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1.
Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum 总被引:2,自引:2,他引:0
Objective The purpose of this study was to determine the utility of fat-suppressed gradient-recalled echo (GRE) compared with conventional
spin echo T1-weighted (T1W) sequences in direct shoulder MR arthrography for evaluating labral tears.
Materials and methods Three musculoskeletal radiologists retrospectively reviewed MR arthrograms performed over a 12-month period for which surgical
correlation was available. Of 180 serial arthrograms, 31 patients had surgery with a mean of 48 days following imaging. Paired
coronal oblique and axial T1W or GRE sequences were analyzed by consensus for labral tear (coronal oblique two-dimensional
multi-echo data image combination, 2D MEDIC; and axial three-dimensional double-echo steady-state, 3D DESS; Siemens MAGNETOM
Sonata 1.5-T MR system). Interpretations were correlated with operative reports.
Results Of 31 shoulders, 25 had labral tears at surgery. The GRE sequences depicted labral tears in 22, while T1W images depicted
tears in 16 (sensitivity 88% versus 64%; p < 0.05). Subdividing the labrum, GRE was significantly more sensitive for the posterior labrum (75% versus 25%; p < 0.05) with a trend toward greater sensitivity at the anterior labrum (78% versus 56%; p = 0.157) but not significantly different for the superior labrum (50% versus 57%; p > 0.7). Specificities were somewhat lower for GRE.
Conclusion Thin section GRE sequences are more sensitive than T1W for the detection of anterior and posterior labral tears. As the specificity
of GRE was lower, it should be considered as an adjunctive imaging sequence that may improve depiction of labral tears, particularly
smaller tears, in routine MR arthrography protocols.
Preliminary results of this study were presented at the Annual Meeting of the Society of Skeletal Radiology, Orlando, FL,
USA, on 21 March 2007. 相似文献
2.
Ali Guermazi Nabil Jomaah Daichi Hayashi Mohamed Jarraya Jose Roberto Silva Jr. Jingbo Niu Emad Almusa Philippe Landreau Frank W. Roemer 《European journal of radiology》2014
Objectives
To compare axial T1weighted fat-saturated (T1w fs) and T1w non-fs sequences, and coronal T1w-fs and T2w-fs sequences, for evaluation of cartilage and labrum using CT arthrography (CTA) as the reference.Methods
Patients had MR arthrography (MRA) and CTA of the shoulder on the same day. Cartilage was assessed for superficial and full thickness focal and diffuse damage. Labral lesions were graded for Bankart variants and SLAP lesions. CTA images were read for the same features. The diagnostic performance of MRA including area under the curve (AUC) was evaluated against CTA.Results
When comparing axial sequences, the diagnostic performance for cartilage lesion detection on T1w non-fs was 61.9% (sensitivity) 93.6% (specificity) and 89.5% (accuracy) with AUC 0.782, while that for T1w fs was 61.9%, 94.0%, 89.8% and 0.783. For labral assessment, it was 89.1%, 93.0%, 91.4% and 0.919 for T1w non-fs, and 89.9%, 94.0%, 92.6% and 0.922 for T1w fs. Comparing coronal sequences, diagnostic performance for cartilage was 42.5%, 97.5%, 89.8% and 0.702 for T1w fs, and 38.4%, 98.7%, 90.2%, and 0.686 for T2w fs. For the labrum it was 85.1%, 87.5%, 86.2%, and 0.868 for T1w fs, and 75.7%, 97.5%, 80.8% and 0.816 for T2w fs.Conclusions
Axial T1w fs and T1w non-fs sequences are comparable in their ability to diagnose cartilage and labral lesions. Coronal T1w fs sequence offers slightly higher sensitivity but slightly lower specificity than T2w fs sequence for diagnosis of cartilage and labral lesions. 相似文献3.
Mohammad Koriem Mahmoud Yousef Mohamad Badran Hatem Galal Zaki Abeer Houssein Ali 《The Egyptian Journal of Radiology and Nuclear Medicine》2013
Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of sub-millimeter multiple detector CT (MDCT) technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. 相似文献
4.
Purpose The purpose of the study is to describe, based on shoulder MRI and MR arthrography with arthroscopic correlation, a posterior
joint capsule fold.
Materials and methods A retrospective review of 410 shoulder MRIs and direct MR arthrograms with arthroscopic correlation in positive cases (when
available) was obtained with IRB approval and HIPPA compliance. The study was performed by three musculoskeletal radiologists.
The criteria utilized to establish the diagnosis of posterior synovial fold included: (1) axial T1-weighted (T1W) on MR arthrography
or axial T2* GRE-weighted on MRI demonstrating rounded thickening of the posterior shoulder joint capsule with a thickness
at least 2 mm in diameter. (2) The posterior synovial fold extends in an oblique craniocaudal direction from the posterior–inferior
joint capsule adjacent to the posterior–inferior glenoid labrum (7 o'clock) and continues superiorly away from the glenoid
labrum to the posterior–superior joint capsule (11 o'clock).
