Ultrasonographic guidance of needle placement for shoulder arthrography.

We describe a technique using high resolution ultrasonography for needle placement for shoulder arthrography employing the posterior approach, which to our knowledge has not been reported previously. Twenty-four patients with clinical suspicion of rotator cuff lesion underwent shoulder arthrography under sonographic control. Patients ranged in age from 26 to 72 years (mean, 57 years). Accuracy of the needle placement using this technique was 100%. There were no injuries to adjacent structures and no extravasation outside the joint. Although fluoroscopic control of needle placement during shoulder arthrography is the technique of choice, sonographic control using the posterior approach may be useful in certain situations (e.g., if the patient is concerned about radiation dose or if there is soft tissue injury at the anterior of the shoulder.     

肩关节MR造影对前下肩关节囊撕裂的诊断价值

目的评估肩关节MR造影对前下肩关节囊撕裂的诊断价值,并总结前下肩关节囊撕裂的影像表现。方法由2名影像诊断医师独立回顾分析183例经肩关节镜证实的肩关节不稳的肩关节造影MR图像,判定有无前下肩关节囊撕裂。计算肩关节MR造影对前下肩关节囊撕裂的敏感度和特异度。采用Kappa统计计算2名影像诊断医师评价的一致性。之后,对照肩关仃镜结果,2名医师共同总结前下肩关节囊撕裂的MR造影征象。结果183例患者中,肩关节镜证实前下肩关节囊撕裂28例（15.3％）,肩关节MR造影的敏感度为57．1％～67．9％,特异度为96．7％～98．7％,2名影像诊断医师的评价一致性好（K=0．698）。在肩关节MR造影中,14例前F肩关节囊撕裂表现为前下肩天节囊的连续性中断,5例表现为下盂眩韧带前束的连续性中断,6例表现为前关节囊松弛,其余3例前关节囊未见异常。结论肩关节MR造影诊断前下肩关节囊撕裂的敏感度中等,特异度较高,前下肩关节囊和下盂肱韧带前束的连续性中断为其主要表现。     

常规MRI与MR关节造影诊断肩关节前脱位所致盂肱下韧带及前下盂唇撕裂

目的 对比观察常规M RI与M R关节造影(M RA)对肩关节前脱位所致盂肱下韧带及前下盂唇撕裂的诊断价值.方法 对56例肩关节前脱位患者(56侧患肩)行肩关节常规M R检查及M RA,以手术结果为金标准,对比观察其对盂肱下韧带撕裂及前下盂唇撕裂的诊断价值.结果 56侧患肩中,38侧(38/56,67.86％)盂肱下韧...     

肩关节MR造影各向同性三维容积插入屏气序列评价盂唇撕裂

目的 评价肩关节MR造影各向同性三维容积插入屏气(VIBE)序列对盂唇撕裂的诊断价值。方法 由2名影像诊断医师独立回顾性对比分析79例肩关节造影常规二维序列图像和各向同性三维VIBE重建图像,判定有无盂唇撕裂,计算敏感度和特异度,比较常规二维序列与各向同性三维VIBE诊断价值及两名影像诊断医师评价的一致性。结果 79例患者中,肩关节镜证实上方盂唇撕裂(SLAP损伤)27例,前方盂唇撕裂44例,后方盂唇撕裂10例。肩关节MR造影各向同性三维VIBE以及常规二维序列对上方盂唇撕裂的敏感度分别为81.48%(22/27)~88.89%(24/27)、85.19%(23/27)~92.59%(25/27),特异度为82.69%(43/52)~84.62%(44/52)、84.62%(44/52)~86.54%(45/52);对前方盂唇撕裂的敏感度分别为88.64%(39/44)~90.91%(40/44)、90.91%(40/44)~95.45%(42/44),特异度为94.29%(33/35)~97.14%(34/35)、97.14%(34/35);对后方盂唇撕裂的敏感度分别为80.00%(8/10)~90.00%(9/10)、80.00%(8/10),特异度为92.75%(64/69)~95.65%(66/69)、94.20%(65/69)~95.65%(66/69)。2名影像诊断医师评价的一致性极好。各向同性三维VIBE和常规二维序列对于盂唇撕裂的诊断效能差异均无统计学意义。结论 肩关节MR造影各向同性三维VIBE序列成像是评价盂唇撕裂比较可靠的影像方法。     

