Comparison of 3.0-T MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population

Objective:

We report our experience in diagnostic sensitivity of 3.0-T conventional MR vs 3.0-T MR arthrography of the hip for detection of acetabular labral tears and chondral defects in the same patient population.

Methods:

43 consecutive patients had both conventional hip MR and MR arthrography examinations performed. These examinations were reviewed retrospectively by independent reading of two musculoskeletal radiologists who read the MR and MR arthrogram examinations in a randomized fashion (i.e. MR and MR arthrogram examinations were read at separate sittings and in a randomized fashion so as not to bias reviewers). Scans were assessed for acetabular labral tears and chondral defects. All patients went on to arthroscopy.

Results:

Of these 43 patients, 40 had acetabular labral tears read by Reader 1 and 39 had acetabular labral tears read by Reader 2 on MR arthrogram, 39 had acetabular labral tears read by Reader 1 and 38 had acetabular labral tears read by Reader 2 on conventional MR examination. There were 42 labral tears in 43 patients at arthroscopy. There were four false-negative labral tears compared with arthroscopy on MR and three false negatives on MR arthrography for Reader 1 and five false negatives on MR and four false negatives on MR arthrography for Reader 2. Each reader had one false-positive labral tear compared with arthroscopy on both MR and MR arthrography. There were 32 acetabular chondral defects at arthroscopy. Reader 1 saw 21 acetabular chondral defects on conventional MR and 27 chondral defects at MR arthrography. Reader 2 saw 19 acetabular chondral defects at conventional MR and 25 acetabular chondral defects on MR arthrography. There were no false-positive readings of chondral defects compared with arthroscopy on MR and one false positive for Reader 1 and two false positives for Reader 2 on MR arthrography as compared with arthroscopy. On conventional MR examination, sensitivities and specificities as compared with arthroscopy were as follows: Reader 1 acetabular labral tear (90% sensitivity, 0% specificity) and Reader 2 acetabular labral tear (88% sensitivity, 0% sensitivity). On MR arthrogram, sensitivities and specificities as compared with arthroscopy for Reader 1 were 93%, 0% and for Reader 2 were 90%, 0%, respectively. Sensitivities and specificities for detection of acetabular chondral defects as compared with arthroscopy were Reader 1 conventional MR (65% sensitivity, 100% specificity), Reader 1 MR arthrography (81% sensitivity, 91% specificity), Reader 2 conventional MR (59% sensitivity, 100% specificity) and Reader 2 MR arthrography (71% sensitivity, 82% specificity).

Conclusion:

In this series, 3.0-T MR demonstrated sensitivity for detection of acetabular labral tears that rivals the sensitivity of 3.0-T MR arthrography of the hip. In this series, 3.0-T MR arthrography was more sensitive than conventional 3.0-T MR for detection of acetabular chondral defects.

Advances in knowledge:

3.0-T MR and MR arthrography are near equivalent in the diagnosis of acetabular labral tears. This information is useful for pre-operative planning.MR arthrography has been reported to be more sensitive and specific for detection of acetabular labral tears in the hip than conventional MRI.^1–10 MR arthrography has also been reported to be superior in detection of acetabular cartilage defects as compared with conventional MRI.¹¹ To our knowledge 3.0-T MR vs 3.0-T MR arthrography sensitivity for detection of acetabular labral tears and chondral defects has not been specifically assessed.To our knowledge, Petersilge et al¹ first reported the utility of hip MR arthrography in the diagnosis of acetabular labral tears. Toomayan et al² compared MR arthrography of the hip with conventional MRI of the hip in different patient populations. He found MR arthrography with a small field of view to be substantially more sensitive for detection of acetabular labral tears than conventional MRI. Sutter et al¹¹ found 1.5 T MR arthrography to be superior to conventional MRI for detecting labral tears and acetabular cartilage defects.Patients with acetabular labral tears present with symptoms of persistent pain, clicking, locking and decreased range of motion. With the availability of hip arthroscopy, labral tears can more easily be addressed with minimally invasive surgery. Accurate pre-operative identification of labral tears is needed.² Based on previous studies demonstrating the accuracy of MR arthrography in detection of acetabular labral tears, surgeons often request MR arthrography of the hip to characterize labral tears prior to surgery.^1–10 The purpose of this study is to assess 3.0-T MR vs MR arthrography diagnostic performance in detection of acetabular labral tears and chondral defects in the same patient population using arthroscopy as a reference standard.     

