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The combined use of shoulder arthrography with MR and CT imaging offers distinct advantages over conventional nonarthrographic imaging techniques. The improved contrast and joint distension afforded by direct arthrography optimize evaluation of various intra-articular structures and help to define subtle abnormalities and distinguish normal variants from true shoulder pathology. In this article, we review the rationale and basic approaches to shoulder arthrography as well as the imaging appearance of the normal shoulder, anatomical variants, and pathology highlighted by this technique., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: The purpose of this study was to determine the incidence and severity of arthrographic pain after intraarticular injection of a gadolinium mixture diluted in normal saline for direct MR arthrography., Subjects and Methods: From March 2009 until January 2010, 155 consecutive patients underwent direct MR arthrography; 20 patients were lost to follow-up. Patients were contacted by telephone between 3 and 7 days after joint injection. Using an 11-point numeric pain rating scale, patients were asked to report if they had experienced joint pain that was different or more intense than their preinjection baseline, the severity of pain, the duration of pain, time to onset of pain, and eventual resolution of pain., Results: The incidence of postarthrographic pain was 66% (89/135), with an average intensity of pain of 4.8 ± 2.4 (range, 1-10). Postarthrographic pain lasted an average of 44.4 ± 30.5 hours (range, 6-168 hours). The time to onset of pain after joint injection was on average 16.6 ± 13.1 hours (range, 4-72 hours). There was no significant difference regarding the severity or incidence of postarthrographic pain between groups on the basis of patient age (p = 0.20 and 0.26), patient sex (p = 0.20 and 0.86), contrast mixture contents (p = 0.83 and 0.49), or joint injected (p = 0.51 and 0.47). No patients experienced any other serious side effects., Conclusion: Sixty-six percent of patients who undergo direct MR arthrography will experience a fairly severe delayed onset of pain that completely resolves over the course of several days.

Magnetic resonance arthrography is widely used throughout the world for joint imaging. It extends the capabilities of conventional MR imaging because contrast solution distends the joint capsule, outlines intraarticular structures, and extends into soft tissue tears and defects. MR arthrography exploits the natural advantages gained from a joint effusion and can be performed on any joint.

Purpose: In this invited review, the main subtypes of commoner bone tumors will be reviewed. Background and general concepts on pathology and surgery will be given with magnetic resonance imaging features of bone tumors. TEXT: The main malignant bone tumors being: osteogenic sarcoma, Ewings sarcoma, and chondrosarcoma are reviewed. Malignant intra-articular tumors are mentioned. The differential diagnoses including tumor mimickers are also reviewed., Conclusion: Magnetic resonance imaging allows for basic anatomical review and characterization of tumor type for diagnosis, therapy monitoring, and preoperative planning. A team approach to tumor imaging and treatment is optimal.

Direct magnetic resonance (MR) arthrography with injection of saline solution or diluted gadolinium can be useful for evaluating certain pathologic conditions in the joints. It is most helpful for outlining labral-ligamentous abnormalities in the shoulder and distinguishing partial-thickness from full-thickness tears in the rotator cuff, demonstrating labral tears in the hip, showing partial- and full-thickness tears of the collateral ligament of the elbow and delineating bands in the elbow, identifying residual or recurrent tears in the knee following meniscectomy, increasing the certainty of perforations of the ligaments and triangular fibrocartilage in the wrist, correctly identifying ligament tears in the ankle and increasing the sensitivity for ankle impingement syndromes, assessing the stability of osteochondral lesions in the articular surface of joints, and delineating loose bodies in joints. Indirect MR arthrography with intravenous administration of diluted gadolinium may be performed when direct arthrography is inconvenient or not logistically feasible. Although indirect MR arthrography has some disadvantages vis-à-vis direct MR arthrography, it does not require fluoroscopic guidance or joint injection and it is superior to conventional MR imaging in delineating structures when there is minimal joint fluid. In addition, vascularized or inflamed tissue will enhance with this method. Indirect MR arthrography can be used to rule in or diagnose abnormalities and to exclude abnormalities.

Elbow arthrography provides useful information that is not available with noninvasive imaging. This article describes normal elbow anatomy as seen by arthrography. Technical aspects of arthrography with regard to radiographs and CT and MR imaging are reviewed. Indications for MR arthrography include identification of loose bodies, chondral and osteochondral fractures, collateral ligament tears, and synovial and capsular abnormalities.

Our understanding of shoulder disorders has changed considerably as a result of improved diagnostic tools, such as arthroscopy and multiplanar imaging modalities. The diagnosis of the cause of shoulder pain can be difficult because a spectrum of disorders, including cervical spine disease, acromioclavicular arthritis, and shoulder instability. Impingement and denervation syndromes can present with similar clinical findings. Accurate depiction of anatomic abnormalities is important for treatment planning. The purpose of this article is to report on the application of available imaging modalities, with emphasis on MR imaging. A strategy for the appropriate use of these studies and their variations of technique is also provided.

Para-articular cysts frequently are seen on routine imaging examinations. They may be clinically asymptomatic or may cause pain, swelling, or impaired joint function. They often are associated with underlying joint disorders, such as trauma, degeneration, or inflammation. This article discusses the cause, symptoms, and appearance of para-articular cysts on various imaging examinations including arthrography, ultrasound, CT scan, and MR imaging. Specific attention is focused on those cystic masses appearing around the hip, knee, ankle and foot, shoulder, elbow, wrist and hand, spine, temporomandibular joints, and periosteum.