Results Although uncommon, the posterior synovial fold was present in 2% (8/410) of studies reviewed and found predominantly in women
(75%, 6/8). Four patients had arthroscopic confirmation of the posterior synovial fold. A higher percentage of posterior synovial
folds were observed on shoulder MR arthrography (2.7%, 4/150) than on shoulder MRI (1.5%, 4/260).
Conclusion Although rare, the posterior synovial fold can be recognized and should not be confused with a posterior labral tear. Further
investigation is needed to assess its histologic properties and its clinical significance. 相似文献
5.
In the setting of glenohumeral instability or when internal derangement of the shoulder joint is suspected, MR arthrography
has been demonstrated to be an accurate diagnostic imaging technique. Knowledge of the complex anatomy of the shoulder and
its variations is essential in order to maximize diagnostic accuracy.
Received: 24 February 1999 Revision requested: 19 April 1999 Revision received: 12 May 1999 Accepted: 13 May 1999 相似文献
6.
Sports-related shoulder pain and injuries represent a common problem. In this context, glenohumeral instability is currently believed to play a central role either as a recognized or as an unrecognized condition. Shoulder instabilities can roughly be divided into traumatic, atraumatic, and microtraumatic glenohumeral instabilities. In athletes, atraumatic and microtraumatic instabilities can lead to secondary impingement syndromes and chronic damage to intraarticular structures. Magnetic resonance (MR) arthrography is superior to conventional MR imaging in the diagnosis of labro-ligamentous injuries, intrinsic impingement, and SLAP (superior labral anteroposterior) lesions, and thus represents the most informative imaging modality in the overall assessment of glenohumeral instability. This article reviews the imaging criteria for the detection and classification of instability-related injuries in athletes with special emphasis on the influence of MR findings on therapeutic decisions. 相似文献
7.
Merila M Leibecke T Gehl HB Busch LC Russlies M Eller A Haviko T Kolts I 《European radiology》2004,14(8):1421-1426
The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band—the spiral GHL—was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images. 相似文献
8.
Purpose. In a patient with internal derangement of the shoulder, the diagnostic method of choice is controversial. Conventional arthrography
can diagnose most rotator cuff tears accurately; however, in many institutions MR arthrography is usually necessary to diagnose
labral tears. We utilized decision tree methodology to compare the cost- effectiveness of conventional arthrography and conventional
MRI with a hypothetical algorithm in which a patient underwent arthrography, performed with admixed gadolinium, which if negative,
was followed by MRI.
Design. The use of double-contrast arthrography alone, conventional MRI alone, and gadolinium-enhanced MRI used as an adjunct to
conventional arthrography were modeled for the diagnosis of full-thickness rotator cuff tears (RCT), partial RCTs, labral
tears, and the absence of cuff/labral tears using decision analysis methodology. English language medical publications were
searched to determine the base probabilities for the accuracy of the diagnostic tests. The outcome utilities ranged from –1
to +1 to reflect the value of correct diagnostic evaluation. Charges for diagnostic tests and appropriate surgical treatments
were based on 1997 Medicare reimbursement rates for professional fees and hospital charges in an outpatient setting. Sensitivity
analyses were performed to evaluate the effects of uncertainty regarding the prevalence of each disease state and the accuracy
of several diagnostic tests.
Results. In the base-case analysis, the average effectiveness of double-contrast arthrography alone, MRI alone and arthrography selectively
followed by MRI were 0.6610, 0.6715, and 0.7204, respectively. The average costs for each of these strategies were $1090,
$2033, and $2339, respectively.
Conclusion. Arthrography performed with admixed diluted gadolinium, which if negative is immediately followed by MRI, was somewhat more
expensive than conventional MRI. However, because of much greater effectiveness, cost-effectiveness was significantly higher
for our proposed algorithm. Conventional arthrography without gadolinium, although less expensive, had severely limited effectiveness.
Received: 4 June 1999 Revision requested: 6 August 1999 Revision received: 30 August 1999 Accepted: 1 September 1999 相似文献
9.
In the age of cost containment and urgent reductions in health care expenditures, new options have to be explored to satisfy
both diagnostic requirements and economic limitations. The introduction of low-field MR systems for assessment of joint disorders
seemed to be an option for lower costs. The purpose of this article is to summarize available experiences with low-field MR
arthrography of the glenohumeral joint with respect to image quality and diagnostic accuracy in detecting labral and rotator
cuff lesions. Up to now, there has been only a limited number of studies available dealing with low-field MR arthrography
of the glenohumeral joint. They reveal that, despite a minor image quality in comparison with high-field imaging, low-field
MR arthrography of the shoulder allows for sufficient evaluation of intra- and extra-articular structures in the detection
of major abnormalities such as glenohumeral instability or rotator cuff disease. Furthermore, open-configured MR scanners
enable kinematic studies: Besides the analysis of normal motion, pathological findings in patients with instabilities and
impingement syndrome can be delineated. They further offer the possibility for performing MR imaging-guided arthrography of
the shoulder. This was first described using an open C-arm scanner with a vertically oriented magnetic field so that MR arthrography
may be performed in one setting.
