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ABSTRACT Purpose: To investigate the relationship between the cartilage acetabular index and acetabular development and secondary dysplasia. Methods: A total of 58 hips underwent intraoperative arthrography-guided open reduction or limited open reduction due to developmental hip dysplasia between 2011 and 2015 was included in the study. We evaluated patients with acetabular angle 8º as group 2. Intraoperative acetabular cartilage index measurements were performed, and patients with low and high cartilage acetabular index were divided into two groups. Results: There was a correlation between the cartilage acetabular index value, which indicates preoperative cartilage acetabular coverage, and acetabular development and secondary acetabular development. Conclusion: The cartilage acetabular index is a technically easy and uncomplicated evaluation method that can be used to estimate acetabular development and should be used routinely together with the bone acetabular index.

The presence of healthy cartilage in the knee joint, featuring smooth articular surfaces, is crucial for normal physiological knee function. However, noninvasive in-vivo assessment of cartilage quality in the knee remains challenging and has not been thoroughly investigated. We aimed to illustrate two clinical cases, a 62-year-old male and a 67-year-old male, presented to the orthopaedic outpatient clinic with severe knee complaints. The novel combination of sodium fluoride-18 positron emission tomography/computed tomography and intra-articular injection of a contrast agent (Na[18F]F-PET/CT arthrography) was performed to evaluate cartilage defects of the knee as part of a prospective patient study. The lesion size observed on the Na[18F]F-PET was substantially larger compared to the findings on CT. This might indicate that Na[18F]F-PET/CT arthrography was able to image osseous and chondral pathological changes in an early stage and in a single procedure. Na[18F]F-PET/CT arthrography is a promising imaging technique and might extend the diagnostic potential of nuclear and radiological imaging in the evaluation of cartilage defects.

This study aims to establish an optimized CTA protocol for qualitatively evaluating the ligamentous structures and menisci of the canine stifle. CTA of the stifle joint was conducted on six healthy beagle dogs. Each dog underwent a total of nine scans to evaluate various contrast protocols. These protocols involved three different concentrations of iodine (50, 100, and 150 mgI/mL) and three different volumes of contrast media injection (0.2, 0.3, and 0.4 mL/kg). Subsequently, the acquired arthrographic images were qualitatively assessed to determine the visibility of the stifle ligaments. The quantitative evaluation of CTA revealed that the cranial and caudal cruciate ligaments were more clearly visible in groups M2 (100 mgI/mL, 0.3 mL/kg) and M3 (100 mgI/mL, 0.4 mL/kg) in comparison to S1 (50 mgI/mL, 0.2 mL/kg) and L3 (150 mgI/mL, 0.4 mL/kg). The visibility of the medial meniscus was notably lower in S1 and S2 (50 mgI/mL, 0.3 mL/kg), while the lateral meniscus exhibited reduced visibility in S1. Overall, the high contrast settings (M2, M3) generally improved the visualization of the meniscofemoral ligament, meniscotibial ligament, and the intermeniscal ligament. For optimal evaluation of the canine stifle ligament using CTA, it is recommended to use 100 mgI/mL iodine at a dosage of 0.3 mL/kg or 0.4 mL/kg.

PurposeThis study aimed to report the preliminary outcome of gradual reduction (GR) utilizing two-stage traction (TST) compared with traditional traction (TT) in the treatment of developmental dysplasia of the hip (DDH) and to evaluate whether the prognosis of the TST is better than that of TT.MethodsThe following information on children diagnosed with DDH who underwent treatment with GR using two-stage traction or traditional traction between June 2016 and August 2017 was collected: sex, age, weight, acetabular index (AI), International Hip Dysplasia Institute (IHDI) classification, femoral head ossification, traction time, reduction quality, and labrum shape in arthrography. The AI, IHDI classification, second operation rate, and incidence of femoral head avascular necrosis (AVN) were analyzed after the final comprehensive 1-year follow-up.ResultsIn this study, 27 cases (31 hips: 18 left and 13 right) were enrolled, with 18 hips (16 cases) assigned to the TT group and 13 hips (11 cases) assigned to the TST group, with the corresponding average age at diagnosis of 5.56 ± 1.66 and 4.06 ± 1 months (p

This paper provides a comprehensive overview of the potential applications of dual-energy CT (DECT) in improving image quality and the diagnostic capabilities of CT arthrography (CTA) in clinical practice. The paper covers the use of virtual non-contrast (VNC) images, in which the injected contrast medium is subtracted from the articular cavity in order to better analyze 2D and 3D images of the bone. Moreover, virtual monoenergetic imaging (VMI) applications and their potential use for the reduction of metal artifacts and improving image contrast are reviewed. The role of virtual non-calcium (VNCa) in detecting bone marrow edema surrounding the imaged joint will be discussed. Furthermore, the role of iodine maps in enhancing the contrast between soft tissues, optimizing the visualization of contrast material, and distinguishing contrast material from calcifications is described. Finally, a case series including different joints is provided to underline the additional advantages of high-spatial-resolution dual-energy CT reconstructed images.