3.0T常规MRI与MR髋关节造影诊断髋臼唇撕裂的对比研究

目的 在3.0 T场强中,比较常规髋关节MRI及MR髋关节造影对髋臼唇撕裂的诊断价值.方法 回顾分析44例髋关节病变患者的患侧髋关节常规MRI及MR髋关节造影资料,将每例患者的臼唇划分为前、上、后3处区域(共计132处),确定有无撕裂,并进行分型.其中5例患者经髋关节镜检查.对于常规MRI及MR髋关节造影获得的臼唇撕裂及分型数据差异比较采用Wilcoxon秩和检验,一致性比较采用Kappa检验.结果 常规MRI与MR髋关节造影诊断完全相同者计116处臼唇,只有16处存在诊断差异.其中,前者诊断无撕裂而后者诊断撕裂者9处,前者诊断撕裂但后者诊断无撕裂者6处,其余1处两者均诊断为撕裂但分型不同.常规MRI与MR髋关节造影的评价差异没有统计学意义(Z=0.347,P＞0.05),且具有极好的一致性(K=0.781,P＜0.01).在接受关节镜的5例患者中,常规MRI、MR髋关节造影及关节镜结果均完全吻合.结论 对髋臼唇撕裂,3.0 T常规髋关节MRI可获得与MR髋关节造影基本相同的诊断效果.     

The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder

Purpose

The purpose of this study is to compare MR arthrography in abduction and external rotation (ABER) position with conventional MR arthrography in neutral position for the detection and further classification of anteroinferior labroligamentous lesions.

Materials and methods

Two hundred and twenty-nine cases of shoulder MR arthrography with subsequent arthroscopy were retrospectively evaluated. All MR arthrograms in ABER position and neutral position were independently assessed by two radiologists who were blinded to the arthroscopic findings. Sensitivities and specificities of both positions for detection and further categorization of anteroinferior labroligamentous lesions were calculated and compared using paired McNemar test. K values were calculated to quantify the level of interobserver agreement.

Results

At arthroscopy, 24 Bankart lesions, 59 ALPSA lesions, 39 Perthes lesions, 8 GLAD lesions, 4 ALIPSA lesions, 31 nonclassifiable lesions and 60 intact anteroinferior complexes were found. The sensitivity of MR arthrography in ABER position for detecting anteroinferior labroligamentous lesions was significantly higher than that of in neutral position (92.7–94.5% versus 81.8–83%, P < 0.05). For the detection rate of the mentioned 6 subtypes of lesions, only the Perthes lesions had significant improvement in ABER position when compared with conventional MR arthrography (observer 1, 61.5–87.2%, P = 0.006; observer 2, 69.2–92.3%, P = 0.004). MR arthrography in ABER position was more effective in identifying of Perthes lesions (66.7–74.4% versus 35.9–40%, P < 0.05) while the conventional MR arthrography was more effective in accurate diagnose of ALPSA lesions (74.6–78.0% versus 54.2–55.9%, P < 0.05). No statistically significant difference of the diagnostic accuracy was found between the two positions for Bankart lesions, GLAD lesions, and ALIPSA lesions.

Conclusion

MR arthrography in ABER position has more added value on detection of Perthes lesions in evaluation of anteroinferior labroligamentous complex tear.     

