Radiologic anatomy of the metacarpophalangeal joints II to V

The metacarpophalangeal (MCP) joints II to V of 21 hands were examined radiologically and arthrographically. Different recesses of the joint cavity were demonstrated both radiologically and macroscopically, with a dominating dorsal recess. The existing forms of the dorsal recess were one-tailed, two-tailed, three-tailed, symmetric and cap-like. Additionally, a palmar recess was found in the specimens examined, which presented as a small protrusion of the capsule and lay between the metacarpal head and the palmar plate. Furthermore, a distal recess was filled and unfolded in almost all the cases. Lateral recesses were found in the radial and ulnar directions beneath the collateral ligaments. The dorsal recess, due to its ability to collect fluid, is of clinical importance in pathologic processes causing effusions, while the clinical importance of the lateral recesses lie in their proximity to the stabilizing collateral ligaments of the metacarpophalangeal joints. The above mentioned recesses were seen as normal formations of the MCP joints and should therefore be taken into account in pathologic processes in this area.     

The scapholunate interosseous ligament in MR arthrography of the wrist: correlation with non-enhanced MRI and wrist arthroscopy

 Objective. To compare three-compartment MR wrist arthrography with non-enhanced MRI in correlation with wrist arthroscopy, and to evaluate the potential of MR arthrography for consistently visualizing all parts of the scapholunate interosseous ligament of the wrist (SLIL) and exactly diagnosing the site and extent of SLIL defects. Design and Patients. In 41 patients with wrist pain (34 patients with wrist pain for more than 6 months) plain radiographs, stress views, non-enhanced MRI and three-compartment MR arthrography were done within 2 h of each other, using three-dimensional volume acquisition (0.6–1.0 mm effective slice thickness) with a gradient-recalled echo sequence and a 1.5-T magnet. The MR arthrography findings were compared with the findings from non-enhanced MRI and correlated with the arthroscopic findings in all patients. Results. The dorsal, central and palmar segments of the SLIL could be delineated exactly by MR arthrography in 95% of the patients; with non-enhanced MRI only 28% of SLIL segments were seen consistently. Demonstration of SLIL defects was possible with high diagnostic confidence in 42% of SLIL segments by non-enhanced MRI and in 94% by MR arthrography. With wrist arthroscopy as the standard of reference, sensitivity and specificity values for SLIL perforations were 52%/34% for non-enhanced MRI and 90%/87% for MR arthrography. Conclusions. MR arthrography, using three-dimensional volume acquisition with thin slices (0.6–1.0 mm), combines the advantages of three-compartment arthrography and non-enhanced MRI. It shows the precise location and magnitude of ligamentous defects of all parts of the SLIL, correlates well with wrist arthroscopy and has potential implications for diagnosis and treatment planning.     

Arthrography of painful hips following arthroplasty: digital versus plain film subtraction

Digital and manual subtraction images obtained during the arthrographic evaluation of 78 painful hip prostheses were reviewed retrospectively. Revision arthroplasty was performed in 53 of these cases, and the arthrographic and surgical findings were correlated. The digital and manual subtraction images were evaluated without knowledge of the surgical results using established criteria for component loosening. Digital subtraction arthrography of the femoral component demonstrated a 96% sensitivity and 100% specificity for the diagnosis of component loosening. Sensitivity and specificity for acetabular component loosening were 83% and 80%, respectively. Plain film subtraction of the femoral component demonstrated a 79% sensitivity and 100% specificity; the sensitivity and specificity for the acetabular component were 75% and 80%, respectively. The difference between detection of femoral component loosening on digital as opposed to manual subtraction images was statistically significant (P<0.05). This study demonstrates that digital subtraction improves the evaluation of femoral component loosening in painful hip prostheses.     