Abstract Background Capsular contracture is a well-known etiology in the primary stiff shoulder; thus capsular contracture and resultant decreased joint volume could lead to postoperative stiffness, which is a commonly reported morbidity after arthroscopic rotator cuff repair (ARCR). The purpose of this study was (1) to quantify the joint volume (total joint volume and each quadrant compartmental volume) using computed tomography arthrography (CTA) and (2) to demonstrate the relationship between joint volume and postoperative range of motion (ROM) after ARCR. Materials and methods Eighty-three patients (60 ± 5.11 years, men = 26, women = 57) who had undergone ARCR between January 2015 to December 2020 due to small to medium full-thickness tear and followed by CTA 6 months postoperatively were retrospectively reviewed. An image reconstruction program (3D Slicer, version 4.11.2 software) was used to calculate the joint volume (total joint volume and quadrant compartment joint volumes; anteroinferior, anterosuperior, posterosuperior and posteroinferior). For shoulder ROM, data including scaption (Sc), external rotation on side (ERs), external rotation at 90° (ER90), and internal rotation on back (IRb) were collected 6 months postoperatively. An evaluation of the correlation between joint volume and each shoulder motion was performed. Results There were moderate correlations between the total joint volume and each motion (Sc: Pearson coefficient, 0.32, p = 0.0047; ERs: Pearson coefficient, 0.24, p = 0.0296; ER90: Pearson coefficient, 0.33, p = 0.0023; IRb: Pearson coefficient, 0.23, p = 0.0336). Among the quadrant compartments, the anteroinferior (Sc: Pearson coefficient, 0.26, p = 0.0199; ERs: Pearson coefficient, 0.23, p = 0.0336; ER90: Pearson coefficient, 0.25, p = 0.0246; IRb: Pearson coefficient, 0.26, p = 0.0168) and posterosuperior (Sc: Pearson coefficient, 0.24, p = 0.029; ER90: Pearson coefficient, 0.29, p = 0.008; IRb: Pearson coefficient, 0.22, p = 0.0491) and posteroinferior (Sc: Pearson coefficient, 0.30, p = 0.0064; ER90: Pearson coefficient, 0.29, p = 0.0072) showed moderate correlations with each shoulder motion. Conclusion Total joint volume, anteroinferior compartment joint volume, posterosuperior compartment joint volume and posteroinferior compartment joint volume were related to postoperative ROM after ARCR. Perioperative methods to increase the joint volume, especially the anteroinferior, posterosuperior and posteroinferior parts of the capsule may prevent postoperative stiffness after ARCR. Level of Evidence Level III; Retrospective Case-Control Study.

Abstract Background The current diagnosis of feline carpal injuries is based on radiographic examination including stress views and computed tomography; however, these techniques do not allow for direct evaluation of the carpal ligaments. The purpose of this cadaveric study was to assess the ability of CT arthrography (CTA) and MR arthrography (MRA) to provide this information using a single contrast mixture. A protocol for intra-articular injection of the feline carpus was also described. A contrast solution containing gadolinium and iohexol with a 50% gadolinium solution (Magnevist—gadolinium 0.5 mmol/mL diluted to a 0.05 mmol/mL solution) and 50% of iodine (Iohexol—iodine 300mgI/mL) was injected into the antebrachiocarpal and middle carpal joints of feline carpi using fluoroscopic guidance. Results CTA allowed for identification of intra-articular ligaments and the silhouette of select extra-articular ligaments when there was adequate joint distension, however it was not considered to be superior to MRI. MRA allowed for improved identification of the dorsal radiocarpal, accessorioulnocarpal, accessorioquartile, short ulnar and short radial collateral ligaments. Conclusion In this ex-vivo study, combined CTA and MRA enhanced the appearance of the feline carpal ligaments and may provide a foundation for future studies in the diagnosis of carpal injuries.

Abstract Background In wrist arthrograms, aberrant contrast material is frequently seen extending into the soft tissue adjacent to the ulnar styloid process. Since the prestyloid recess can mimic contrast leakage in CT arthrography, this study aims to provide a detailed analysis of its morphologic variability, while investigating whether actual ulnar-sided leakage is associated with injuries of the triangular fibrocartilage complex (TFCC). Methods Eighty-six patients with positive wrist trauma history underwent multi-compartment CT arthrography (40 women, median age 44.5 years). Studies were reviewed by two board-certified radiologists, who documented the morphology of the prestyloid recess regarding size, opening type, shape and position, as well as the presence or absence of ulnar-sided contrast leakage. Correlations between leakage and the presence of TFCC injuries were assessed using the mean square contingency coefficient (rɸ). Results The most common configuration of the prestyloid recess included a narrow opening (73.26%; width 2.26 ± 1.43 mm), saccular shape (66.28%), and palmar position compared to the styloid process (55.81%). Its mean length and anterior–posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively. Ulnar-sided contrast leakage was reported in 29 patients (33.72%) with a mean extent of 12.30 ± 5.31 mm. Leakage occurred more often in patients with ulnar-sided TFCC injuries (rɸ = 0.480; p

