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Background: MR arthrography (MRA) has previously been the radiological gold standard for investigating labral and chondral lesions of the hip joint. In recent years, 3T MRI has demonstrated comparable accuracy, being adopted as the first-line imaging investigation in many institutions. Aims: We compare the associated increased cost and radiation dose of the fluoroscopic component of the MRA compared to MRI. Methods: In this retrospective review over 2 years, 120 patients (mean age 27.3 years ± 13.2, range 8–67) underwent 3T MRA or non-contrast 3T MRI. Three musculoskeletal radiologists reported the data independently. Primary objectives included cost-comparison between each and radiation dose of the fluoroscopic component of the MRA. Secondary objectives included comparing detection of pathology involving the acetabular labrum, femoral cartilage, and acetabular cartilage. Results: Then, 58 (48%) underwent 3T MRA and 62 (52%) patients underwent 3T MRI. The added cost of the fluoroscopic injection prior to MRA was €116.31/patient, equating to €7211.22 savings/year. MRA was associated with a small radiation dose of 0.003 mSv. Conclusions: Transitioning from 3T MRA to 3T MRI in the investigation of intra-articular hip pathology increases cost savings and reduces radiation dose. [ABSTRACT FROM AUTHOR]

Objective: To determine the preferred ankle, knee, and elbow arthrography injection techniques for Society of Skeletal Radiology (SSR) members and whether more recently described techniques are gaining acceptance. We also sought to determine whether the concept of knowledge translation might explain differences between the preferred technique, year of fellowship graduation, and year the newer technique was described. Materials and methods: A 29-question survey was created in Qualtrics and submitted to current SSR members to determine if they perform knee, elbow, and ankle arthrography, and if so, the year of fellowship completion and preferred approaches. Survey respondents indicated the starting and ending needle tip positions for three knee, two elbow, and three ankle arthrography approaches using grids placed over provided frontal and lateral radiographs. Results: Two hundred seventy-four SSR members (mean post-fellowship 13 years; range 0–38) completed the survey and performed fluoroscopic-guided knee (93%), elbow (95%), and ankle (75%) arthrography. Preferred approaches included the following: knee lateral subpatellar (43%), anterior (40%); elbow radiocapitellar (74%); ankle anterior/peritendon (70%), lateral mortise (24%). Preference of newer technique was related to fellowship graduation year and publication year for the ankle mortise (26% before, 42% after; p = 0.03) and posterior trans-triceps elbow articles (19% before, 33% after; p < 0.01). The anterior knee approach preference increased from 11% in 2008 to 40% (p ≤ 0.001). Conclusion: Nearly twice as many SSR members who graduated after the posterior trans-triceps and ankle mortise techniques were published prefer them for performing arthrography, possibly due to knowledge translation. The preference of the anterior knee arthrography approach has increased nearly fourfold since 2008. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we aimed to compare conventional and T1-weighted volumetric magnetic resonance arthrography (MRA) in the diagnosis and grading of glenoid cartilage defects that accompany labral pathologies. Materials and methods: A total of 79 patients who were prediagnosed with labrum pathologies based on shoulder magnetic resonance imaging (MRI) had MRA and CTA between December 2021 and May 2022. CTA was regarded as reference standard. CTA images were examined by a radiologist experienced in musculoskeletal radiology, and MRA images were examined by two radiologists independently to determine presence, grade, and localization of any glenoid cartilage defect, if present. Sensitivity, specificity, and accuracy were calculated separately for conventional and T1-weighted volumetric MRA. In addition, at the last stage, two observers examined all MRAs together, and the presence of a cartilage defect was decided by consensus, and the overall sensitivity, specificity, and accuracy were calculated. Results: Cartilage defect was detected on CTAs of 48 (60.75%) cases of among 79 patients with labrum pathology. The sensitivity, specificity, and accuracy of conventional MRA for two examiners were 17–19%, 100–100%, and 49–51%, respectively, while those values were 67–65%, 92–97%, and 84–77%, respectively, for T1-weighted volumetric MRA. Inter-examiner agreement was excellent for diagnosis of cartilage defects on all MRAs. The overall sensitivity, specificity, and accuracy for detection of glenoid cartilage lesions by MRA were 69%, 97%, and 80%, respectively. Conclusion: T1-weighted volumetric MRA seems to demonstrate cartilage defects accompanied with labrum pathologies accurately with high sensitivity, specificity, and excellent inter-examiner agreement. [ABSTRACT FROM AUTHOR]

Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes. KEY POINTS: 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance. 2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis. 3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.

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.