结合关节造影、单人闭合复位治疗儿童肱骨远端全骨骺分离骨折的疗效观察

目的探讨关节造影下单人闭合复位治疗儿童肱骨远端全骨骺分离骨折的手术技巧及疗效。 方法回顾性分析2017年1月至2020年1月期间中山市中医院收治的43例肱骨远端全骨骺分离骨折患儿的临床病历资料,其中男32例、女11例;年龄1.5 ~ 4.2个月,平均2.8个月。伸直尺偏型37例,伸直桡偏型6例;高处坠落伤18例,运动中摔伤25例。受伤至手术时间为12 ~ 34 h,平均20.5 h。均可采用关节造影、单人操作完成闭合复位,助手经皮克氏针内固定术,术后石膏托外固定。术后3、6、9个月时采用Flynn肘关节临床功能评分标准评定疗效。 结果本组手术时间（32.8±10.6）min,术中透视次数（10.5±3.2）次。平均住院时间4 d（3 ~ 7 d）。43例均获得随访,平均随访时间18.4个月（9 ~ 36个月）。术后3 ~ 4周,X线片显示骨折临床愈合后,拆除石膏并拔除克氏针。按照Flynn肘关节临床功能评分标准评定疗效：术后3个月优良率为81.4％（35/43）,术后6个月优良率为88.3％（38/43）,术后9个月优良率为88.3％（38/43）。术后患儿均未出现骨筋膜室综合征、血管神经损伤、皮肤坏死、钉道感染等并发症。 结论术中肘关节造影可清晰地显示肱骨远端软骨,指导单人闭合复位微创治疗肱骨远端全骨骺分离骨折,直观判断复位后效果,指导经皮穿入克氏针,取得满意的治疗效果,本方法操作相对简单,易于掌握,疗效确切,有利于肘关节功能早期恢复,值得推广。     

The comparison of direct magnetic resonance arthrography with volumetric interpolated breath-hold examination sequence and multidetector computed tomography arthrography techniques in detection of talar osteochondral lesions

ObjectiveThe aim of this study was to compare additive diagnostic values of magnetic resonance (MR) arthrography with volumetric interpolated breath-hold examination (VIBE) sequence and multidetector computed tomography (MDCT) arthrography for diagnosis and grading of talar osteochondral lesions.MethodsMDCT arthrography and MR arthrography with three dimensional VIBE sequence were performed in 27 patients. Findings of MR arthrography and MDCT arthrography images were compared with arthroscopic findings. Sensitivity, specificity, and accuracy rates were calculated for both MR arthrography and MDCT arthrography imaging findings.ResultsFor grade I osteochondral lesions; sensitivity, specificity and accuracy rates of MR arthrography were 95%, 73%, 90%, respectively; For grade I osteochondral lesions; sensitivity, specificity and accuracy rates of MDCT arthrography were 96%, 79%, 81%. For grade IV osteochondral lesions; sensitivity, specificity and accuracy rates of MDCT arthrography and MR arthrography were 100%. For grade II lesions, the sensitivity, specificity and accuracy rates of the MR arthrography were 80%, 76%, 77%, respectively; for grade III lesions, the sensitivity, specificity and accuracy rates of the MR arthrography were 78%, 68%, 75%. For grade II osteochondral lesions; the sensitivity, specificity and accuracy rates of the MDCT arthrography were 91%, 81%, 86%; for grade III osteochondral lesions; the sensitivity, specificity and accuracy rates of the MDCT arthrography were 90%, 83%, 89%; For grade II and III osteochondral lesions, MDCT arthrography had higher sensitivity, specificity and accuracy rates than MR arthrography. MDCT arthrography had higher diagnostic performance than MR arthrography for detection of grade II and III lesions (p = 0.041 and p = 0.038, respectively).ConclusionMDCT arthrography appears to be more reliable than MR arthrography with three dimensional VIBE sequence for accurate detection and grading of osteochondral lesions.Level of evidenceLevel III, Diagnostic Study.     