Abstract Background This meta-analysis aimed to evaluate the current evidence on the diagnostic performance of MRI/MRA for detecting acetabular labral tears (ALT). Methods We systematically searched the PubMed, Embase, and Cochrane library until February 5, 2021, to identify original research studies reporting the diagnostic performance of MRI/MRA for the detection of ALT. Study methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. The summary sensitivity (Se) and specificity (Sp) of the studies were estimated using a bivariate model. We calculated the post-test probability to assess the clinical utility of MRI/MRA. Univariate meta-regression and subgroup analyses were performed to assess between-study heterogeneity. Results We included 22 studies (n = 1670 patients). The meta-analytic summary Se and Sp for MRI were 0.8 (95% CI 0.51–0.94) and 0.77 (95% CI 0.68–0.84), respectively, while for MRA they were 0.89 (95% CI 0.82–0.93) and 0.69 (95% CI 0.56–0.80). MRA showed a higher area under the summary receiver operating curve (SROC) (0.87 vs. 0.80) than MRI. MRI could increase the post-test probability to 0.78 and could decrease the post-test probability to 0.21, MRA could increase the post-test probability to 0.74 and could decrease the post-test probability to 0.14. Meta-regression analysis showed two significant factors affecting study heterogeneity: MR field strength and reference standard. After dividing the studies into two subgroups based on the MR field strength, we found that the Se values of 3.0 T MRI were very close to MRA (0.87 vs. 0.89), the Sp values of 3.0 T MRI were superior to MRA (0.77 vs. 0.69). Conclusions Given that 3.0 T MRI could provide a non-invasive, fast and convenient method to recognize suspicious ALT cases, 3.0 T MRI is more recommended than MRA.

Biceps tendon rupture is a rare condition that has been previously reported in athletic animals. In the present case study, biceps tendon rupture was diagnosed in two Beetal goats. Tendon rupture was indicated by performing a biceps test while diagnostic confirmation was achieved by arthrography and ultrasonography. Bicep tendon appeared hyperechoic but it was noted with disruption and swollen (slightly hypoechoic). Moreover, it was moderately in-homogenous fibrillar structure. While some parts of the tendon has normal echo structure. Tenotomy was performed to mitigate the aforementioned rupture. The follow-up of cases were done for six weeks after the surgery, whereby both goats demonstrated complete recovery. Despite the infrequency of biceps tendon rupture in pasture animals, analysis of diagnostic procedures and surgical stabilization was undertaken for its mitigation is imperative for the clinical understanding of the affection.

The aim was to analyze patients with clinical diagnosis of triangular fibrocartilage complex (TFCC) lesion using standard x-ray, ultrasound, conventional magnetic resonance imaging (MRI) and MR arthrography (MRA); to evaluate the accuracy of MRA compared with MRI in the diagnosis of this lesion; and to evaluate ultrasound as a method of diagnosing TFCC lesion. We analyzed 72 patients (46 female and 26 male; age range, 22-61 years; mean age 37 years; 50 right and 22 left wrists) with suspected TFCC lesion with clinical examination, standard x-rays, and ultrasound. We confirmed patients with traumatic TFCC injury on MRI and MRA. Ultrasound found 13 lesions in 72 patients with suspected TFCC lesions. Conventional MRI found 66 and MRA 68 TFCC lesions. Ultrasound is useful for visualizing intra-articular effusion, soft tissue, bone surface, and for early detection of occult fractures. MRI is a better diagnostic modality, fully able to visualize the TFCC cartilage and ligaments. MRA is consistently and accurately able to visualize structural abnormalities of TFCC.

Tearing of the acetabular labrum is a common cause of chronic hip pain. MR arthrography (MRA) of the hip is the imaging procedure of choice for the evaluation of acetabular labrum. Familiarity with the various imaging findings of MRA of the hip allows recognition of normal variants and differentiation from true pathologic conditions. This article comprehensively reviews the technical aspects and interpretation of MRA of the hip. The appearances of normal and abnormal labra in MRA are discussed. Potential pitfalls in labral tear interpretation, such as sulci around the hip, normal variants of the labrum and plicae, and osseocartilaginous and soft tissue lesions identified on MRA of the hip are also described.

Wrist osteoarthritis (OA) is a common painful condition that affects the patient’s quality of life by limiting the range of wrist motion and grip strength. Wrist OA often results from scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC). Early diagnosis of SLAC and SNAC is crucial because it affects treatment planning. Thus, radiologists should be able to interpret the early imaging findings. This pictorial review discusses the pathophysiology and the clinical symptoms of SLAC and SNAC and presents the imaging findings with emphasis on the proper imaging algorithm. Finally, it focuses on the treatment according to the degenerative status of each of these patterns.