Objectives: In this study, ultrasound (US) contrast arthrography and subacromial-subdeltoid bursography with the contrast agent of SonoVue were performed to evaluate their value for detecting and differentiating the rotator cuff tear (RCT) subtypes in patients with the uncertain RCT. Methods: A total of 102 patients with the clinically suspected RCTs in the orthopedic clinic were prospectively recruited and underwent conventional high-frequency US for the category of undoubted full-thickness RCT, uncertain RCT, and intact rotator cuff. Among these patients, the patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. The arthroscopic findings were used as the gold standard in this study. Results: After the conventional US screening, 62 patients with uncertain RCT underwent the subsequent US contrast arthrography and subacromial-subdeltoid bursography. All the US contrast arthrography and subacromial-subdeltoid bursography were successfully performed and no severe side effects were observed in all the patients. For full-thickness tears, the sensitivity and specificity of the combined US contrast arthrography and subacromial-subdeltoid bursography were 94.7% (CI: 0.72–1.0) and 81.4% (CI: 0.66–0.91), respectively, and for articular-side tears 100% (CI: 0.51–1) and 100% (CI: 0.92–1), respectively, and for the bursal-side tears 84.6% (CI: 0.54–0.97) and 97.9% (CI: 0.88–1.0), respectively. The main inconsistency between the contrast-enhanced US and arthroscopy was that 7 patients with arthroscopic proved concurrent articular- and bursal-side tears were indicated as full-thickness RCTs on contrast-enhanced US. Conclusions: Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs. Clinical relevance statement: When conventional high-frequency US has some difficulty in differentiating the full-thickness from partial-thickness RCTs, combined US contrast arthrography and subacromial-subdeltoid bursography could be used to improve the detection accuracy of RCT subtypes. Key Points: • This is the first study by injection of the US contrast agent SonoVue into the shoulder joint cavity and subacromial-subdeltoid bursa for the detection and differentiation of the RCT subtypes among the people with the uncertain RCT by conventional US screening. • The SonoVue was injected into the glenohumeral joint cavity under US guidance to differentiate the full-thickness RCTs from partial-thickness RCTs. • Combined US contrast arthrography and subacromial-subdeltoid bursography are useful for detecting the RCT subtypes in patients with the uncertain RCTs. [ABSTRACT FROM AUTHOR]

Objective: To assess the applicability of a semiquantitative index for symptomatic minor instability of the lateral elbow (SMILE). Materials and methods: CT arthrograms of consecutive patients with lateral elbow pain who underwent ultrasound-guided CT arthrography at our orthopedic center between April 2019 and May 2022 were included. Images were acquired at 100 kVp and 80 mAs. An expert radiologist (R1) and a radiology resident (R2) retrospectively performed an independent, blinded evaluation of the arthrograms to assess the presence of imaging findings suggestive of elbow instability. The SMILE index (0–8) was obtained adding (I) radial head chondromalacia (0 − 1); (II) humeral capitellum chondromalacia (0 − 1); (III) humeral trochlear ridge chondromalacia (0 − 1); (IV) annular ligament laxity (0 − 2); (V) synovial thickening (0 − 1); (VI) humeroradial joint asymmetry (0 − 1); and (VII) capsular tear (0 − 1). R1 repeated the assessment after 14 days. Cohen's weighted κ statistic and raw concordance were used to appraise reproducibility. Results: Eighty patients (median age 49 years, interquartile range 40–53 years, 49, 61% males) underwent CT arthrography at our center, and 10 (12%) of them underwent bilateral elbow examination, leading to 90 included CT arthrograms. Median SMILE index was 4 (IQR: 2–5) for R1, 4 (IQR: 2–5) for R2, and 4 (IQR: 2–5) for the second assessment by R1. Intra-reader agreement was excellent (κ = 0.94, concordance 87%), while inter-reader agreement was substantial (κ = 0.75, concordance 67%). Conclusion: The proposed SMILE index showed good reproducibility; further studies are warranted to correlate our index with clinical and surgical data. Clinical relevance statement: Our scoring system allows a standardized evaluation of patients with lateral elbow pain and instability suitable for application into clinical practice, complementing the orthopedic surgeon's clinical diagnosis with imaging findings that may aid treatment choices. Key Points: • Lateral elbow pain is often interpreted clinically as lateral epicondylitis, but it can also encompass intra-articular pathology. • The proposed arthrographic index allows comprehensive quantification of lateral elbow pathology with good reproducibility and application times. • Our index provides the orthopedic surgeon with information regarding intra-articular findings, aiding treatment choices. [ABSTRACT FROM AUTHOR]

