Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography

OBJECTIVE: To compare MR arthrography and CT arthrography for the evaluation of cartilage lesions in the ankle joint. DESIGN AND PATIENTS: Thirty-six consecutive patients with clinically suspected cartilage lesions were prospectively included in the study. A 1:1 mixture of diluted gadoteridol (4 mmol/l) and iopamidol (300 mg iodine/ml) was injected. The articular cartilages of the talus, tibia, and fibula were analyzed separately by two musculoskeletal radiologists. A review panel consisting of two musculoskeletal radiologists and an orthopedic surgeon represented the standard of reference. RESULTS: For reader 1 accuracy of MR arthrography in the talus/tibia/fibula (88%/88%/94%) was slightly inferior to CT arthrography (90%/94%/92%). For reader 2, the accuracy was 76%/78%/83% for MR arthrography, and 92%/93%/92% for CT arthrography, respectively. Interobserver agreement for MR arthrography was 79%/74%/89% (kappa 0.47/0.34/0.27), while interobserver agreement for CT arthrography was 89%/90%/89% (kappa 0.69/0.54/0.54). CONCLUSION: CT arthrography appears to be more reliable than MR arthrography for the detection of cartilage lesions in the ankle joint.     

The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: comparison with arthroscopic findings

Purpose

The purpose of the study is to determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery

Material and methods

This was a prospective study including fifty nine clinically diagnosed SLAP patients. The study was done during the period from January 2008 to June 2010. All patients were submitted to history taking, clinical examination and conventional MRI examination of the shoulder, MRA was done in patients with negative conventional MRI, all of these patients underwent arthroscopy for diagnosis wither open or arthroscopy for diagnosis and treatment and results were compared with MRA findings.

Main outcome measures

Sensitivity, specificity, positive and negative predictive values, and overall accuracy of MR arthrography in detection and grading of SLAP lesions of the gelnoid labrum.

Results

Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results.The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients.

Conclusion

MR arthrography is a sensitive minimally invasive technique for detection and grading of SLAP lesions, it can help in avoiding patients unnecessary diagnostic arthroscopy.     

Variants of the superior labrum and labro-bicipital complex: a comparative study of shoulder specimens using MR arthrography, multi-slice CT arthrography and anatomical dissection

The purpose of the present study was to evaluate the anatomical variability of the superior labrum and to compare the value of MR arthrography and multi-slice CT arthrography in the diagnosis of variants of the labro-bicipital complex. Forty-three human shoulder specimens (age range and mean age at death, 61–89 years and 78.3 years) were examined with the use of MR arthrography and multi-slice CT arthrography prior to joint exploration and macroscopic inspection of the superior labrum and labro-bicipital complex. Two radiologists evaluated MR and CT arthrograms, and the results were compared with macroscopic assessments. Anatomical dissection of all shoulder specimens revealed a sublabral recess in 32/43 (74%) cases. The attachment of the superior labrum was categorised as type 1 in ten (23%) cases, as type 2 in eight (19%), as type 3 in ten (23%), and as type 4 in 14 (33%) cases. One superior labrum showed detachment consistent with a superior labral anteroposterior (SLAP) type 3 lesion. On MR arthrography and CT arthrography the attachment of the superior labrum was categorised in concordance with macroscopic assessments in 79% and 84% of cases, respectively. The anteroposterior extension of sublabral recesses was accurately determined with MR and CT arthrography in 59% and 81% of cases, respectively. The attachment of the superior labrum shows considerable variability. Thus, exact depiction of variants is essential in order to avoid the false positive diagnosis of a superior labral tear (SLAP or Andrews lesion). Both, MR arthrography and multi-slice CT arthrography were effective in the detection and classification of sublabral recesses.     