This descriptive anatomical study investigates the relationship between the third interosseous muscle, also known as the suspensory ligament, and the carpometacarpal joint in forelimbs of horses, with the hypothesis that there was a direct synovial communication between these structures as shown by computed tomographic arthrography, histology, and gross anatomy sections. Computed tomography of the carpus and metacarpal region was performed on two groups. Group 1 consisted of eight cadaver limbs undergoing computed tomographic arthrography following injection of a mixture of positive contrast medium, saline, and color-pigmented fluid solution into the middle carpal joint. Group 2 consisted of eight forelimbs assessed using plain computed tomography. The images were interpreted subjectively for contrast medium distribution and objectively by comparing Hounsfield values of the proximal suspensory ligament at 0.5 cm intervals starting at the origin and extending 3 cm distal to the proximal subchondral bone plate of the third metacarpal bone. Of the 16 limbs, two were sectioned for gross anatomy and one was documented histologically. The proximal suspensory ligament was visualized with clear margins on computed tomography images. The positive contrast medium was found within the lateral and medial lobes of the suspensory ligament in all eight (100%) limbs. Hounsfield units within the suspensory ligament following contrast injection were significantly higher than in those in the plain CT group between 0.5 and 2.5 cm distal to the proximal subchondral bone plate of the third metacarpal bone (p < 0.05). The gross anatomy sections showed color pigmentation within the suspensory ligament correlating to the contrast medium distribution evident on computed tomography images. Histology confirmed a synovial lined cavity within the suspensory ligament. The demonstration of a direct synovial communication between the internal structure of the proximal suspensory ligament and the carpometacarpal joint in horses offers further explanation for commonly encountered interactions of diagnostic local anesthesia of the carpal and subcarpal regions. When performing diagnostic or therapeutic injections into the middle carpal joint, the likely effect on the proximal suspensory ligament should be considered. Furthermore, as the proximal suspensory ligament was identified clearly on CT images, further studies are needed to elucidate the utility of CT in clinical cases with suspected soft tissue pathology in the subcarpal region.

This study was designed to investigate the image quality of ultra-high-resolution ankle arthrography employing a photon-counting detector CT. Bilateral arthrograms were acquired in four cadaveric specimens with full-dose (10 mGy) and low-dose (3 mGy) scan protocols. Three convolution kernels with different spatial frequencies were utilized for image reconstruction (ρ50; Br98: 39.0, Br84: 22.6, Br76: 16.5 lp/cm). Seven radiologists subjectively assessed the image quality regarding the depiction of bone, hyaline cartilage, and ligaments. An additional quantitative assessment comprised the measurement of noise and the computation of contrast-to-noise ratios (CNR). While an optimal depiction of bone tissue was achieved with the ultra-sharp Br98 kernel (S ≤ 0.043), the visualization of cartilage improved with lower modulation transfer functions at each dose level (p ≤ 0.014). The interrater reliability ranged from good to excellent for all assessed tissues (intraclass correlation coefficient ≥ 0.805). The noise levels in subcutaneous fat decreased with reduced spatial frequency (p < 0.001). Notably, the low-dose Br76 matched the CNR of the full-dose Br84 (p > 0.999) and superseded Br98 (p < 0.001) in all tissues. Based on the reported results, a photon-counting detector CT arthrography of the ankle with an ultra-high-resolution collimation offers stellar image quality and tissue assessability, improving the evaluation of miniscule anatomical structures. While bone depiction was superior in combination with an ultra-sharp convolution kernel, soft tissue evaluation benefited from employing a lower spatial frequency.

Abstract Background Evaluating of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound imaging of the elbow is increasingly being used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children with minimally displaced fractures. The aims of this study were to assess the correlations between ultrasound and arthrography findings for predicting the integrity of the cartilage hinge and to describe the utility of ultrasound in determining the need for pre-treatment. Methods Thirty-nine patients with minimally displaced lateral humeral condyle fractures who underwent ultrasound and arthrography examinations before surgery from May 2018 to December 2019 were included in this study. Ultrasound and arthrography predictors of the cartilage hinge status were independently measured. The ultrasound and arthrography results were compared. Results The mean displacement of the fractures was 3.1 mm (range, 2.0~5.0 mm). Arthrography showed incomplete fractures in 24 patients (61.5%) and complete fractures in 15 patients (38.5%). Ultrasound showed incomplete fractures in 25 patients (64.1%) and complete fractures in 14 patients (35.9%). The ultrasound and arthrography results of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 that were predicted to have an intact articular surface and 13 that were predicted to have an incongruity articular surface. There was no correlation between the displacement and the fracture appearing complete on the ultrasound scan. The Pearson coefficient between ultrasound and arthrography for assessing the integrity of the articular surface was 0.837. Conclusions Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status in children with minimally displaced lateral humeral condyle fractures. Level of evidence Prospective study; level II.