Objective To investigate the optimal display orientation of rotator cuff space (RI) structures on magnetic resonance (MR) scanning and arthrography. Methods A total of 80 patients who underwent MR scanning and arthrography in our hospital from January 2021 to March 2023 were selected and all of them were confirmed to have normal RI by shoulder arthroscopy. The RI and the superior glenohumeral ligament (SGHL), the long head of biceps tendon (LHBT), and the coracohumeral ligament (CHL) in the transverse axial, oblique sagittal, and oblique coronal positions were counted in the transverse axial, oblique sagittal, and oblique coronal positions on MR scanning and arthrography. Results The display rate of RI structure by oblique sagittal scan was 17.50% higher than that by horizontal scan, 0.00% and oblique coronal scan, 5.00% (4/80) (χ² = 18.739, P < 0.001). The display of SGHL, LHBT and CHL in RI by MR Oblique sagittal scan was better than that in transverse axis and oblique coronal scan ( χ² = 26.036, P<0.001). MR oblique sagittal arthrography showed a higher rate of RI structures 57.50% than transverse axial 5.00% and oblique coronal 17.50% (χ² = 61.534, P<0.001); MR oblique sagittal arthrography showed better display of SGHL, LHBT, and CHL structures in RI than transverse axial and oblique coronal (χ² = 64.569, P < 0.001); MR oblique sagittal arthrography had a significantly higher rate of complete visualization of RI structures in 57.50% than MR oblique sagittal plain scanning in 17.50% (χ² = 27.307, P<0.05). Conclusion Oblique sagittal position is the optimal display orientation for MR scanning and arthrography to show RI structures. [ABSTRACT FROM AUTHOR]

Joint effusion is diagnostically important. The canine carpal joint effusion, which is sometimes difficult to detect clinically, has received less attention in diagnostic ultrasound (US) studies. The aim of the present study was to provide a description of the morphological appearance of the canine carpal joint cavities and recesses using US, radiography, helical computed tomography (CT) and three‐dimensional volume rendering technique (3D‐VRT) images and to prove the applicability of musculoskeletal US for the detection of artificial carpal joint effusion in dogs. The understanding of the characteristics of these structures in normal patients is essential in the diagnosis. Twenty‐eight clinically and radiologically unremarkable canine carpal cadavers of different breeds were examined, representative images were selected and anatomical structures were labelled. The canine carpal joint cavities and in particular its recesses had a complex appearance with a basic structure found in all dogs: Antebrachiocarpal joint: dorsoproximal antebrachiocarpal recess, dorsodistal antebrachiocarpal recess, medial antebrachiocarpal recess, lateral antebrachiocarpal recess and five palmar antebrachiocarpal recesses. Middle carpal joint: two dorsal middle carpal recesses, medial common middle carpal and carpometacarpal recess, lateral common middle carpal and carpometacarpal recess, four palmar middle carpal recesses. The carpometacarpal joint had dorsal and palmar funnel‐shaped and irregular, finely tubular extensions, the most prominent ran dorsal to metacarpal III, the maximum distal end represented the proximal metacarpal diaphysis. All recesses presented ultrasonographically as a generalized anechogenic to hypoechoic filled continuation of the articular capsule with an indistinct peripheral hypoechogenic to isoechogenic fine capsule, the synovial‐connective tissue interface was difficult to identify. The novel results of this study provide the first morphological description of the ultrasonographic, radiographic and computed tomographic arthrographic appearance of the canine carpal joint cavities and recesses with different injection volumes. The canine carpal joint cavities and in particular its recesses had a complex appearance with a basic structure found in all dogs. The applicability of musculoskeletal US to visualize an artificial carpal effusion has been demonstrated. The results of this study, and in particular US, give the practitioner an advantage in visualizing joint effusion and assist in the decision to perform arthrocentesis. [ABSTRACT FROM AUTHOR]

Objective: To describe the aponeurotic expansion of supraspinatus tendon (AEST) and biceps tendon abnormalities with magnetic resonance (MR) arthrographic examinations and determine their prevalence in patients, we performed a high-resolution 3D direct MR arthrography. Materials and methods: This was a retrospective study of 700 shoulder MR arthrograms performed between May 2010 and January 2022. Extension in the coronal plane of an AEST on 3D fat-suppressed T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography was identified. Based on its morphology, the AEST on MR arthrography was divided into four subtypes: absence of tendinous thickness in the bicipital synovial surface or intra-synovial tendon-like structure in the bicipital groove, thin and flat tendinous thickness ≥1 mm of bicipital synovium, oval tendinous structure less than half the size of the adjacent biceps tendon, oval tendinous structure more than half the size of the adjacent biceps tendon, and oval tendinous structure larger than the adjacent biceps tendon. Based on its origin and termination, aponeurotic expansions can be divided into three subtypes: proximal pulley zone, middle humeral neck zone, and distal myotendinous junction zone. Association with the biceps synovium of the AEST was categorized into three types: intra-synovial, extra-synovial, and trans-synovial. Results: An AEST in the anterior shoulder joint in 3D VIBE MR arthrography images was identified in 63 (9%) of 700 arthrograms. The most common arthrographic type of AEST was type 1—this was detected in 39 of 63 patients. The most common course type of the AEST was anteriorly midline. The most common distal insertion type was at the tenosynovial sheath of the long head of the biceps tendon (LHBT) in the middle humeral neck zone—this was detected in 31 of 63 patients. There were only 10 MR arthrograms biceps tendon abnormality, including 4 biceps agenesis and 6 split ruptures. Conclusion: A 2D and high-resolution 3D MR arthrography can demonstrate the anatomical detail around the bicipital groove and facilitate the differentiation between a biceps tendon anomaly and an AEST. On high-resolution 3D MR arthrographic images, the AEST tends to be in the anterior midline and anteromedial portions of the biceps synovium with intra-synovial, extra-synovial, and trans-synovial courses and its three different insertion types. [ABSTRACT FROM AUTHOR]