3.0T MR髋关节造影诊断髋臼唇撕裂

目的 探讨3.0T MR髋关节造影(MRA)在髋臼唇撕裂诊断中的价值.方法 回顾性分析74例髋关节疾病患者的髋关节镜及术前髋关节MRA资料.以关节镜检查结果为金标准,评估3.0T MRA诊断髋臼前唇和上唇撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确率,并比较MRA诊断髋臼前唇和上唇撕裂的差异.结果 74例患者的75个髋关节中,关节镜证实61处前唇撕裂,29处上唇撕裂.2名医师(医师1和医师2)采用MRA诊断髋臼前唇撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为90.16%(55/61)和91.80%(56/61)、78.57%(11/14)和85.71%(12/14)、94.83%(55/58)和96.55%(56/58)、64.71%(11/17)和70.59%(12/17)、88.00%(66/75)和90.67%(68/75),诊断上唇撕裂的敏感度、特异度、阳性预测值、阴性预测值和准确率分别为89.66%(26/29)和93.10%(27/29)、91.30%(42/46)和95.65%(44/46)、86.67%(26/30)和93.10%(27/29)、93.33%(42/45)和95.65%(44/46)、90.67%(68/75)和94.67%(71/75).2名医师诊断髋臼前唇和上唇撕裂的一致性好(Kappa值分别为0.924和0.916).MRA诊断髋臼上唇撕裂的阴性预测值高于前唇,差异有统计学意义(P=0.01),而敏感度、特异度、阳性预测值和准确率的差异均无统计学意义(P均>0.05).结论 3.0T髋关节MRA是诊断髋臼唇撕裂的可靠影像方法.     

Sonography of the shoulder after arthrography (arthrosonography): preliminary results.

PURPOSE: The purpose of this study was to verify whether arthrosonography improves diagnostic accuracy in diseases of the shoulder and provides additional information for therapeutic planning, compared with conventional sonography. METHODS: We prospectively studied 113 consecutive patients with chronic shoulder pain. Sonography was performed before and after arthrography, with the radiologist blinded to the results of arthrography. When a rotator cuff tear was detected sonographically, its type, location, and size were recorded; we also evaluated any changes in the subacromial-subdeltoid bursa and any abnormalities in the biceps tendon sheath. The diagnostic accuracy of conventional sonography and arthrosonography was compared with that of arthrography for rotator cuff tear. Changes in the subacromial-subdeltoid bursa and biceps tendon sheath seen on conventional sonography were also compared with those seen on arthrosonography. RESULTS: The sensitivity and specificity of conventional sonography in the diagnosis of rotator cuff tear were 86% (25/29) and 95% (80/84), respectively; for arthrosonography, the values were 97% (28/29) and 95% (80/84), respectively. The differences in sensitivity and specificity for the 2 sonographic techniques were not statistically significant (p > 0.05). The accuracy in localizing the tear was also not significantly different between the 2 sonographic techniques. Synovial proliferation was more easily detected with arthrosonography than it was with conventional sonography in the subacromial-subdeltoid bursa (p < 0.01) and in the biceps tendon sheath (p < 0.0001). CONCLUSIONS: Our preliminary results suggest that although arthrosonography was not superior to conventional sonography in the diagnosis of rotator cuff tears, it may provide a better assessment of the size of tears and additional information about synovial proliferation in the subacromial-subdeltoid bursa and the biceps tendon sheath.     