Diagnosis of superior labral lesions: comparison of noncontrast MRI with indirect MR arthrography in unexercised shoulders

Objective To prospectively compare the accuracy of noncontrast magnetic resonance imaging (MRI) with indirect MR arthrography (I-MRa) of unexercised shoulders for diagnosis of superior glenoid labral lesions. Materials and methods Institutional Review Board approval and patient informed consent were obtained for this prospective study. Superior labral findings on shoulder MRI and unexercised I-MRa studies of 104 patients were correlated with findings at arthroscopic shoulder surgery. Two musculoskeletal radiologists independently reviewed the two sets of MR images while blinded to arthroscopic results. For each radiologist, the McNemar test was used to detect statistically significant differences between techniques. Results The superior labrum was intact in 24 and abnormal in 80 subjects. For detection of superior labral lesions by each radiologist, I-MRa was more sensitive (84–91%) than MRI (66–85%), with statistically significant improvement in sensitivity for one reader (p = 0.003). However, I-MRa was less specific (58–71%) than MRI (75–83%). Overall, accuracy was slightly improved on I-MRa (78–86%) compared with MRI (70–83%), but this difference was not statistically significant for either reader. Conclusion Compared with noncontrast MRI, I-MRa was more sensitive for diagnosis of superior glenoid labral lesions. However, the diagnostic value of I-MRa in shoulders remaining at rest is potentially limited by decreased specificity of the technique. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

Cartilage lesions in the hip: diagnostic effectiveness of MR arthrography

PURPOSE: To evaluate the diagnostic performance of magnetic resonance (MR) arthrography in the detection of articular cartilage lesions in patients suspected of having femoroacetabular impingement and/or labral abnormalities. MATERIALS AND METHODS: Forty-two MR arthrograms obtained in 40 patients with a clinical diagnosis of femoroacetabular impingement and/or labral defect were retrospectively analyzed. Two readers independently interpreted the images for cartilage lesion location, depiction, and characteristics. Within 6 months after MR arthrography, each patient underwent open hip surgery, during which the entire cartilage of the hip joint was inspected. Sensitivity, specificity, accuracy, and positive and negative predictive values were calculated. kappa values were calculated to quantify the level of interobserver agreement. RESULTS: At surgery, most (37 [88%] of 42) cartilage defects were identified in the anterosuperior part of the acetabulum. In 23 (55%), 12 (29%), 10 (24%), and 10 (24%) hips, lesions were found in the posterosuperior acetabulum, anteroinferior acetabulum, posteroinferior acetabulum, and femoral head, respectively. The sensitivities and specificities of MR arthrographic detection of cartilage damage in all regions combined were 79% (73 of 92 regions) and 77% (91 of 118 regions), respectively, for reader 1 and 50% (46 of 92 regions) and 84% (99 of 118 regions), respectively, for reader 2. At interobserver comparison, agreement was fair (kappa = 0.31) for detection of cartilage lesions in the femoral head and poor (kappa 相似文献   

肩袖损伤的影像学及关节镜诊疗价值

目的探讨肩袖损伤的影像学改变及关节镜检查在诊疗中的价值。方法18例肩袖损伤术前行造影和磁共振成像(MRI)。关节镜手术18例，其中关节镜下肩峰成形减压术16例，小切口肩峰成形2例。全层肩袖损伤10例行小切口肩袖缝合，肩袖部分磨损8例行关节镜下刨削清理术。结果肩关节造影13例，其中9例显示肩关节腔与肩峰下滑囊和三角肌下滑囊沟通，4例未见异常。MRI检查18例，其中10例显示肩袖全层损伤，8例冈上肌腱信号异常为部分损伤。根据关节镜检查结果判断其诊断准确率，MRI为100％，肩关节造影69％。术后随访时间3～22个月，平均7个月。根据美国加州洛杉矶大学(UCLA)肩关节评分标准，优9例，良6例，可3例，优良率达83％。结论肩关节造影有助于全层肩袖损伤的诊断；MRI对肩袖部分和全层损伤正确诊断率和敏感性最高；关节镜治疗肩袖损伤具有微创，有利于功能恢复。     

MR appearance of cartilage defects of the knee: preliminary results of a spiral CT arthrography-guided analysis