Acetabular labral tears: contrast-enhanced MR imaging under continuous leg traction

 Objective. The objective of this study was to evaluate the effects of continuous leg traction on contrast-enhanced MR imaging of the hip joint and to determine whether MR imaging under these conditions is useful for demonstrating acetabular labral tears. Design and patients. Nineteen hips underwent MR imaging with a T1-weighted spin-echo sequence, followed by MR imaging under continuous leg traction after intravenous injection of gadolinium-DTPA. Joint fluid enhancement and labral contour detection were evaluated. Eleven hips had labral tears shown by conventional arthrography, arthroscopy and macroscopic surgical findings. Assessment of labral tears by MR imaging was correlated with the diagnosis based on these standard techniques. Results and conclusions. Joint fluid enhancement was obtained in all hips at 30 min after injection. Superior and inferior labral surfaces were completely delineated in 1 hip on the unenhanced MR images, and in 7 and 13 hips, respectively, on the enhanced images under traction. The enhanced images under traction depicted 9 of the 11 labral tears. Comparison between the unenhanced image and the enhanced image under traction avoided mistaking undercutting of the labrum for a tear in 4 hips. Contrast-enhanced MR imaging under traction was valuable for detecting labral tears non-invasively and without radiation. Follow-up examinations using this method in patients with acetabular dysplasia can help to clarify the natural course of labral disorders and enable better treatment planning.     

Ultrasound versus magnetic resonance arthrography in acetabular labral tear diagnostics: a prospective comparison in 20 dysplastic hips

Background: Acetabular labral tears are highly associated with hip dysplasia. Magnetic resonance arthrography (MR arthrography) is the expensive and time-consuming contemporary gold-standard method in the radiological assessment of acetabular labral tears.

Purpose: To assess the diagnostic ability of noninvasive ultrasound (US) examination compared to MR arthrography in diagnosing acetabular labral tears in dysplastic hip joints.

Material and Methods: The study compared US examination and MR arthrography diagnosis of labral tears in 20 consecutively referred dysplastic hip joints.

Results: The ability to diagnose acetabular labral tears upon US examination was calculated: sensitivity 44%, specificity 75%, positive predictive value 88%, and negative predictive value 25%.

Conclusion: The ability of US examination in diagnosing acetabular labral tears is not yet good enough. The technique is still to be developed, and more experience, especially with the interpretation of US examinations, is needed.     

Sensitivity of MR arthrography in the evaluation of acetabular labral tears

OBJECTIVE: MRI has historically provided suboptimal visualization of tears of the acetabular labrum. Degenerative fraying and underlying cartilage abnormalities can often mimic tears of the labrum on conventional MRI. Administration of intraarticular gadolinium enhances the MRI appearance of the labrum to improve detection of labral abnormalities. This study examined the improved diagnostic sensitivity of MR arthrography compared with conventional MRI and the importance of confining the study to a small field of view. MATERIALS AND METHODS: Fifty-one hips were imaged in 48 patients. Fourteen hips underwent conventional MRI with a large field of view (30-38 cm). Seven hips underwent conventional MRI with a small field of view (14-20 cm). Thirty hips underwent MR arthrography with a small field of view (14-20 cm). Labral tears were diagnosed when contrast material was identified within the labrum or between the labrum and the acetabulum, when a displaced fragment was noted, or when a paralabral cyst was identified. All study results were compared with findings at the time of hip arthroscopy. RESULTS: Conventional MRI with a large field of view was 8% sensitive in detecting labral tears compared with findings at the time of arthroscopy. Diagnostic sensitivity was improved to 25% with a small field of view. MR arthrography with a small field of view was 92% sensitive in detecting labral tears. CONCLUSION: A combination of MR arthrography and a small field of view is more sensitive in detecting labral abnormalities than is conventional MRI with either a large or a small field of view.     