Purpose: MR arthrography (MRA) is the most accurate method for preoperatively diagnosing superior labrum anterior–posterior (SLAP) lesions, but diagnostic results can vary considerably due to factors such as experience. In this study, deep learning was used to facilitate the preliminary identification of SLAP lesions and compared with radiologists of different seniority. Methods: MRA data from 636 patients were retrospectively collected, and all patients were classified as having/not having SLAP lesions according to shoulder arthroscopy. The SLAP-Net model was built and tested on 514 patients (dataset 1) and independently tested on data from two other MRI devices (122 patients, dataset 2). Manual diagnosis was performed by three radiologists with different seniority levels and compared with SLAP-Net outputs. Model performance was evaluated by the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), etc. McNemar's test was used to compare performance among models and between radiologists' models. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 was considered statistically significant. Results: SLAP-Net had AUC = 0.98 and accuracy = 0.96 for classification in dataset 1 and AUC = 0.92 and accuracy = 0.85 in dataset 2. In dataset 1, SLAP-Net had diagnostic performance similar to that of senior radiologists (p = 0.055) but higher than that of early- and mid-career radiologists (p = 0.025 and 0.011). In dataset 2, SLAP-Net had similar diagnostic performance to radiologists of all three seniority levels (p = 0.468, 0.289, and 0.495, respectively). Conclusions: Deep learning can be used to identify SLAP lesions upon initial MR arthrography examination. SLAP-Net performs comparably to senior radiologists. [ABSTRACT FROM AUTHOR]

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

ObjectivesThe purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.MethodsNineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists.ResultsTen of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.ConclusionsDelphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.Key points• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.

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.

Shoulder joint disease is a common cause of forelimb lameness in dogs. To diagnose this condition, shoulder magnetic resonance arthrography (MRA) is performed, which involves the injection of contrast agents into the shoulder joint space under ultrasound (US)‐guidance. The objective of this study was to compare the craniolateral and caudolateral approaches for shoulder MRA using US‐guided injection techniques, and investigate their clinical feasibility in dogs. Forty shoulder joints from 10 adult beagles were studied in two repetitions. The craniolateral (n = 20) and caudolateral (n = 20) injection techniques were applied randomly under US‐guidance. The shoulder MRA was conducted immediately after the contrast agents was injected. The procedure time (scan and injection time), number of attempts, joint distension and degree of extraarticular extravasation were recorded and compared between the two groups. The results showed that the caudolateral approach had significantly more contrast agents extravasation compared to the craniolateral approach (p < 0.05). However, there were no significant differences between the two groups in terms of procedure time (scan time p = 0.80, injection time p = 0.74), number of attempts (p = 0.70) and joint distension (p = 0.23). The craniolateral approach of US‐guided contrast injection techniques for shoulder MRA minimizes damage to the juxta‐articular structures and reduces extraarticular extravasation, resulting in good‐quality images. This study demonstrates the feasibility and advantages of the craniolateral approach under US‐guidance for shoulder MRA in dogs. [ABSTRACT FROM AUTHOR]