Abstract Background Triangular fibrocartilage complex (TFCC) lesions commonly cause ulnar-sided wrist pain and instability of the distal radioulnar joint. Due to its triangular shape, discontinuity of the TFCC is oftentimes difficult to visualize in radiological standard planes. Radial multiplanar reconstructions (MPR) may have the potential to simplify diagnosis in CT wrist arthrography. The objective of this study was to assess diagnostic advantages provided by radial MPR over standard planes for TFCC lesions in CT arthrography. Methods One hundred six patients (49 women, 57 men; mean age 44.2 ± 15.8 years) underwent CT imaging after wrist arthrography. Two radiologists (R1, R2) retrospectively analyzed three randomized datasets for each CT arthrography. One set contained axial, coronal and sagittal planes (MPRStandard), while the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid (MPRStyloid) or in the ulnar fovea (MPRFovea). Readers evaluated TFCC differentiability and condition. Suspected lesions were categorized using Palmer’s and Atzei’s classification and diagnostic confidence was stated on a five-point Likert scale. Results Compared to standard planes, differentiability of the superficial and deep TFCC layer was superior in radial reconstructions (R1/R2; MPRFovea: p

Objective To evaluate the use of Ilizarov external mini-fixation in the treatment of Monteggia fractures (dislocation of the radial head with an associated fracture of the proximal ulna) in children. Methods Children with proximal ulnar fracture were included and underwent fracture reduction surgery with Ilizarov external mini-fixators, followed by immobilization of the supinated forearm with plaster. The reduction was evaluated intra-operatively using arthrography. Mackay criteria were used to evaluate clinical outcomes at follow-up. Results A total of 15 children were included in the study. Mackay efficacy was 100 %, indicating excellent outcomes using the Ilizarov external mini-fixator. Conclusion Use of the Ilizarov external mini–fixator is particularly suitable in the treatment of children with comminuted and compression fractures of proximal ulna. It is easy to operate, low invasive and is worthy of promotion.

Background: There is conflicting evidence regarding communication between the two compartments of the equine temporomandibular joint (TMJ). Understanding the inter-relationship between TMJ compartments is critical for diagnostic and clinical management purposes.Objective: To determine the frequency of communication between the discotemporal joint (DTJ) and the discomandibular joint (DMJ) of the equine TMJ in horses free of overt disease.Study Design: A randomized, blinded, controlled cadaveric study.Methods: Equine cadaver heads (n = 20), with no reported history of potential TMJ disease, were collected and stored frozen until use. Horses were randomized to the treatment group, such that Group A horses (n = 10) underwent arthrocentesis of the left DTJ and the right DMJ compartments, while Group B (n = 10) underwent arthrocentesis of the left DMJ and the right DTJ compartments of the TMJ, for a total of 40 joints. Computed tomography (CT) imaging was performed before, and after, intra-articular injection of contrast media in each head. Two observers, blinded to the treatment group, independently interpreted CT images.Results: Communication between synovial compartments occurred in the left TMJ of two horses. Arthroscopic evaluation revealed that both horses had a perforation of the intra-articular disc in the region of the caudomedial fibrous expansion. Mild anterior displacement of the abnormal disc in the joint of one horse was demonstrated using magnetic resonance imaging (MRI).Main Limitations: Sample size, the use of owner provided animals' history, and frozen specimens.Conclusions: No physiological communication was present between the DTJ and the DMJ in the equine TMJ of the cases studied, regardless of which compartment underwent arthrocentesis. Two joints had pathological communications. These results suggest that diagnostic, and medical, treatment of intra-articular disease may be most effective when both joint compartments are injected. Furthermore, this study illustrates the value of contrast enhancement while imaging the equine TMJ.

Aim:The aim of this study was to compare the re-tear rates and clinical results between mini-open and full arthroscopic techniques of the rotator cuff repair.Methods:We retrospectively reviewed a total of 82 patients. Mini-open and full arthroscopic techniques were performed in 30 patients (group MO) and 52 patients (group A), respectively. The main outcome measurements were the University of California at Los Angeles (UCLA) and American Shoulder and Elbow Surgeons (ASES) scores, abduction and external rotation strengths (kg), and re-tear rate on magnetic resonance arthrography. All variables were compared between the groups.Results:The mean age of all patients included in the study was 55.4±6.1 years. Sixty (73.2%) patients were female. The mean follow-up was 12.3±1.4 months. The mean UCLA and ASES scores and external rotation strength in group A were significantly higher than in group MO. The mean abduction strengths were similar. There was no statistically significant difference in terms of re-tear rates.Conclusion:Rotator cuff tears can be successfully treated with either mini-open or arthroscopic techniques. Although there was no statistically significant difference in re-tear rates, full arthroscopic repair had better functional outcomes.

Introduction: Arthrography is a rare congenital disorder which is identified with joint involvement, muscle weakness and fibrosis and sometimes is accompanied with a series of cholestasis renal tubes abnormalities and bone disorder. Arthrography has no definite treatment, but rehabilitation for improvement of organs' function is possible. In this study, a case of male embryo with Arthrography and decision for abortion in 21st weeks of pregnancy is reported. Case presentation: The patient was a 34-year-old woman with fourth pregnancy, second parity and history of spontaneous abortion. The screening tests were normal embryo in the first and second stages, but regarding the findings of one-way hydronephrosis, one-way coronary cyst, two-way fierce club in the examination of fetal organs, relative reduction in fetal movements and bilateral articulation, amniocentesis was performed and arthrography was detected. The mother was hospitalized at gestational age of 21 weeks and 4 days and underwent abortion. After receiving misoprostol and oxytocin, she was unresponsive and hysterotomy was performed and the placenta and embryo were removed. Conclusion: Arthrography is a congenital disorder that due to the occurrence of abnormalities and problems, early and timely diagnosis before delivery should be considered. This syndrome is detectable by ultrasound and therefore, it is recommended that screening and imaging measures, and prenatal care be performed more sensitively especially in high risk pregnant women.