肩关节造影及液压扩张疗法治疗冻结肩的临床研究

目的 探讨肩关节造影及液压扩张法治疗冻结肩的关节造影表现、评价治疗作用和影响疗效的相关因素,材料和方法 对19例经我院骨科确诊为冻结肩的病人进行肩关节造影并同时进行液压扩张治疗,观察造影表现和临床随诊、评价其症状缓解和关节功能恢复情况。结果 19例冻结肩均有关节容量的缩小,平均容量仅6.5ml,其中腋隐窝缩小、消失者14肩（73％）;肱二头肌长头腱鞘不显影或育盈不良者15肩（79％）;肩胛肌下滑囊缩小者10肩（53％）;关节囊边缘不规整者7肩（37％）。液压扩张治疗优效率：轻、中型100％,重型70％。结论 液压扩张疗法治疗冻结肩,并辅以积极的术后功能锻练是安全、经济而有效的方法,能达到缓解临床症状、恢复关节功能的目的。     

MRI检查在肩关节损伤的临床应用

目的评价MRI检查在肩关节的临床应用。方法分析31例肩关节常规MRI检查和17例肩关节MRI造影检查的形态学特点。结果扫描发现肩袖完全撕裂、肩袖部分撕裂、肌腱炎、盂唇撕裂、关节积液、肱二头肌长头腱损伤等;常规MRI诊断关节盂唇撕裂的敏感性为78％,特异性为88％;诊断肩袖部分撕裂敏感性为80％,特异性均为75％,诊断肩袖完全撕裂的敏感性为95％,特异性为88％。MRI肩关节造影诊断肩袖部分撕裂的敏感性为91％,特异性为100％;肩袖完全撕裂的敏感性为95％,特异性为100％;诊断关节盂唇撕裂的敏感性为78％,特异性为88％。结论肩关节MRI能清晰显示出肩关节的复杂解剖结构,肩关节MRI造影能清晰显示肩袖、关节盂唇等正常机病理情况,对肩关节损伤的诊断和鉴别诊断具有较高的价值。     

Evaluation of the clinical significance of classification of traumatic anterior shoulder instability using double-contrast computed tomography arthrography

This study evaluated the clinical significance of traumatic anterior shoulder instability (TASI) classification using double-contrast computed tomography (CT) arthrography. Patient were randomly assigned to two groups: group 1 (n = 62); and group 2 (n = 63). TASI symptom severity in group 1 was assessed using physical signs of shoulder trauma and conventional X-ray, CT and magnetic resonance imaging; these patients received either conservative management (with physical rehabilitation) or standard surgery. Group 2 underwent double-contrast CT arthrography to classify TASI; its findings formed the basis of subsequent management. At 24 months post-therapy, significant improvements in clinical outcomes were observed in group 2: Constant scores were higher and Western Ontario Shoulder Instability Index scores were lower. At 24 months, recurrence rates were 21.0% (13/62) in group 1 and 7.9% (5/63) in group 2. Findings suggested that TASI classification using double-contrast CT arthrography provided meaningful information thereby improving treatment efficacy.     

外伤性肩袖损伤MR平扫与MR关节造影的诊断价值

目的：评价ＭＲ平扫和ＭＲ关节造影在外伤性肩袖损伤中的诊断价值。材料与方法：经关节镜证实的外伤性肩袖撕裂２５例,其中左肩１０例,右肩１５例,男性１９例,女性６例;行常规的ＭＲ平扫后,在透视下穿刺肩关节腔注入１５～２０ｍｌ的混合性造影剂,在４５分钟内完成再一次的ＭＲ扫描。结果：关节镜证实肩袖的完全撕裂、部分撕裂分别为１０例和１５例。在肩袖完全撕裂中,ＭＲ平扫和ＭＲＡ诊断的准确率分别为８０％（８／１０）     

Sonography and sonoarthrography of the scapholunate and lunotriquetral ligaments and triangular fibrocartilage disk: initial experience and correlation with arthrography and magnetic resonance arthrography.