Objective: To compare image quality and diagnostic performance of preoperative direct hip magnetic resonance arthrography (MRA) performed with gadolinium contrast agent and saline solution. Methods: IRB-approved retrospective study of 140 age and sex-matched symptomatic patients with femoroacetabular impingement, who either underwent intra-articular injection of 15–20 mL gadopentetate dimeglumine (GBCA), 2.0 mmol/L ("GBCA-MRA" group, n = 70), or 0.9% saline solution ("Saline-MRA" group, n = 70) for preoperative hip MRA and subsequent hip arthroscopy. 1.5 T hip MRA was performed including leg traction. Two readers assessed image quality using a 5-point Likert scale (1–5, excellent-poor), labrum and femoroacetabular cartilage lesions. Arthroscopic diagnosis was used to calculate diagnostic accuracy which was compared between groups with Fisher's exact tests. Image quality was compared with the Mann–Whitney U tests. Results: Mean age was 33 years ± 9, 21% female patients. Image quality was excellent (GBCA-MRA mean range, 1.1–1.3 vs 1.1–1.2 points for Saline-MRA) and not different between groups (all p > 0.05) except for image contrast which was lower for Saline-MRA group (GBCA-MRA 1.1 ± 0.4 vs Saline-MRA 1.8 ± 0.5; p < 0.001). Accuracy was high for both groups for reader 1/reader 2 for labrum (GBCA-MRA 94%/ 96% versus Saline-MRA 96%/93%; p > 0.999/p = 0.904) and acetabular (GBCA-MRA 86%/ 83% versus Saline-MRA 89%/87%; p = 0.902/p = 0.901) and femoral cartilage lesions (GBCA-MRA 97%/ 99% versus Saline-MRA 97%/97%; both p > 0.999). Conclusion: Diagnostic accuracy and image quality of Saline-MRA and GBCA-MRA is high in assessing chondrolabral lesions underlining the potential role of non-gadolinium-based hip MRA. Key Points: • Image quality of Saline-MRA and GBCA-MRA was excellent for labrum, acetabular and femoral cartilage, ligamentum teres, and the capsule (all p > 0.18). • The overall image contrast was lower for Saline-MRA (Saline-MRA 1.8 ± 0.5 vs. GBCA-MRA 1.1 ± 0.4; p < 0.001). • Diagnostic accuracy was high for Saline-MRA and GBCA-MRA for labrum (96% vs. 94%; p > 0.999), acetabular cartilage damage (89% vs. 86%; p = 0.902), femoral cartilage damage (97% vs. 97%; p > 0.999), and extensive cartilage damage (97% vs. 93%; p = 0.904). [ABSTRACT FROM AUTHOR]

ObjectiveTo examine the relation of knee pain patterns to pain severity and to radiographic osteoarthritis (OA) severity and duration.MethodsThe Multicenter Osteoarthritis Study is a longitudinal cohort of older adults with or at risk of knee OA. Participants' Intermittent and Constant Osteoarthritis Pain (ICOAP) scores were characterized as 1) no intermittent or constant pain, 2) intermittent pain only, 3) constant pain only, and 4) a combination of constant and intermittent pain. Knee pain severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and a visual analog scale (VAS). Radiographic knee OA (ROA) severity was defined as Kellgren/Lawrence grade ≥2, and ROA duration was defined according to the clinic visit at which ROA was first noted. We assessed the relation of ICOAP pain patterns to knee pain severity, ROA severity, and ROA duration using regression models with generalized estimating equations.ResultsThere were 2,322 participants (mean age 68.8 years, body mass index 31.0 kg/m2 , 60% female). Higher ICOAP pain patterns, i.e., a mix of constant and intermittent pain, were associated with greater WOMAC pain severity compared with those patients without either pain pattern (odds ratio [OR] 43.2 [95% confidence interval (95% CI) 26.4-61.3]). Results were similar for the VAS (OR 71.2 [95% CI 45.7-110.9]). Those patients with more severe and longer duration of ROA were more likely to have a mix of constant and intermittent pain compared with those without either pain (OR 3.7 [95% CI 3.1-4.6] and OR 2.9 [95% CI 2.5-3.5], respectively).ConclusionKnee pain patterns are associated with radiographic disease stage and duration, as well as pain severity, highlighting the fact that pain patterns are important for understanding symptomatic disease progression.

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.

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 FROM AUTHOR]

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 FROM AUTHOR]

Objective: To describe cases of parafoveal chondral lesion of the femoral head in patients with femoroacetabular impingement, correlating the clinical and imaging data. Materials and Methods: This was a retrospective descriptive case series of parafoveal chondral lesion of the femoral head in 21 patients who underwent computed tomography and magnetic resonance arthrography scans of the hip, having then received an imaging-based diagnosis of femoroacetabular impingement. Results: Of the 21 patients evaluated, 15 (71%) had cam-type femoroacetabular impingement, whereas five (24%) had mixed-type impingement, and one (5%) had pincer-type impingement. Twelve patients (57%) had a low frequency of physical activity, which was significantly associated with the presence of cam-type impingement (p = 0.015). Although the extent of the lesion correlated significantly with the acetabular coverage angle (p = 0.04), it did not correlate significantly with the alpha angle or femoral head-neck offset value (p = 0.08 and p = 0.06, respectively). We also found no correlation between the extent of the lesion and the other main parameters that define the femoroacetabular impingement types. Conclusion: This was one of the largest case series of parafoveal chondral lesion of the femoral head in patients with imaging findings of femoroacetabular impingement. The extent of such lesions does not appear to correlate with the parameters of femoroacetabular impingement, with the exception of the acetabular coverage angle. [ABSTRACT FROM AUTHOR]

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.