INTRODUCTION: In this study, we aimed to compare the ultrasound guided injection and injection with palpation using MR arthrography regarding the differences in success rate and the extravasation rate of the two techniques. METHODS: In this prospective study, we planned to include patients to whom an injection to the wrist was performed due to an indication. First, forty patients were divided into two groups and, ultrasound guided injection was performed to one group whereas injection was performed with palpation to the other. After the procedures, MR arthrography was performed to assess the reach of the contrast in to the joint space as well as extravasation into the adjacent soft tissues. RESULTS: There was contrast in the joint space in all injections guided by ultrasound (100%). Seventeen out of 20 injections which performed with palpation, there was contrast within the joint space (85%). Extravasations were seen in 3 patients (15%) with ultrasound guided injections group and 5 patients (25%) with palpation group. DISCUSSION AND CONCLUSION: Injection to the wrist either under ultrasound guidance or with palpation, there was no significant difference by means of success and extravasation rate. Injection with palpation is a rapid and cost-effective technique however its success rate is hindered by pathologies that affect the palpation of the joint structure. In such circumstances, ultrasound guidance increase the success rate of the procedure.

INTRODUCTION: We aimed to evaluate the effectiveness of ultrasound and its association with joint structure by comparing success and extravasation rates of the glenohumeral joint and the ankle joint injections. METHODS: MR arthrography examinations of 114 glenohumeral joints and 86 tibiotalar joints were assessed in this retrospective study and, success and extravasation rates were compared statistically. RESULTS: Extravasation rate at the injection site was significantly higher in patients with glenohumeral injection compared to tibiotalar injection (p: 0.026). There was no contrast material within the joint space along with extravasation in 6 (5.2%) patients in glenohumeral injection group whereas contrast material was seen within the joint space in all patients in tibiotalar injection group (p: 0.038). DISCUSSION AND CONCLUSION: In intra-articular injections, the success rate of articular injection is affected by the distance of capsule to skin and capsule to cartilage. For this reason, higher extravasation rates with lower success rates were encountered in deep located joints and joints with the reduced capsule to cartilage distance.

Purpose To determine the additional diagnostic benefits of fluoroscopic arthrography (FA) in patients with full-thickness supraspinatus tendon (SST) tears by comparing FA images with magnetic resonance arthrography (MRA) images. Materials and Methods This study included FA and MRA images of 53 patients who were confirmed to have full-thickness SST tears by arthroscopy. In the FA analysis, the presence of contrast leakage into the subacromial-subdeltoid bursa was recorded. In the MRA analysis, contrast leakage, retraction of a torn tendon, width and length of the tear, and supraspinatus atrophy were evaluated. Patients were divided into the concordant group or the discordant group based on the presence of contrast leakage to compare the characteristics of SST tears. We used Fisher's exact test and two-sample t-test for the comparison. Results Of the 53 patients, 34 were included in the concordant group and 19 were included in the discordant group. In the concordant group, the grades of retraction were higher than those in the discordant group; the width and length of the tears were larger. Muscle atrophy was more severe in the concordant group. Conclusion A full-thickness SST tear did not always exhibit contrast leakage on FA, particularly small SST tears or tears with low-grade retraction. FA can provide diagnostic information regarding the severity of full-thickness SST tears by itself.

Purpose To correlate rotator interval dimensions on direct CT arthrography (CTA) with external rotation shoulder stress radiographs in patients with shoulder instability. Materials and Methods One hundred and twenty-three shoulders of 115 patients with shoulder instability that underwent direct CTA and shoulder stress radiographs in neutral position and external rotation were enrolled. Axial, oblique coronal, oblique sagittal CT images were obtained after intra-articular contrast injection. Width and depth of rotator interval on sagittal CTA images were evaluated and acromiohumeral (AH) distance on neutral and external rotation stress radiographs were measured. CTA measurements were compared with AH on stress radiographs according to the group with or without "external rotational instability". Results Out of 123 shoulders, 79 with external rotation instability showed increased or unchanged AH distance on external rotation compared with neutral position. Width of rotator interval was 2.43 ± 0.31 cm and depth was 0.87 ± 0.2 cm. Forty-four shoulders without external rotation instability showed decreased AH distance on external rotation compared with neutral position. Width of rotator interval was 2.02 ± 0.45 cm and depth was 0.75 ± 0.2 cm. Width and depth of rotator interval were significantly greater in the external rotation instability group. Conclusion Width and depth of rotator interval on CTA were significantly correlated with AH distance on external rotation stress radiographs.