MR arthrography of the hip joint

MR arthrography of the hip joint is usually performed after a conventional MRI has been obtained to rule out other pathologies of the hip joint as for instance bone marrow edema or osteonecrosis of the hip. MR arthrography is mainly performed as a very special investigation, and it is executed in most cases if the clinician asks for the diagnosis of a labral lesion. In very rare cases, MR arthrography of the hip is performed to image cartilage disease or osteochondrosis dissecans or free intraarticular bodies. In this paper, the indications, the technique, and the most important pathology of the hip joint--labral lesions--will be described as well as variants of the normal acetabular labrum. After a conventional MRI of the hip joint has been performed, a MR arthrography of the hip will be obtained to search for labral pathology or cartilage disease. MR arthrography is obtained after the intraarticular injection of 10-20 ml of a 0.1 mmol solution of gadopentate-dimeglumine has been performed. The intraarticular injection can either be fluoroscopic-guided or CT-guided or directly MR-guided. After the intraarticular injection, MR arthrography will be performed by the use of paracoronal and parasagittal T1-weighted spin echo or gradient echo sequences. In cases of labral lesions (degeneration, labral tear, labral detachment) or cartilage disease MR arthrography proved to be more sensitive as conventional MRI as shown in the literature. The sensitivity of MRI to detect labral pathology was reported to be about 65%, and that of MR arthrography was reported to be about 92-95% compared to surgical results. According to the current literature, MR arthrography is the most sensitive method to delineate these kind of pathologies. Therefore, the invasive technique of MR arthrography may be justified for the correct diagnosis of these kind of pathologies after other pathologic entities have been ruled out by conventional MRI.     

Synovial plicae of the hip: evaluation using MR arthrography in patients with hip pain

Objective  

The appearance and distribution of the intra-articular plicae of the hip have been addressed in few reports in the anatomic and radiological literature. This study aims to determine the prevalence of visible synovial hip plicae using MR arthrography and to measure the association of visible synovial hip plicae with MR arthrographic diagnosis of labral tears, femoroacetabular impingement, and osteoarthritis.     

Conventional magnetic resonance imaging versus MR arthrography (MRA) of the wrist in the evaluation of triangular fibrocartilage lesions

Objective

The aim of this study is to assess the diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the triangular fibrocartilage.

Subjects and methods

This study included 51 patients complaining of chronic wrist pain. Conventional MRI and MR arthrography (MRA) was done for all cases.

Results

A comparison of the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. MRI revealed a sensitivity (SEN) of 88.5%, specificity (SPE) of 100%, positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 69.2%, with an overall accuracy (ACC) of 90.9%, while MRA revealed a SEN of 94.2%, SPE of 100%, PPV of 100%, NPV of 81.8%, and ACC of 95.5%.

Conclusion

MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the triangular fibrocartilage requiring surgical intervention and help to reduce arthroscopic interventions.     

Sublabral sulcus at the posteroinferior acetabulum: a potential pitfall in MR arthrography diagnosis of acetabular labral tears

OBJECTIVE: Our study correlated findings on hip MRI and MR arthrography with hip arthroscopy to assess the location, prevalence, and potential pitfall of a normal acetabular sublabral sulcus. MATERIALS AND METHODS: We retrospectively collected 58 hip MRI studies along with surgical reports in 58 patients who underwent hip arthroscopy over a 5-year period. Intraoperative photography (n = 23), radiography (n = 56), unenhanced MRI (n = 13), and MR arthrography (n = 54) studies were available for review. Two radiologists described hip anatomy on radiology studies with agreement by consensus. RESULTS: A normal posteroinferior sublabral groove was confirmed on available arthroscopy photographs in four (17.4%) of 23 hips. In each of these four patients, the anatomic sublabral groove correlated with apparent partial labral detachment on MR arthrography. On review of all studies, 13 hips (22.4%) without a posterior labral tear at surgery had imaging findings of a sublabral sulcus. The sulcus was not associated with acetabular dysplasia, which was radiographically noted in 12 cases (21.4%). Preoperatively, the sulcus was misdiagnosed as a tear in two cases. Labral tears were anterior or anterosuperior in 51 patients. CONCLUSION: A posteroinferior sublabral groove is a relatively common normal anatomic hip variation. If not recognized as normal, the sulcus may serve as a diagnostic pitfall on MR arthrography. Its location is distinct from most labral tears. We did not discover a sublabral sulcus at the anterior or anterosuperior acetabulum, the most common sites of labral injury.     