OBJECTIVE: The purpose of this study was to determine the utility of sonography and sonoarthrography in evaluation of dorsal bands of the scapholunate ligament (SLL), lunotriquetral ligament (LTL), and triangular fibrocartilage (TFC) disk in correlation with arthrography and magnetic resonance arthrography (MRA). METHODS: High-resolution sonography of the SLL, LTL, and TFC disk was performed on symptomatic wrists in 16 patients referred by a hand surgeon for MRA of the symptomatic wrists. All patients then underwent arthrography and an MRA study of the same wrist. After MRA, sonography was repeated. The imaging findings of these different techniques were then compared. Four patients (25%) underwent surgery of their wrists. In these 4 patients, the surgical and imaging findings were correlated. RESULTS: For the SLL, the results were concordant for all imaging modalities in 15 patients (93.75%) and partially concordant in 1 (6.25%). For the LTL, the results were concordant for all imaging modalities in 12 patients (75%), partially concordant in 3 (18.75%), and discordant in 1 (6.25%). For the TFC disk, the results were concordant for all imaging modalities in 13 patients (81.25%), partially concordant in 2 (12.5%), and discordant in 1 (6.25%). The arthroscopic and imaging findings were concordant for 3 SLLs, 3 LTLs, and 3 TFC disks. CONCLUSIONS: Our preliminary results are encouraging. Sonography may be used at least as a screening imaging modality in evaluation of the SLL and TFC disk. Sonoarthrography improves evaluation of the LTL.     

Magnetic resonance artfrography of the shoulder

Background. There is constant increase in number of patients seeking medical help due to shoulder diseases. Imaging techniques may facilitate making the diagnosis and decide about the treatment modality, including decision on operative treatment. Magnetic resonance is widely accepted for imaging of soft tissue lesions of the shoulder.
Material and Methods. This study was based on material of 26 patients with shoulder pain and dysfunction with diagnostic difficulties or postoperative monitoring. Standard MR was performed first, followed by direct arthrography in MR.
Results. MR arthrography of the shoulder revealed more labral and capsule (ligament) as well as SLAP lesions than standard MR. Arthrography enabled better visualization of degree of rotator cuff lesion. There was more III and IV grade lesions shown in the cuff.
Conclusions. MR arthrography enabled better assessment of rotator cuff lesions and better visualization of capsulo-labral complex lesions.     

Focal splenic lesions: US findings

Ultrasound (US) imaging of the spleen was considered of little use in the past and was performed only to distinguish between cystic and solid lesions. However, in the last decade due to experience acquired and the introduction of second-generation contrast agents, this technique has been re-evaluated as contrast-enhanced US (CEUS) allows detection and characterization of most focal lesions of the spleen with a high sensitivity and a good specificity. Gray-scale US presents a low specificity in splenic infarctions with a high rate of false negative cases, whereas specificity reaches 100 %, if the examination is performed using US contrast agents. Gray-scale US can provide a correct diagnosis in simple cysts, whereas CEUS is useful when cystic lymphangioma is suspected. In the study of splenic lesions, the most important problem is to differentiate between angioma, hamartoma, lymphoma, and metastasis. CEUS reaches a good specificity in the differentiation of benign from malignant splenic lesions, as hypo-enhancement in the parenchymal phase is predictive of malignancy in 87 % of cases. In conclusion, Gray-scale US and particularly CEUS are at present widely indicated in the study of focal splenic lesions.     

Role of magnetic resonance in shoulder disease

Next to the knee, the shoulder is the most common joint to be referred for MRI. Excellent soft tissue contrast and multiplanar acquisition provide optimal assessment of muscle, tendons, hyaline and fibrous cartilage, joint capsule, fat, bursae and bone marrow. In this article the most common indications for shoulder MRI are reviewed and discussed, but we focused primarily on the rotator cuff syndrome and shoulder instability. Correct diagnosis requires the use of appropriate pulse sequences and imaging planes, proper patient positioning, and a satisfactory surface coil. Moreover, technical improvements continuously augment the ability of MRI to study the shoulder; for example Magnetic Resonance arthrography is superior to the other imaging techniques in evaluation of glenohumeral joint. This interdependence between technical development in MRI and clinical advance in shoulder therapy ensures that MRI will continue to play an important role in the routine management of patients with shoulder disease.     