Electronic Publication 相似文献
10.
Sasaki T Saito Y Yodono H Prado GL Miura H Itabashi Y Ishibashi Y 《Acta radiologica (Stockholm, Sweden : 1987)》2003,44(4):435-439
Purpose:
To assess the ability of double oblique axial (DOA) MR arthrography in evaluating labral-ligamentous complex compared with conventional axial (CA) MR arthrography. Material and Methods:
MR arthrography of 51 shoulders, subsequently examined with arthroscopy, were retrospectively reviewed. DOA imaging was performed in all 51 shoulders and both DOA and CA imaging in 37 using a 1.5 T unit with gradient recalled-echo T2*-weighted sequences. DOA imaging was performed using perpendicular planes to the long axis of the glenoid fossa obtained by an oblique sagittal scout image. We compared the ability of DOA with that of CA MR arthrography to assess labral injuries and to demonstrate the whole length of the anterior band of the inferior glenohumeral ligament (AIGHL), which were shown to be intact by arthroscopy. Results:
For anterior labral injuries, sensitivity and specificity were 87% and 93% with CA, and 94% and 100% with DOA imaging, respectively. For posterior labral injuries, sensitivity and specificity were 47% and 100% with CA, and 79% and 96% with DOA imaging, respectively. There were no statistically significant differences between CA and DOA images, except for the ability to diagnose posterior labral injuries, where DOA imaging had a significant superior sensitivity (p = 0.0327). DOA images also demonstrated the whole length of the intact AIGHL in 10 of 11 shoulders, while CA imaging showed this in only 3 of 11. Conclusion:
DOA imaging was equal or better than CA imaging for evaluating the labral-ligamentous complex. 相似文献
To assess the ability of double oblique axial (DOA) MR arthrography in evaluating labral-ligamentous complex compared with conventional axial (CA) MR arthrography. Material and Methods:
MR arthrography of 51 shoulders, subsequently examined with arthroscopy, were retrospectively reviewed. DOA imaging was performed in all 51 shoulders and both DOA and CA imaging in 37 using a 1.5 T unit with gradient recalled-echo T2*-weighted sequences. DOA imaging was performed using perpendicular planes to the long axis of the glenoid fossa obtained by an oblique sagittal scout image. We compared the ability of DOA with that of CA MR arthrography to assess labral injuries and to demonstrate the whole length of the anterior band of the inferior glenohumeral ligament (AIGHL), which were shown to be intact by arthroscopy. Results:
For anterior labral injuries, sensitivity and specificity were 87% and 93% with CA, and 94% and 100% with DOA imaging, respectively. For posterior labral injuries, sensitivity and specificity were 47% and 100% with CA, and 79% and 96% with DOA imaging, respectively. There were no statistically significant differences between CA and DOA images, except for the ability to diagnose posterior labral injuries, where DOA imaging had a significant superior sensitivity (p = 0.0327). DOA images also demonstrated the whole length of the intact AIGHL in 10 of 11 shoulders, while CA imaging showed this in only 3 of 11. Conclusion:
DOA imaging was equal or better than CA imaging for evaluating the labral-ligamentous complex. 相似文献
11.
Patrícia Martins e Souza Rodrigo Oliveira Carvalho de Aguiar Edson Marchiori Simon Alexander Weiers Bardoe 《European journal of radiology》2010,74(3):e29
Objective
To describe an ultrasound guided technique of shoulder joint injection at the rotator interval space, using an endocavitary transducer and performed by a radiologist with no previous experience with arthrography.Materials and method
Accuracy of the intra-articular puncture and incidence of complications were evaluated in 180 consecutive patients submitted to joint puncture for shoulder MR arthrography.Results
Puncture was accomplished successfully in all cases, of which 92% with one attempt, and 8% with two, both well tolerated by patients. No relevant complications were reported after the procedure.Conclusion
This study has shown that puncture of the glenohumeral joint guided by ultrasound at the rotator interval space using an endocavitary transducer is easy and quick, even when performed by radiologists with no experience in arthrographic procedures. 相似文献12.
13.
Woertler K 《European radiology》2007,17(12):3038-3055
Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography,
computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates
familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal
postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical
information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment
of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions
and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications
in a multimodality approach. 相似文献
14.
Omoumi P Teixeira P Lecouvet F Chung CB 《Journal of magnetic resonance imaging : JMRI》2011,33(1):2-16
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. 相似文献
15.