The aim of this study was to determine signal intensity patterns of cartilage defects at MR imaging. The MR imaging (3-mm-thick fat-suppressed intermediate-weighted fast spin-echo images) was obtained in 31 knees (21 male and 10 female patients; mean age 45.5 years) blindly selected from a series of 252 consecutive knees investigated by dual-detector spiral CT arthrography. Two radiologists determined in consensus the MR signal intensity of the cartilage areas where cartilage defects had been demonstrated on the corresponding reformatted CT arthrographic images. There were 83 cartilage defects at spiral CT arthrography. In 52 (63%) lesion areas, the MR signal intensity was higher than that of adjacent normal cartilage with signal intensity equivalent to (n=31) or lower than (n=21) that of articular fluid. The MR signal intensity was equivalent to that of adjacent normal cartilage in 17 (20%) lesion areas and lower than that of adjacent cartilage in 8 (10%) lesion areas. In 6 (7%) lesion areas, mixed low and high signal intensity was observed. The MR signal intensity of cartilage defects demonstrated on spiral CT arthrographic images varies from low to high on fat-suppressed intermediate-weighted fast spin-echo MR images obtained with our equipment and MR parameters.     

Evaluation of patellar cartilage surface lesions: comparison of CT arthrography and fat-suppressed FLASH 3D MR imaging

The aim of this study was to evaluate the sensitivity and specificity of fat-suppressed fast low-angle shot (FLASH) 3D MR imaging in the detection of patellar cartilage surface lesions in comparison with CT arthrography. Fifty patients, with or without symptoms of chondromalacia, were prospectively examined by CT arthrography and fat-suppressed 3D gradient-echo MR imaging. All MR examinations were evaluated by three observers, two of them reaching a consensus interpretation. The lesions were graded according to their morphology and their extent. The CT arthrography was considered as the reference examination. For both sets of observers, the final diagnosis of chondromalacia was obtained in 92.5 %. The specificity was 60 % on a patient-by-patient basis. Fissures were missed in 83 and 60 %, respectively, but were isolated findings only in 2.5 % of the cases. Considering ulcers involving more than 50 % of the cartilage thickness, 65 and 88 %, respectively, were recognized. Fat-suppressed FLASH 3D is an adequate pulse sequence for the detection of patellar cartilage ulcers. It can be applied on a routine clinical basis, but it does not show as many fissures as CT arthrography and is less precise for grading of lesions. Received 30 July 1997; Revision received 23 December 1997; Accepted 29 December 1997     

Spiral CT arthrography of the knee: technique and value in the assessment of internal derangement of the knee

Computed tomography imaging has achieved excellent multiplanar capability and submillimeter spatial resolution due to the development of the spiral acquisition mode and multidetector row technology. Multidetector spiral CT arthrography (CTA) yields valuable information for the assessment of internal derangement of the joints. This article focuses on the value of spiral CTA of the knee in the assessment of the meniscus, anterior cruciate ligament, and hyaline cartilage lesions. Advantages and disadvantages of spiral CTA with respect to MR imaging are presented.     

Ultra-high resolution C-Arm CT arthrography of the wrist: Radiation dose and image quality compared to conventional multidetector computed tomography

ObjectiveObjective of this phantom and cadaveric study was to compare the effective radiation dose (ED) and image quality (IQ) between C-arm computed tomography (CACT) using an ultra-high resolution 1 × 1 binning with a standard 16-slice CT (MDCT) arthrography of the wrist.MethodsED was determined with thermoluminescence dosimetry using an anthropomorphic phantom and different patient positions. Imaging was conducted in 10 human cadaveric wrists after tri-compartmental injection of diluted iodinated contrast material and a wire phantom. IQ of MDCT was compared with CACT reconstructed with a soft (CACT1) and sharp (CACT2) kernel. High and low contrast resolution was determined. Three radiologists assessed IQ of wrist structures and occurrence of image artifacts using a 5-point Likert scale.ResultsED of MDCT was comparable to standard CACT (4.3 μSv/3.7 μSv). High contrast resolution was best for CACT2, decreased to CACT1 and MDCT. Low contrast resolution increased between CACT2 and MDCT (P < 0.001). IQ was best for CACT2 (1.3 ± 0.5), decreased to CACT1 (1.9 ± 0.6) and MDCT (3.5 ± 0.6). Non-compromising artifacts were only reported for CACT.ConclusionsThe results of this phantom and cadaveric study indicate that ultra-high resolution C-Arm CT arthrography of the wrist bears the potential to outperform MDCT arthrography in terms of image quality and workflow at the cost of mildly increasing image artifacts while radiation dose to the patient is comparably low for both, MDCT and C-Arm CT.     