髋关节MR造影在髋臼唇撕裂诊断中的应用

目的 探讨髋关节MR造影在髋臼唇撕裂诊断中的应用价值.方法 临床高度怀疑髋臼唇撕裂的15例20个髋关节在透视下行髋关节穿刺造影,采用SE T1WI加脂肪抑制技术,进行髋关节冠状面、矢状面、斜轴面及放射状位扫描.其中12例行关节镜检查.结果 在行髋关节镜检查的12例14个髋关节中,11例13个髋关节MR造影诊断为髋臼唇撕裂,与关节镜诊断相符;1例MR造影示正常,关节镜检查亦未发现髋臼唇撕裂.13个髋臼唇撕裂中位于前上象限12个髋关节,后上象限1个髋关节.在关节镜诊断髋臼唇撕裂的13个髋关节中,MR造影冠状面诊断髋臼唇撕裂3个髋关节,矢状面诊断10个髋关节,斜轴面及放射状位诊断髋臼唇撕裂均为13个髋关节.15例20个髋关节中有5例6个髋关节在后下象限有髋臼唇下沟表现.结论 MR髋关节造影是诊断髋臼唇撕裂的可靠方法,扫描方法应选择T1WI加脂肪抑制的矢状面及斜轴面或矢状面加放射状位.后下象限撕裂的诊断中应注意正常变异的存在.

Abstract：

Objective To investigate the application value of MR rthrography (MRA) in the diagnosis of acetabular labral tears. Methods Fifteen patients with a high degree of suspected acetabular labral tears received fluoroscope-guided injection of the contrast media into the hip joint ( hip arthrography) and fat-saturated spin-echo T1-weighted images were obtained in the coronal, sagittal, oblique-axial and radial planes. Hip arthroscopy was performed on 12 of them. Results Labral tears which were diagnosed in 11 patients by hip MRA were confirmed at hip arthroscopy. One patient showed no MRA indication of labral tear, also showed normal on arthroscopy. Tear in the anterior-superior quadrant 10 cases of 12 joints ( 12/13), posterior-superior quadrant 1 case of a joint (1/13). In 11 patients who underwent arthroscopy, hip MRA diagnosed 3 (3/13) joints labral tears in coronal planes, 10 (10/13) joints in sagittal planes and 13 (13/13) labral tears in axial-oblique and radial planes. In 15 patients with 20 hip joints, 5 cases 6 joints (6/20) with normal acetabular sublabral sulcus were performed. Conclusions MR arthrography of hip is a reliable method in the diagnosis of acetabular labral tears. Scanning method should be included fat-saturated spin-echo T1-weighted images in sagittal and oblique-axial planes or sagittal plus radial planes. The diagnosis of tor posterior-inferior quadrant should pay attention to the existence of a normal variation.     

Evaluation of radial-sequence imaging in detecting acetabular labral tears at hip MR arthrography

Objective In recent years, radial imaging has been advocated for improved visualization of the acetabular labrum in magnetic resonance arthrography of the hip. The purpose of this study was to investigate whether radial imaging demonstrates labral tears not visible on standard imaging planes. Methods Fifty-four consecutive magnetic resonance (MR) arthrograms of the hip that included radial imaging over 2 years were retrospectively analyzed by two radiologists. Standard imaging planes and radial imaging were reviewed for identification of labral tears in four specific areas of the labrum: anterosuperior, posterosuperior, anteroinferior, and posteroinferior. The standard imaging sequences include fat-saturated spin-echo T1-weighted images in the coronal and oblique axial planes, non-fat-saturated T1-weighted images in the coronal and sagittal planes, and T2-weighted sequence in the axial plane. Radial imaging was performed as previously described using fat-saturated T1-weighted sequences. Results Using standard imaging planes, 50 anterosuperior, 31 posterosuperior, 10 anteroinferior, and 9 posteroinferior labral tears were detected in 54 MR arthrograms of the hip. Using radial sequences alone, 44 anterosuperior, 25 posterosuperior, 9 anteroinferior, and 5 posteroinferior labral tears were detected. In all four areas of the labrum, the radial imaging did not show any labral tear not seen on standard imaging planes. Discussion In MR arthrography of the hip, radial imaging did not reveal any additional labral tears. Standard imaging planes sufficiently demonstrate all acetabular labral tears.     