P. F. J. Tirman Lynne S. Steinbach John F. Feller Anthony E. Stauffer 《Skeletal radiology》1996,25(8):743-748
Objective. To demonstrate the MRI findings of an anterior shoulder capsular avulsion from the humerus, with or without subscapularis
rupture, after anterior dislocation or severe abduction external rotation injury. Design and patients. We retrospectively reviewed the MRI and MR arthrographic examinations of seven patients who were identified at surgery with
avulsion of the anterior shoulder stabilizers from the humerus. MRI was correlated with clinical history and surgical results.
Results. MRI findings included: inhomogeneity or frank disruption of the anterior capsule at the humeral insertion (all), fluid intensity
anterior to the shoulder (six patients), tear of the subscapularis tendon (six patients), dislocation of the biceps tendon
(four patients), and a Hill-Sachs deformity (four patients). MR arthrography additionally found extravasation of contrast
through the capsular defect (two patients). Conclusions. Our findings suggest that MRI is helpful for diagnosing humeral avulsion of the anterior glenohumeral capsule, especially
when a tear of the subscapularis tendon insertion is present. MR arthrography may be of benefit for diagnosing capsular avulsion
without associated subscapularis tendon abnormality. 相似文献
16.
17.
Yagci B Manisali M Yilmaz E Ozkan M Ekin A Ozaksoy D Kovanlikaya I 《European radiology》2001,11(2):258-262
The aim of this study was to compare the efficacy of indirect MR arthrography images obtained following intravenous contrast
injection and conventional MR imaging in the diagnosis of rotator cuff tears. Twenty-four patients with clinically suspected
rotator cuff disease were examined. Conventional MR images and post-contrast indirect MR arthrography images were obtained.
All images were evaluated in a blinded fashion by two musculoskeletal radiologist. Results were than analyzed depending on
surgical output. The correlation coefficient (Spearman rank correlation test) and the kappa values for agreement between surgery
and imaging techniques were calculated. The correlation coefficients between indirect MR arthrography and surgery for reader
1 and reader 2 were 0.9137 and 0.9773, respectively. Whereas the agreement between conventional MR imaging and surgery was
moderate (ϰ = 0.383–0.571), the agreement between indirect MR arthrography and surgery was excellent (ϰ = 0.873–0.936). We
suggest the use of indirect MR arthrography technique when conventional MR images are equivocal in diagnosis of rotator cuff
disease.
Received: 12 April 2000/Revised: 22 May 2000/Accepted: 23 May 2000 相似文献
18.
Mellado JM Salvadó E Camins A Ramos A Merino X Calmet J Saurí A 《European radiology》2002,12(3):650-659
The MR imaging features of fluid collections and juxta-articular cystic lesions of the shoulder are discussed, with special focus on those related to subacromial impingement and rotator cuff tears. Other more unusual fluid collections and cystic lesions are described, including rice-bodies bursitis, idiopathic synovial osteochondromatosis, dialysis-related amyloid arthropathy, hemophilic arthropathy, infectious conditions, non-infectious inflammatory arthritis, and paralabral cysts. 相似文献
19.
MRI of the shoulder 总被引:2,自引:0,他引:2
Vahlensieck M 《European radiology》2000,10(2):242-249
Shoulder imaging is one of the major applications in musculoskeletal MRI. In order to analyze the images it is important
to keep informed about anatomical and pathological findings and publications. In this article MRI technique, anatomy and pathology
is reviewed. Technical considerations about MR sequences and examination strategy are only shortly discussed with emphasis
on turbo spin echo and short T1 inversion recovery imaging. Basic anatomy as well as recent findings, including macroscopic
aspects of the supraspinatus fat pad, composition of the supraspinatus muscle belly, and variability of the glenohumeral ligaments
or coracoid ligament, are presented. Basic pathological conditions are described in detail, e. g. instability particularly
problems in differentiating the various subtypes of labral pathology. Rotator cuff diseases are elucidated with emphasis on
some rarer entities such as subscapularis calcifying tendinitis, coracoid impingement, chronic bursitis producing the double-line
sign, prominent coraco-acromial ligament and the impingement due to an inflamed os acromiale. 相似文献
20.
Magnetic resonance imaging is an established technique for imaging the shoulder because it demonstrates clearly the articular
surfaces, medullary canal and the extra-articular soft tissues which can be affected in shoulder disorders. The value of MR
imaging in the evaluation of the traumatized shoulder has been described [1]; however, few cases of MR imaging in nontraumatic
disorders in children have been reported. We reviewed the findings in 55 children undergoing MRI of the shoulder for nontraumatic
conditions and included selected cases showing a broad range of imaging findings.
Received 13 November 1995; Revision received 23 February 1996; Accepted 23 May 1996 相似文献