Articular cartilage lesions of the glenohumeral joint: diagnostic effectiveness of MR arthrography and prevalence in patients with subacromial impingement syndrome

PURPOSE: To determine the prevalence of articular cartilage lesions in patients with subacromial impingement syndrome and to assess the diagnostic effectiveness of magnetic resonance (MR) arthrography in detecting such cartilage abnormalities. MATERIALS AND METHODS: MR arthrographic images obtained in 52 consecutive patients (mean age, 45.8 years; age range, 17-73 years; 26 male and 26 female patients) were retrospectively evaluated for glenohumeral cartilage lesions. Two experienced musculoskeletal radiologists who were blinded to the arthroscopy report independently analyzed the articular cartilage. Humeral and glenoidal cartilage were assessed separately. The lesions were graded as either subtle or marked. Arthroscopic findings were the standard of reference. Sensitivity, specificity, accuracy, and interobserver agreement were calculated. RESULTS: At arthroscopy, humeral cartilage lesions were found in 15 patients (frequency, 29%). Four lesions were subtle, and 11 were marked. Cartilage lesions of the glenoid were less frequent (eight patients; frequency, 15%): Three were subtle, and five were marked. For reader 1 and reader 2, respectively, sensitivity of MR arthrography for humeral cartilage lesions was 53% and 100%, specificity was 87% and 51%, and accuracy was 77% and 65%; sensitivity for glenoidal cartilage lesions was 75% and 75%, specificity was 66% and 63%, and accuracy was 67% and 65%. Interobserver agreement for the grading of cartilage lesions with MR arthrography was fair (humeral lesions, kappa = 0.20; glenoidal lesions, kappa = 0.27). CONCLUSION: Glenohumeral cartilage lesions are found in up to one third of patients referred for MR arthrography for subacromial impingement syndrome. The performance of MR arthrography in the detection of glenohumeral cartilage lesions is moderate.     

Lipoma arborescens of the glenohumeral joint: a possible cause of osteoarthritis

Lipoma arborescens is a very rare intra-articular lesion characterized by villous lipomatous proliferation of the synovium, usually involving the knee joint. To date, in the literature, there has been only one reported case of lipoma arborescens in the glenohumeral joint. But, the authors treated the patient conservatively and reported only the magnetic resonance imaging (MRI) findings. We report a case of a patient with lipoma arborescens involving the glenohumeral joint. To our knowledge, this is the first reported case of lipoma arborescens involving the glenohumeral joint managed by arthroscopic synovectomy. We identified reactive bone erosions and arthritic changes in the humeral head in a 22-year-old male patient by arthroscopy.     

Diagnostic value of MR arthrography in detection of intrinsic carpal ligament lesions: use of cine-MR arthrography as a new approach

Twenty-five patients with chronic wrist pain and a preliminary diagnosis of carpal instability were examined with conventional MR imaging and MR arthrography with single compartment intra-articular injection. A new cine-MR arthrography technique, with image acquisition at every 5 s during intra-articular injection, was performed in 17 subjects. The purpose of this study was to determine the diagnostic value of MR arthrography in ligamentous lesions of the wrist and to assess the value of cine-MR arthrography in comparison with arthroscopy and/or surgery. Magnetic resonance arthrography, a semi-invasive technique, increased the diagnostic accuracy of intrinsic carpal ligament injuries. Cine-MR arthrography can be considered as a promising technique especially for the evaluation of lunatotriquetral and scapholunate ligament injuries of the wrist. Received 6 December 1995; Revision received 29 November 1996; Accepted 24 February 1997     