Objectives: To determine the diagnostic accuracy of non-arthrographic MR imaging, conventional MR arthrography, and 3D T1-weighted volumetric interpolated breath-hold examination (VIBE) MR arthrography sequences as compared with a CT arthrography in the diagnosis of glenoid bare spot. Methods: A retrospective study of 216 patients who underwent non-arthrographic MR imaging, conventional MR arthrography, VIBE MRI arthrography, and CT arthrogram between January 2011 and March 2022 was conducted. The diagnostic accuracy of non-arthrographic MR imaging, direct MR arthrography, and VIBE MRI arthrography in the detection of glenoid bare spot was compared with that of CT arthrography. All studies were reviewed by 2 MSK radiologists. Interobserver agreement for MR imaging and MR arthrographic findings was calculated. Results: Sixteen of 216 patients were excluded. Twenty-three of 200 shoulders had glenoid bare spot on CT arthrographic images. The glenoid bare spot was detected in 11 (47.8%) and 7 (30.4%) patients on conventional non-arthrographic MR images and in 18 (78.3%) and 16 (69.6%) patients on conventional MR arthrograms by observers 1 and 2, respectively. Both observers separately described the bare spot in 22 of 23 patients (95.7%) on 3D volumetric MR arthrograms. Interobserver variabilities were fair agreement for conventional non-arthrographic MR imaging (κ = 0.35, p < 0.05), moderate agreement for conventional MR arthrogram (κ = 0.50, p < 0.05), and near-perfect agreement for 3D volumetric MR arthrogram reading (κ = 0.87, p < 0.05). Conclusions: A 3D high-resolution T1-weighted VIBE MR arthrography sequence may yield diagnostic performance that is comparable with that of CT arthrography in the diagnosis of glenoid bare spot. Key Points: •Glenoid bare spot should not be misdiagnosed as a transchondral defect of the glenoid surface by radiologists. •A 3D high-resolution T1-weighted VIBE MR arthrography sequence may be used as a high-sensitivity imaging technique in the diagnosis of glenoid bare spot. [ABSTRACT FROM AUTHOR]

• Adolescent transitional ankle fracture is a specific type of fracture that occurs during the adolescent growth phase. • Arthrography is an important surgical method in pediatric orthopedic surgery. • In order to improve the success rate of closed reduction, we use the joystick technique to transitional ankle fracture. • The arthrography-assisted joystick technique provide an important guidance to transitional ankle fracture. To investigate the feasibility and short-term clinical efficacy of the arthrography-assisted joystick technique for the treatment of adolescent transitional ankle fracture. A retrospective analysis was performed in 10 adolescent transitional ankle fracture patients treated with the arthrography-assisted joystick technology. There were 7 male patients and 3 female patients with a mean age of 12.80 ± 1.81 years (range: 10–16 years). All cases were closed fractures, and the operation was performed after the failure of manual reduction [X-ray or computed tomography (CT) showed that the fracture gap was > 2 mm]. After the operation, X-ray or CT examination was performed to assess reduction of the fracture. Ankle function and fracture healing were evaluated by assessing the imaging indexes and evaluating the American Orthopedic Foot and Ankle Society (AOFAS) ankle score system. All patients were followed up for an average period of 12.00 ± 3.40 months (range: 8–20 months). The operation time was 40.50 ± 16.90 min (range: 25–80 min), the number of intraoperative fluoroscopy sessions was 18.70 ± 5.91 (range: 10–30 sessions), and the intraoperative blood loss was 5.90 ± 3.38 ml (range: 2–10 ml). X-ray examination showed that all cases achieved bone healing. The fracture healing time was 11.00 ± 2.45 weeks (range: 8–16 weeks). Four cases showed early closure of the epiphysis. The AOFAS scoring system evaluation results of these 10 pediatric cases were excellent. The arthrography-assisted joystick technique for the treatment of adolescent transitional ankle fracture offers advantages, such as minimal trauma, simple operation, ideal reduction effect, and the recent curative effect is satisfactory. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic performance of hip magnetic resonance (MR) arthrography with a gadolinium-based contrast agent (GBCA) or normal saline (NS) for intra-articular pathologies.Methods: This retrospective study was approved by the institutional review board of our hospital, and the requirement for informed consent was waived. The study included 37 consecutive patients (38 hips; 21 right hips; 24 males; mean age, 33 years) who underwent GBCA-hip MR arthrography from July 2011 to January 2020 and 30 consecutive patients (30 hips; 20 right hips; 21 males; mean age, 40 years) who underwent NS-hip MR arthrography from January 2018 to June 2020. All images were evaluated twice independently by two radiologists blinded to the arthroscopic findings for the presence of labral tears, cartilage abnormalities, or ligamentum teres tears. Intra- and inter-reader reliabilities were determined by kappa values (k) using the Chi-squared test, and diagnostic performance was evaluated based on the arthroscopic findings. A p-value less than 0.05 was considered to indicate statistical significance.Results: Intra-reader reliability in the detection of intra-articular pathologies ranged from moderate to almost perfect (k =0.510-0.840) and inter-reader reliability ranged from moderate to substantial (k =0.441-0.695) for GBCA- and NS-hip MR arthrography. The diagnostic accuracy of GBCA- and NS-hip MR arthrography was as follows: 81.6-92.1% and 66.7-73.3% for labral tears, respectively; 68.4-86.8% and 63.3-70.0% for cartilage abnormality, respectively; and 68.4-76.3% and 50.0-56.7% for ligamentum teres tears, respectively.Conclusion: NS-hip MR arthrography may be less accurate than GBCA-hip MR arthrography.Level Of Evidence: Level II of Development of diagnostic criteria (consecutive patients with consistently applied reference standard and blinding). [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]