MR arthrography of the hip: normal intra-articular structures and common disorders

This pictorial review illustrates the anatomical features of normal intra-articular components of the hip and their common disorders on MR arthrography. On T1-weighted MR arthrograms, the normal contrast-filled joint cavity shows a homogeneous high signal intensity. Normal acetabular labrum appears as a well-delineated triangle showing a low signal intensity, surrounded by contrast material in the perilabral recess. Intra-articular paramagnetic contrast outlines labral tears, loose bodies, communicating labral cysts and cartilage lesions (traumatic tears, focal defects, degenerative fissures and thinning), and improves their detection. Overall, MR arthrography enables accurate detection and staging of hip intra-articular structure abnormalities. Received: 6 June 1998; Revision received: 2 January 1999; Accepted: 2 April 1999     

MR versus MR arthrography in detection of supraspinatus tendon tears in patients without previous shoulder surgery

Purpose

We report the prevalence of supraspinatus tendon tears seen on MR arthrography that are not seen on conventional MR exam in the same patient population.

Materials and methods

A total of 150 consecutive conventional shoulder MR and MR arthrography exams performed on the same patients who went on to arthroscopy were reviewed retrospectively by consensus reading of two musculoskeletal radiologists. Full-thickness supraspinatus tendon tears were assessed. None of the patients had previous shoulder surgery.

Results

There were 113 full-thickness supraspinatus tendon tears seen on conventional MR exam while there were 119 full-thickness supraspinatus tendon tears seen on MR arthrography. The six additional full-thickness supraspinatus tendon tears seen on MR arthrography but not seen on conventional MR exam were confirmed at arthroscopy.

Conclusions

Some full-thickness supraspinatus tendon tears are not seen on conventional MR exam but are seen on MR arthrography. This is most likely due to fibrosis at the supraspinatus tendon tear site simulating an intact tendon on conventional MR.     

MR imaging of anterior cruciate ligament reconstruction poor outcomes

Purpose

Is to study the diagnostic value of MR imaging in assessment of poor outcomes of ACL reconstruction using second look arthroscopy of the knee as a gold standard.

Patients and methods

51 patients were included in this study who did ACL reconstruction followed by MRI and second look arthroscopy. Arthroscopy study was performed within 7–15 days from MR examination. The time interval between ACL reconstruction and MRI examination was 10 months to 9 years. MR images were evaluated for; (1) ACL graft failure assessing the primary and secondary signs, (2) Tibial and femoral tunnel location, and (3) Complication of ACL graft reconstruction. MR imaging results were compared with the arthroscopic results.

Results

Second look arthroscopy revealed 23 patients with full- thickness ACL graft tears, 17 partial -thickness ACL graft tears and 11 intact ACL grafts. Complete ACL graft discontinuity, focal ACL graft thinning and preserved 100% graft thickness were the most valuable primary MRI signs in the diagnosis of full thickness ACL graft tear, partial tear and intact graft respectively.

Conclusion

We found MR imaging to be reliable for the evaluation of ACL graft poor outcomes including graft failure and complications.     

Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology

Objective  

To compare the diagnostic ability of MR arthrography (MRa) and MDCT arthrography (CTa) in depicting surgically proven hip labral tears and articular cartilage degradation.     

MR Arthrography of the Hip

Magnetic resonance imaging (MRI) of the hip has been valuable in the diagnosis of occult osseous abnormalities and of periarticular soft tissue disorders. MRI has been less useful in the evaluation of acetabular labral tears and other intra-articular abnormalities. Image optimization is more technically challenging in the hip than in smaller joints because the overlying soft tissues are thicker, resulting in decreased spatial and contrast resolutions that may not be adequate to distinguish the acetabular labrum from subchondral bone, articular cartilage, and joint capsule. MR arthrography (MRA) extends the capabilities of conventional MRI because contrast solution separates intra-articular structures and outlines abnormalities. In hips with suspected acetabular labral injury, arthrographic MR images demonstrate the location and length of tears and the presence of associated capsular defects. Arthrographic MR images may also enable the accurate diagnosis of cartilage lesions and intra-articular loose bodies. This article illustrates normal arthrographic MR features of the hip as well as pathologic disorders of the acetabular labrum, capsule, and articular cartilage     