Multirater agreement for grading the femoral and tibial cartilage surface lesions at CT arthrography and analysis of causes of disagreement

ObjectiveTo assess the multirater agreement of the modified Outerbridge system for the grading of predefined areas of femorotibial cartilage at CT arthrography with multiple readers, with varying experience.DesignFive readers with varying experience (two junior radiologists, three musculoskeletal radiologists including two experts in cartilage imaging) separately analyzed 962 cartilage sectors from pre-divided knee CT arthrograms with femorotibial osteoarthritis (Kellgren/Lawrence = 3). Each cartilage area was graded twice by each reader, at a three-month interval, according to the modified 5-grade Outerbridge system. Interobserver and intraobserver agreement were assessed. After the second reading, 121 areas exhibiting the highest interobserver disagreement were reviewed in consensus to determine the sources of disagreement.ResultsThe global interobserver agreement was fair (k = 0.35), and increased with the grade (from k = 0.14 to k = 0.76 from grade 0–4). The intraobserver agreement varied with the readers’ experience from moderate (k = 0.59) to almost perfect (k = 0.92). The majority of cases of disagreement (44%) was due to difficulties in assessing the normal variations of cartilage thickness, including diffuse cartilage thinning (23%) and normal variants of cartilage thickness (22%). 32% of cases of disagreement were due to retrospectively avoidable interpretation errors.ConclusionsThe multirater agreement of the modified Outerbridge system is only fair when readers of different level of experience are taken into account, and interobserver agreement increases with readers’ experience. However, interobserver agreement is substantial for grade 4 lesions. We report normal variations of cartilage thickness that may improve observer agreement in reporting cartilage lesions.     

肩关节MR造影对肩关节前方盂唇病变的诊断价值

目的明确肩关节造影MR对肩关节前方盂唇病变的诊断价值，并比较中立位肩关节造影MR和外展外旋（abduction and external rotation, ABER）造影MR的价值。方法回顾性分析经证实的44例肩关节造影MR资料，以肩关节镜检查结果为金标准，对比中立位肩关节造影MR和ABER造影MR对肩关节前方盂唇病变的诊断价值。结果中立位肩关节造影MR对前方盂唇的诊断敏感度为79．3％（23／29），特异度为100％（15／15），准确度为86．4％（38／44）；ABER造影MR的敏感度为93．1％（27／29），特异度为100％（15／15），准确度为95．5％（42／44）。ABER造影MR显著提高了前方盂唇病变的诊断敏感度（P=0．037）。结论ABER造影MR可以提高肩关节前方盂唇病变的诊断敏感度。     

Distribution of normal and abnormal fluid collections in the glenohumeral joint: Implications for MR arthrography

Although magnetic resonance (MR) images of the glenohumeral joint frequently demonstrate intraarticular fluid, no specific criteria have, to the authors' knowledge, been published that allow accurate assessment of the amount of fluid present. Also, despite the increasing use of MR arthrography of the shoulder, the optimal amount of intra-articular fluid that should be used with this technique has not been determined. The authors progressively distended the glenohumeral joint in six cadaveric shoulder specimens with a dilute gadopentetate dimeglumine solution and obtained MR images after injection of 2, 5, 10, 15, and 20 mL of the solution. The pattern of fluid distribution was evaluated, and these results were then used to estimate the amount of fluid that was present in the glenohumeral joint on MR images of 20 shoulders obtained in 12 asymptomatic volunteers. In 14 of these shoulders, intraarticular fluid was present; however, in none was more than 2 mL evident. Results of the cadaveric study also indicated that 15 mL of intraarticular fluid appears to be the optimal amount for MR arthrography.     

Accuracy of double-contrast arthrography and arthroscopy of the knee joint

Only in the diagnosis of medial meniscal lesions is double contrast arthrography superior to arthroscopy, provided that arthroscopy is carried out only from the anterolateral side (94% against 81% positive correlations). The rates in diagnosing lateral meniscal lesions are respectively 90% and 94.5%, in patellar chondropathy 55% and 99.5% respectively, and in diagnosing cruciate ligament lesions 69% and 97% respectively.     

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

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