30 asymptomatic volunteers aged 22–49 years using pre-contrast and post-contrast sequences in the coronal and axial planes. The bases of the metacarpals, the carpus and the distal radius and ulna were evaluated by two musculoskeletal radiologists for lesions, notches, blood vessels and synovial enhancement.Results There were 24 bright osseous lesions (erosions, intraosseous ganglia, oedema or cysts) in 14 subjects. Intraosseous blood vessels were seen in all but one wrist examined, most commonly in the capitate and lunate bones. Enhancement was present in 26 of 27 notches identified at the base of the second metacarpal and less commonly in the capitate, hamate and triquetral notches. A small joint effusion was present in 14 subjects. Joint or soft-tissue enhancement was identified in 16 wrists.Conclusions Many MR abnormalities and variants may be detected in the wrists of asymptomatic subjects. Many of these could be confused with pathologic findings usually associated with inflammatory arthritis.Partial funding provided by the Royal Australian and New Zealand College of Radiologists College Research Fund. 相似文献
18.
H Sugimoto T Ohsawa 《Nihon Igaku Hōshasen Gakkai zasshi. Nippon acta radiologica》1990,50(11):1343-1349
Magnetic resonance (MR) imaging of the carpal tunnel was performed in 23 wrists of 13 patients who were suspected to have carpal tunnel syndrome (CTS). In ten out of 23 wrists, diagnostic images of the carpal tunnel could be obtained. MR images were analysed retrospectively as to swelling of the median nerve, signal intensity of the median nerve on T2 weighted image, and swelling of the tendon sheath. In 8 wrists the median nerve was significantly swollen at the inlet of the carpal tunnel. Four of them showed increased signal intensity of the median nerve on T2 weighed image at the inlet. Swelling of the tendon sheath was demonstrated in two cases. These finding seem to represent edematous change of the median nerve due to compression. Surgical correlation was obtained in two wrists. Since MR imaging is capable of demonstrating pathological changes of the median nerve in CTS, it can be a diagnostic tool in selected cases. 相似文献
19.
MR imaging of the carpal tunnel: normal anatomy and preliminary findings in the carpal tunnel syndrome 总被引:2,自引:0,他引:2
W D Middleton J B Kneeland G M Kellman J D Cates J R Sanger A Jesmanowicz W Froncisz J S Hyde 《AJR. American journal of roentgenology》1987,148(2):307-316
MR imaging was performed through the carpal tunnel in 18 wrists of nine normal volunteers and compared with cryomicrotome sections from cadaver wrists. MR reliably imaged the flexor retinaculum and carpal bones and thus defined the borders of the carpal tunnel. In all cases the median nerve was seen as an ovoid structure of moderate signal intensity and was easily distinguished from the flexor tendons of the hands running in the carpal tunnel. The tendons were separated from each other by their tendon sheaths, and this allowed for identification of the various tendons. Anatomic variations encountered in the normal volunteers included anomalous positioning of the origin of the lumbrical muscles within the carpal tunnel in two, persistent median arteries in two, and interposition of the median nerve between the flexor pollicis longus and the superficial flexor tendon to the index finger in one. Preliminary observations in 10 wrists of patients with carpal tunnel syndrome include segmental and diffuse swelling of the median nerve in six, distortion of the nerve in one, and thickening of the tendon sheaths in one. We conclude that MR imaging accurately and reliably displays the normal anatomy of the carpal tunnel and can detect morphologic changes in patients with carpal tunnel syndrome. 相似文献
20.
Sonography and MR imaging of bifid median nerve with anatomic and histologic correlation 总被引:1,自引:0,他引:1
Propeck T Quinn TJ Jacobson JA Paulino AF Habra G Darian VB 《AJR. American journal of roentgenology》2000,175(6):1721-1725
OBJECTIVE: Imaging of a bifid median nerve has not been previously described in the radiology literature. We present three cases of bifid median nerve. The first is a patient with carpal tunnel syndrome seen on sonography and confirmed at surgery. The other two were found among 10 cadaveric specimens and were imaged with sonography and MR imaging. Confirmation of bifid median nerve in these two specimens was obtained using anatomic and histologic correlation. CONCLUSION: Sonography and MR imaging can allow effective diagnosis and delineation of a bifid median nerve in the wrist. This diagnosis is important to make before carpal tunnel release or other wrist surgeries are performed to avoid nerve injury. Furthermore, the sonographic size criteria for diagnosing carpal tunnel syndrome in nonbifid median nerves may not be accurate in evaluating bifid median nerves. 相似文献