髋关节盂唇撕裂的3.0 T髋关节MR造影与常规MRI对比研究

目的对比分析髋关节MR造影和常规髋关节MRI对髋关节盂唇撕裂的诊断价值。方法 53例患者同时接受了常规髋关节MR检查和髋关节MR造影检查,之后进行了髋关节镜手术。由两名放射医师独立回顾分析髋关节MR图像,观察分析结果与髋关节镜手术相比较。结果 53例患者中,髋关节镜证实髋关节盂唇撕裂31例。髋关节MR造影评估髋关节盂唇撕裂的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为90.32%、77.27%、84.91%、84.85%和85.00%(医师甲),93.55%、77.27%、86.79%、85.29%和89.47%(医师乙),观察者间一致性好(Kappa值=0.797)。常规髋关节MRI评估髋关节盂唇撕裂的敏感度、特异度、准确性、阳性预测值和阴性预测值分别为54.84%、72.73%、62.26%、73.91%和53.33%(医师甲),61.29%、77.27%、67.92%、79.17%和58.62%(医师乙),观察者间一致性好(Kappa值=0.733)。髋关节MR造影诊断髋关节盂唇撕裂的敏感度、准确性和阴性预测值高于常规髋关节MR检查(P0.05),两种检查方法的特异度和阳性预测值无统计学差异(P0.05)。结论髋关节MR造影是评价髋关节盂唇撕裂比较可靠的方法,诊断性能优于常规髋关节MRI。     

MRI与MR关节造影诊断肩袖不同程度撕裂准确性的Meta分析

目的 通过Meta分析评价MRI和MR关节造影（MRA）对肩袖不同程度撕裂的诊断价值。方法 检索Cochrane图书馆、Embase、PubMed、万方、维普及CNKI等数据库,收集符合纳入标准的文献,并对文献进行评价和筛选。应用Metadisc及STATA软件对纳入的试验结果进行分析。结果 共获取符合纳入标准的文献36篇,其中包含全层撕裂文献33组数据、部分撕裂文献25组数据。各研究间存在异质性。MRI及MRA诊断肩袖全层撕裂的汇总加权敏感度、特异度、SROC曲线下面积（AUC）分别为[95%CI（0.85,0.90）]、0.95[95%CI（0.93,0.96）]、0.973 3、0.93[95%CI（0.91,0.95）]、0.96[95%CI（0.93,0.97）]、0.981 4。MRI及MRA诊断肩袖部分撕裂的汇总加权敏感度、特异度、SROC曲线下面积分别为0.70[95%CI（0.64,0.76）]、0.92[95%CI（0.89,0.94）]、0.824 3、0.82[95%CI（0.77,0.86）]、0.94[95%CI（0.92,0.95）]、0.937 6。两种检查手段对诊断肩袖不同程度撕裂的AUC差异无统计学意义。结论 虽然MRA诊断肩袖撕裂的准确率高于MRI,但两者无显著差异。常规MRI诊断肩袖撕裂不明确时,可考虑采用MRA进一步检查。     

Diagnostic sensitivity of ultrasound-guided needle biopsy in soft tissue masses about superficial bone lesions.

We evaluated the value of ultrasound-guided needle biopsy in 20 soft tissues masses about superficial bone lesions in 20 oncology patients. Sonographically guided needle biopsies were performed without an on-site pathologist. A diagnostic sensitivity of 95% and specificity of 100% in separating a benign or a malignant lesion was obtained. Fine needle aspiration cytology allowed the specific cell type of malignancy to be diagnosed in 80% of cases, while core needle biopsy allowed it in 91%. Real-time ultrasonographic guidance permits precise needle placement into the targets, avoidance of hypervascular areas, and flexibility of patient positioning so that needle biopsy can be performed quickly and safely on soft tissue masses about superficial bone lesions.     