Many new, minimally invasive interventional radiology procedures are now viable alternatives to traditional invasive therapy. These interventional radiological procedures can be performed in the outpatient setting and the overall cost to the patient may be less in the long run. Radiofrequency and Laser ablation techniques are now widely used and rapidly expanding technologies in the interventional radiology used in the treatment of tumours, varicose vein and lumbar disc treatment. Similarly percutaneous vertebroplasty (PVP) is used in the treatment of spinal lesions and osteoporotic vertebral collapse. The knowledge of these procedures is vital as medicine moves into minimally invasive procedures with targeted treatments as these procedures offer less risk, less pain and less recovery time compared to various surgical procedures. In this presentation I would like to present my work related to percutaneous vertebroplasty (PVP) in spinal lesions, percutaneous Laser disc decompression (PLDD) in the treatment of chronic discogenic low back pain and percutaneous radiofrequency ablation (RFA) in musculoskeletal lesions. The technique, results and long term outcomes of these newer procedures will be discussed.

Osteochondral lesions (OCL) of the talus involve both articular cartilage and subchondral bone of the talar dome. This term refers to a wide spectrum of pathologies including mild bone marrow contusion as well as severe osteoarthritis resulting from long standing disease. Although Magnetic Resonance Imaging (MRI) at 1.5 Tesla is the leading cross-sectional modality for detection and staging of OCL, lack of spatial resolution hampers accurate assessment of thin articular cartilage. Cone Beam Computed Tomography (CBCT) arthrography is better suited for precise staging of cartilage lesions. The purpose of this pictorial review is to illustrate the strength of each imaging method.

Introduction: Adhesive capsulitis (AC), also known as frozen shoulder, is challenging for diagnosis, particularly in early stages. A promising tool is contrast-enhanced ultrasonography (CEUS), which has been successfully applied on musculoskeletal ultrasonography. Methods and Results: Two antecedent studies reported the application of CEUS on AC patients although different methods were used. The first research team administered the contrast media intravenously to facilitate detection of microcirculation through observing different distributions of time–intensity curves between the affected and unaffected shoulders.The second study has introduced a pioneering approach, injecting the contrast media mixed with saline directly into the glenohumeral joint. The authors designated this novel method as “US arthrography”. According to our best knowledge, this is the first study reporting the application of intraarticular CEUS in humans. Conclusion: Both presented studies reported CEUS to be capable of differentiating shoulders with AC from normal controls.

Background: Ultrasound (US)-guided injection is increasingly used for magnetic resonance (MR) arthrography of the hip. There is no information regarding the utility of anesthetizing the needle path before joint puncture. Thus, the aim of this study was to retrospectively compare the efficacy of the technique and discomfort in patients undergoing US-guided arthrography of the hip using a fixed guide, with or without the use of subcutaneous local anesthesia. Materials And Methods: Eighty-two patients underwent anterior US-guided MR arthrography of the hip, of whom 33 had received anesthesia and 49 had not; these patients were compared for differences in the efficacy of arthrography and the subsequent complications. They were also asked to report the intensity of discomfort using a visual analog scale (VAS). Results: Hip joint arthrography was successful in all cases with no complications. There were no significant differences between the anesthetized and non-anesthetized groups in terms of sex, age, body mass index, side, success rate on first attempt, and extra-articular contrast leakage on MR (P > 0.05). The mean VAS scores were 23.3 (median 25.0; SD 13.3) in anesthetized patients versus 23.6 (median 20.0; SD 19.2) in those who were not anesthetized (P = 0.12, Mann-Whitney U test). Conclusion: Routine local anesthesia is possibly unnecessary in US-guided MR arthrography of the hip using a fixed guide.

Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA) of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC) and to compare the results of the magnetic resonance arthrography (MRA) with the gold standard arthroscopic findings. Methods: The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females) who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA) and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93%) and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactory pain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39), and specificity was 80% (16/20). The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34). Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

Glenohumeral joint instability is usually an intimidating topic for most radiologists due to both the complexity of related anatomical and biomechanical considerations and the increasing number of classifications and acronyms reported in the literature in association with this condition. In this short review, we aim to demystify glenohumeral instability by first focusing on the relevant anatomy and pathophysiology. Second, we will review what the important imaging findings are and how to describe them for the clinician in the most relevant yet simple way. The role of the radiologist in assessing glenohumeral instability lesions is to properly describe the stabilizing structures involved (bone, soft-tissue stabilizers, and their periosteal insertion) to localize them and to attempt to characterize them as acute or chronic. Impaction fractures on the glenoid and humeral sides are important to specify, locate, and quantify. In particular, the description of soft-tissue stabilizers should include the status of the periosteal insertion of the capsulo-labro-ligamentous complex. Finally, any associated cartilaginous or rotator cuff tendon lesion should be reported to the clinician.