ObjectiveThe purpose of this study is to identify features seen at shoulder MR arthrography that distinguish between iatrogenic contrast material extravasation and inferior glenohumeral ligament (IGHL) complex tears.Materials and methodsMR arthrograms (n = 1740) were screened for extravasation through the IGHL complex. Cases were defined on the basis of surgical findings or definitive lack of extravasation in a fully distended joint immediately after contrast agent injection. The location of the disruption and the morphologic features of the torn margin were assessed and compared between groups.ResultsAnterior band disruption was present in eight of 16 patients with true tears and in zero of 19 patients with iatrogenic contrast material extravasation (p < 0.001). Isolated extravasation through the posterior half of the axillary pouch was present in 12 patients with iatrogenic extravasation, compared with none of the patients with true tears (p < 0.001). Thick ends were present in 10 of the true tears, whereas none of the cases of iatrogenic extravasation showed this finding (p < 0.001). Scarred margins were seen in eight true tears and none of the iatrogenic extravasation cases (p < 0.001). The presence of a torn anterior band, thick ligament, reverse-tapered caliber, and scarred appearance of the torn margin were shown to be 100.0% specific, and a torn posterior band showed 84.2% specificity for true tears. The presence of isolated involvement of the posterior portion of axillary pouch showed 63.2% sensitivity and 100.0% specificity for iatrogenic extravasation.ConclusionA torn anterior band, a thickened ligament (> 3 mm), reverse-tapered caliber, and scarred margin were 100.0% specific for a tear. Isolated disruption of the posterior axillary pouch was 100.0% specific for iatrogenic extravasation.

We have developed an MRI-safe needle guidance toolkit for MRI-guided interventions intended to enable accurate positioning for needle-based procedures. The toolkit allows intuitive and accurate needle angulation and entry point positioning according to an MRI-based plan, using a flexible, patterned silicone 2D grid. The toolkit automatically matches the grid on MRI planning images with a physical silicon grid placed conformally on the patient's skin and provides the Interventional Radiologist an easy-to-use guide showing the needle entry point on the silicon grid as well as needle angle information. The radiologist can use this guide along with a 2-degree-of-freedom (rotation and angulation relative to the entry point) hand-held needle guide to place the needle into the anatomy of interest. The initial application that we are considering for this toolkit is arthrography, a diagnostic procedure to evaluate the joint space condition. However, this toolkit could be used for any needle-based and percutaneous procedures such as MRI-guided biopsy and facet joint injection. For matching the images, we adopt a transformation parameter estimation technique using the phase-only correlation method in the frequency domain. We investigated the robustness of this method against rotation, displacement, and Rician noise. The algorithm was able to successfully match all the dataset images. We also investigated the accuracy of identifying the entry point from registered template images as a prerequisite for a future targeting study. Application of the template matching algorithm to locate the needle entry points within the MRI dataset resulted in an average entry point location estimation accuracy of 0.12 ±0.2 mm. This promising result motivates a more detailed assessment of this algorithm in the future including a targeting study on a silicon phantom with embedded plastic targets to investigate the end-to-end accuracy of this automatic template matching algorithm in the interventional MRI room. [ABSTRACT FROM AUTHOR]

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.

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.

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.