Radiographic Evaluation of Patients with Anterior Shoulder Instability

Purpose of Review

Injuries to the labrum, joint capsule (in particular the inferior glenohumeral ligament), cartilage, and glenoid periosteum are associated with anterior shoulder instability. The goal of this review is to provide common radiographic images and findings in patients with anterior shoulder instability. Furthermore, we will demonstrate the best methods for measuring anterior glenoid bone loss.

Recent Findings

Magnetic resonance (MR) imaging is highly relied upon for evaluating anterior shoulder instability and can diagnose soft tissue injuries with high sensitivity. While 3D computed tomography (CT) scan has been considered the optimal tool for evaluating osseous defects, certain MR imaging sequences have been shown to have similar diagnostic accuracy. Repair of Bankart lesions is critical to stabilizing the shoulder, and in the recent years, there has been an increasing focus on imaging to accurately characterize and measure glenoid bone loss to properly indicate patients for either arthroscopic repair or anterior bony reconstruction. Furthermore, Hill-Sachs lesions are commonly seen with shoulder instability, and importance must be placed on measuring the size and depth of these lesions along with possible engagement, as these factors will dictate management.

Summary

The labral-ligamentous complex and rotator cuff are primary stabilizers of the shoulder. With anterior shoulder instability, the labrum is frequently injured. MRI with an arthrogram or provocative maneuvers is the gold standard for diagnosis. Various imaging modalities and methods can be performed to identify and measure Bankart and Hill-Sachs lesions, which can then be used for surgical planning and treating shoulder instability.

     

Use of ultrasound for diagnosis of interposition of soft tissue in bone fracture line

Ultrasound (US) has recently become a favorable diagnostic technique in orthopedics and traumatology, as well as in other medical sciences. We aimed to determine effectiveness of US in diagnosis of soft tissue interposition that impedes or delays the union of fracture. The present study included 55 acute fractures in 39 patients, in whom operation (open reduction and internal fixation) was scheduled because no closed reduction was achieved, in our department between January 1999 and December 2003. Before the operation, the fracture line in all patients was scanned by a 5- to 7-MHz linear probe of the US device. The data obtained by US examination were compared to findings obtained by surgical intervention with the McNemar test. These were calculated as positive predictive value and negative predictive value, with specificity and sensitivity. The difference between the study and control groups was not statistically significant (p = 0.625). These findings demonstrated that sensitivity value, specificity value, positive and negative predictive values were 96.9%, 86.3%, 91.4% and 95%, respectively. US is an efficient, safe and reliable diagnostic technique for detection of interposition of soft tissue in bone fracture line.     

A prospective,observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project

Background

Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.

Methods

A prospective, observational cohort study. Twenty-six patients with acute shoulder trauma and no identifiable radiograph abnormality were screened for inclusion. Those unable to actively abduction their affected arm to 90° at initial presentation and at two week’s clinical review were consented for MRA.

Results

Twenty patients (Mean age 44 years, 4 females) proceeded to MRA. One patient had no abnormality, three patients showed minimal pathology. Four patients had an isolated bony/labral injury. Eight patients had injuries isolated to the rotator cuff. Four patients had a combination of bony and rotator cuff injury. Four patients were referred to a specialist shoulder surgeon following MRA and underwent surgery.

Conclusions

Significant soft tissue pathology was common in our cohort of patients with acute shoulder trauma, despite the reassurance of normal plain radiography. These patients were unable to actively abduct to 90° both at initial presentation and at two week’s post injury review. A more aggressive management and diagnostic strategy may identify those in need of early operative intervention and provide robust rehabilitation programmes.