OBJETIVO: Descrever os achados em artro RM de sujeitos com suspeita de lesão do labrum acetabular. MÉTODO: Foram analisadas 108 artro RM de quadris em 2007/2008. Dois radiologistas independentemente analisaram as imagens e foi considerada a resposta comum entre eles. Com base em seus pareceres observou-se o local e estadiamento das lesões labrais e condrais, as alterações anatômicas, e a presença de tendinite e bursite trocantérica. RESULTADO: As lesões labrais grau I ocorreram em 41% dos casos, grau II em 31%, e grau III em 29%. O IFA tipo cam foi frequente em 36% dos casos, tipo pincer em 11%, e IFA misto em 13%, nestes casos 57% apresentaram lesão labral grau III, A lesão condral grau I foi observada em 51% acetábulos, as de grau II em 13%, e grau III em 18%. CONCLUSÃO: As alterações morfológicas que provocam IFA do tipo cam foram as mais prevalentes. Em relação ao grau de lesão labral e condral foram predominantes as lesões grau I independente da presença ou do tipo de IFA, exceto em IFAs mistos onde houve predomínio de lesão labral grau III. Não foi observada uma relação entre o grau de lesão labral e condral.OBJECTIVE: To describe the MR arthrographic findings in subjects with suspected acetabular labral tears of the hip. METHOD: 108 hip MRa results were analyzed in 2007-2008. Two radiologists independently interpreted the images, and the consensual answers between them were considered for analysis. Based on their opinions, information was obtained on the location, staging of the chondral and labral lesions, anatomic alterations, and the presence of trochanteric bursitis and tendonitis. RESULTS: 1st degree labral lesions occurred in 41% of cases, 2nd degree in 31%, and 3rd degree in 29%. The cam type FAI was common in 36% of cases, pincer FAI in 11%, and mixed cam-pincer FAI in 13%; in these cases 57% had grade III labral lesions. 1st degree chondral lesions were observed in 51% of acetabulum, 2nd degree in 13%, and 3rd degree in 18%. CONCLUSION: The morphologic alterations that cause cam type FAI were the most common. With respect to the degree of labral and chondral lesions, 1st degree lesions were the most common, irrespective of the presence or type of FAI, except in mixed cam-pincer FAIs, in which 3rd degree lesions were predominant. No relationship was observed between the degree of labral and chondral lesion.

Fifty-two newborn knees were used to verify the validity of the arthro-TC of double contrast for the diagnosis of normal synovial plicas, aiming at classifying and verifying their quantitative incidence and ethnic distribution. The plica synovialis mediopatellaris was identified in brown (60%), white (40%) and black races (9%) in this study. The incidence in black people was quite low as compared to white and brown people. The most commonly found folds were the plica synovialis infrapatellaris (69%) followed by the plica synovialis suprapatellaris (44%) and plica synovialis mediopatellaris (31%). Plicas were not found in 6% of the knees. The communication of bursa patellares with the articulation of the knee is present at birth in 85% of newborns. Identification of plica synovialis infrapatellaris was difficult because it is covered by abundant fat tissue. Arthro-TC was studied and analyzed by six observers, three radiologists and three orthopedic surgeons. The results showed a medium sensibility of 72% and a medium specificity of 60% for radiologist versus 89% and 61% for orthopedist surgeons, respectively.

We report on a 17-year-old girl who developed shoulder pain after a fall on an outstretched arm. CT arthrography and MR imaging demonstrated a cartilage defect centrally located in the glenoid. This was accompanied by an eroded appearance of the underlying bone. Since symptoms persisted over several months it was initially thought this represented a cartilage injury. Subsequently arthroscopy was performed and the abnormality was identified as a bare area of the glenoid. A tear of the superior glenohumeral ligament was depicted and was repaired. The bare area is an oval area denuded of cartilage that is probably developmental and that should be differentiated from true cartilage injuries to avoid unnecessary interventions. An eroded appearance of the underlying bone may occur on imaging, a finding that has not been previously reported.

Background and Objective: There are different diagnosis and therapeutic methods for meniscus tears. For obtaining optimal results, the characteristics of each one should be known. This study was performed with regard to epidemiology, causes, diagnosis methods, surgery and after surgery treatments. They were evaluated with regard to effective factors in prognostic. Methods: This descriptive and cross-sectional study was done according to information, which obtained from patients’ files, interviewing and physical and radiographic examination. Final evaluation was done according to the score of patients’ consent of treatment and average score of physical examination with regard to clinical symptoms. Findings: 77% of patients were under 35 years old. 88% of patients were male and 43% were sportsmen. Pain and locking were the most common complaint in 80% and 58% of cases respectively. Arthrography was the most common diagnostic procedure (72%) with accuracy rate of 93% for medical and 74% for lateral meniscus. The rate of pain, swelling, locking and instability before surgery were 80%, 15%, 52% and 33% respectively which after surgery reduced to 70%, 0, 13% and 10% respectively. Conclusion: In patients with trauma of knee especially young sportsmen, presence of meniscus should be considered seriously. Arthrography was known as an accessible, easy and effective method for diagnosis of meniscus. The ideal methods for treatment were repair of meniscus tear and partial menisectomy respectively. Postoperative Jones bandage immobilization for 2 to 4 weeks and postoperative physiotherapy for 10 to 25 sessions had the most effective results.

Arthrography is useful method to evaluate obstruct factors and the congruity of the femoral head for developmental dysplasia of the hip. We usually use an air injection to ascertain whether the needle is accurately insert intraarticularly, because leakage of the contrast medium may make it difficult to identify intraarticular structure in the hip joint. We report the experience the case that suspected air embolism by air injection in the arthrogram. An air injection for arthrography must be avoided the case of infants. To confirm that a needle is correctly inserted intraarticularly, it is preferable to inject saline. Alternatively, it may be suitable to use sonography for confirming the position of the needle for arthrography.