3-T direct MR arthrography of the wrist: Value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears

Purpose

To determine the value of applying finger trap distraction during direct MR arthrography of the wrist to assess intrinsic ligament and triangular fibrocartilage complex (TFCC) tears.

Materials and methods

Twenty consecutive patients were prospectively investigated by three-compartment wrist MR arthrography. Imaging was performed with 3-T scanners using a three-dimensional isotropic (0.4 mm) T1-weighted gradient-recalled echo sequence, with and without finger trap distraction (4 kg). In a blind and independent fashion, two musculoskeletal radiologists measured the width of the scapholunate (SL), lunotriquetral (LT) and ulna-TFC (UTFC) joint spaces. They evaluated the amount of contrast medium within these spaces using a four-point scale, and assessed SL, LT and TFCC tears, as well as the disruption of Gilula's carpal arcs.

Results

With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1 mm, p ≤ 0.040), and noticed more contrast medium therein (p ≤ 0.035). In contrast, the differences in width of the LT (mean Δ = +0.1 mm, p ≥ 0.057) and UTFC (mean Δ = 0 mm, p ≥ 0.728) spaces, as well as the amount of contrast material within these spaces were not statistically significant (p = 0.607 and ≥0.157, respectively). Both readers detected more SL (Δ = +1, p = 0.157) and LT (Δ = +2, p = 0.223) tears, although statistical significance was not reached, and Gilula's carpal arcs were more frequently disrupted during finger trap distraction (Δ = +5, p = 0.025).

Conclusion

The application of finger trap distraction during direct wrist MR arthrography may enhance both detection and characterisation of SL and LT ligament tears by widening the SL space and increasing the amount of contrast within the SL and LT joint spaces.     

Obturator externus bursa: prevalence of communication with the hip joint and associated intra-articular findings in 200 consecutive hip MR arthrograms

The purpose of the study was to demonstrate the prevalence of communication between the hip joint and the obturator externus bursa on hip MR arthrography. Following institutional review board approval, 200 hip MR arthrograms in 196 subjects were independently reviewed by two musculoskeletal radiologists. Discrepancies were resolved by adjudication. The presence or absence of communication between the hip joint and the obturator externus bursa was recorded. Associated lesions involving the acetabular labrum and articular cartilage were recorded. The obturator externus bursa was shown to communicate with the hip joint in 11 of the 200 (5.5%) hip MR arthrograms. Of these, six were in men and five were in women. The age range was 15–63 years with a mean age of 34 years. All 11 patients had labral tears. Eight of the 11 had cartilage lesions. The obturator externus bursa can be seen to communicate with the hip joint in 5.5% of hip MR arthrograms. Associated labral and cartilage lesions are common.     

Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA)

Objective

The aim of this study is to assess the diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the internal ligaments of the wrist mainly the scapholunate and lunotriquetral ligaments.

Subjects and methods

This study included 51 patients complaining of chronic wrist pain. Conventional MRI and MR arthrography (MRA) were done in all cases.

Results

A comparison of the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. Regarding complete SLL tears, MRI revealed a SEN, SPE and ACC of 61.54%, 96.77%, and 86.36%, while MRA showed a SEN, SPE and ACC of 92.31%, 100%, and 97.73% respectively, partial SLL tears, un-enhanced MRI revealed SEN, SPE and ACC of 10%, 94.12%, and 75%, while MRA showed 66.67%, 85.71%, and 81.82% respectively, complete LTL tears un-enhanced MRI revealed a SEN, SPE, and ACC of 25%, 100%, and 79.5% respectively, while MRA showed 91.67%, 100%, and 97.73% respectively.

Conclusion

MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.