Comparison study of indirect MR arthrography and direct MR arthrography of the shoulder

Objective  To compare the diagnostic value of indirect magnetic resonance arthrography (I-MRA) with that of direct MR arthrography (D-MRA) for labral tears, rotator cuff tears, and long head of biceps tendon (LHBT) tears using a 3-T MR unit. Materials and methods  Institutional review board approval was given; written informed consent was obtained from all patients. From November 2005 to June 2006, 19 patients (eight men and 11 women; mean age, 51 years) who had undergone both I-MRA and D-MRA underwent arthroscopic surgery. Both methods were performed in fat-saturated axial, coronal oblique, and sagittal oblique T1-weighted sequences, as well as axial and coronal oblique T2-weighted sequences. Two radiologists independently and retrospectively evaluated two sets of MRA for the diagnosis of superior and anterior labral tears, subscapularis tendon (SSC), and supraspinatus–infraspinatus tendon (SSP–ISP) tears, and LHBT tears. With the arthroscopic finding as a gold standard, we analyzed statistical differences of sensitivities and specificities between two sets of MRA and inter-observer agreement was evaluated using the kappa value. Results  The sensitivity and specificity of I-MRA and D-MRA for reader 1 were 79/80% and 71/80%, respectively, for superior labral tears; 100/100% and 100/100%, respectively, for anterior labral tears; 64/75% and 64/100%, respectively, for SSC tears; 100/86% and 100/100%, respectively, for SSP–ISP tears; and 67/100% and 78/100%, respectively, for LHBT tears. Those of I-MRA and D-MRA for reader 2 were 86/80% and 71/100%, respectively, for superior labral tears; 100/83% and 100/100%, respectively, for anterior labral tears; 64/88% and 82/100%, respectively, for SSC tears; 92/86% and 100/100%, respectively, for SSP–ISP tears; and 78/90% and 89/100%, respectively, for LHBT tears. No significant differences were found between the methods. Inter-observer agreements were higher than moderate (κ > 0.41) with both methods. Conclusions  Based on a relatively small number of patients, no significant difference was detected between I-MRI and D-MRI with regard rotator cuff, labral, and LHBT tears.     

间接法MR膝关节造影在前交叉韧带损伤中的诊断价值

目的:评价间接法MR膝关节造影对前交叉韧带(ACL)损伤的诊断价值.方法:分析78例经手术证实的膝关节MR平扫加间接法MR膝关节造影扫描的膝关节外伤患者的MR资料,与关节镜手术结果对比分析.结果:常规MR平扫诊断ACL损伤的敏感性、特异性、准确性、阳性似然比和阴性似然比分别为83.3％、80.5％、86.5％、4.3421和0.1645,间接法MR关节造影诊断ACL损伤的敏感性、特异性、准确性、阳性似然比和阴性似然比分别为93.5％、92.8％、94.4％、11.7317和0.0531,两者对诊断ACL的损伤在统计学分析上有显著性差异.结论:间接法MR膝关节造影相比于常规MR平扫明显提高了对ACL损伤的诊断符合率.     

Depiction of the triangular fibro-cartilage in patients with ulnar-sided wrist pain: comparison of direct multi-slice CT arthrography and direct MR arthrography

To compare direct multi-slice CT arthrography (MSCT-AG) and direct MR arthrography (MR-AG) of the wrist with regard to the depiction of the triangular fibro-cartilage (TFC). Fifteen consecutive patients with ulnar-sided wrist pain suspicious for TFC tear underwent both MSCT-AG and MR-AG of the wrist. Images obtained were evaluated by two radiologists in a blinded fashion for the depiction of six anatomical areas (radial, central and ulnar portion on the proximal and distal side) of the TFC by means of a five-point scoring system (1 = excellent visibility to 5 = not visible). Scores for MSCT-AG and MR-AG were compared using the Student's t-test. Mean scores for MSCT-AG and MR-AG, respectively, were 2.5/2.0, 3.2/2.5 and 2.8/2.4 for the radial, central and ulnar portion of the TFC on its proximal side, and 2.7/2.0, 3.1/2.3 and 2.9/2.4 for the radial, central and ulnar portion on its distal side (n = 15). Paired Student's t-test showed no significant difference between MSCT-AG and MR-AG (P > 0.05). In a first, small series, depiction of the TFC with MSCT-AG is comparable to that of MR-AG. Further evaluation of direct multi-slice CT arthrography of the wrist in a larger patient population would be promising.