Higher levels of moderate to vigorous physical activity improve all-cause mortality and cardiovascular events. However, the effect of running, a moderate to vigorous activity, in those with knee osteoarthritis (OA), a common arthritis that occurs with aging, a high-risk group for mortality and cardiovascular events, is unclear. Therefore, we aimed to evaluate the association of self-selected running on OA symptom and structure progression in people with knee OA. This nested cohort study within the Osteoarthritis Initiative (OAI) (2004-2014) included those at least 50 years old with OA in at least one knee. Runners were defined using a self-administered questionnaire at the 96-month visit. At baseline and 48-months, symptoms were assessed and radiographs were scored for Kellgren-Lawrence (KL) grade (2-4) and medial Joint Space Narrowing (JSN) score (0-3). We evaluated the association of self-selected running with outcomes: KL worsening, medial JSN worsening, new knee pain, and improved knee pain over 48 months, adjusting for baseline age, sex, body mass index (BMI), KL score, contralateral KL score, contralateral knee pain, and injury. If data were not available at the 48-month visit, then they were imputed from the 36-month visit. One thousand two hundred three participants had a mean age of 63.2 (7.9) years, BMI of 29.5 (4.6) kg/m2, 45.3% male, and 11.5% runners. Data from 8% of participants required imputation. Adjusted odds ratios for KL grade worsening and new frequent knee pain were 0.9 (0.6-1.3) and 0.9 (0.6-1.6) respectively. Adjusted odds ratio for frequent knee pain resolution was 1.7 (1.0-2.8). Among individuals 50 years old and older with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression. Therefore, self-selected running, which is likely influenced by knee symptoms and may result in lower intensity and shorter duration sessions of exercise, need not be discouraged in people with knee OA.

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 FROM AUTHOR]

Purpose: Currently, traumatic arthrotomy of the knee could be diagnosed by saline loading test and computed tomography (CT) which reported excellent sensitivity and specificity. However, there are drawbacks associated with CT, such as cost and radiation hazards. This study aims to evaluate a new diagnostic tool using knee arthrography for individuals with suspected open knee injury and reported sensitivity and specificity using CT scan as the gold standard., Method: A prospective diagnostic study, involving 43 patients who sustained laceration wounds over the knee, was conducted. The physical examination and conventional radiographic imaging were inconclusive in determining the presence of open joint injury. The established protocol involved directing the patients to undergo a CT scan, which is considered the gold standard for detecting open knee injuries. Subsequently, arthrography of the affected knee was performed. The diagnostic value was subsequently determined based on the outcomes derived from these procedures., Results: There were 5/43 cases (11.6%) that diagnosed open knee injuries as determined by CT scans. The calculated diagnostic parameters of arthrography derived from these findings are as follows: The sensitivity was 83.3%, the specificity was 96.5%, the negative predictive value was 96.5%, the positive predictive value was 83.3%, the accuracy is 94.3%, the false positive rate is 16.7%, and the false negative rate was 3.4%. Interobserver reliability was substantial (Kappa 0.617). No complication was observed during the arthrography procedure., Conclusions: Knee arthrography demonstrated high sensitivity, specificity and accuracy for diagnosing open knee injuries, offering a viable alternative to CT scans in certain situations, such as when minimizing radiation exposure is a priority and cost considerations are paramount. Ultimately, careful clinical judgement should guide the choice of diagnostic modality based on individual patient circumstances., Competing Interests: Declarations. Conflict of interest: All authors declare no conflict of interests. Ethical approval: Approved by ethics committee of Queen Savang Vadhana Memorial Hospital. Informed consent: All patients were informed and given consent for the study and publication., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).

Objective: To explore clinical effect of closed reduction percutaneous elastic intramedullary nail assisted by arthrography in the treatment of radial neck fracture in children., Methods: A retrospective analysis was performed on 23 children with radial neck fracture treated with arthrography assisted closed reduction and percutaneous elastic intramedullary nail internal fixation (arthrography with elastic nail group) from January 2019 to December 2022, including 12 males and 11 females, aged from 2 to 12 years old with an average of (7.36±1.89) years old;According to Judet fracture types, 14 children were type Ⅲ and 9 children were type Ⅳ. In addition, 23 children with radial neck fracture were selected from January 2015 to December 2018 who were treated with closed reduction and percutaneous elastic intramedullary nail fixation (elastic nail group), including 11 males and 12 females, aged from 2 to 14 years old with an average of (7.50±1.91) years old;Judet classification included 15 children were type Ⅲ and 8 children were type Ⅳ. Operative time and intraoperative fluoroscopy times were compared between two groups. Metaizeau evaluation criteria was used to evaluate fracture reduction, and Tibone-Stoltz evaluation criteria was used to evaluate functional recovery of elbow between two groups., Results: Both groups were followed up for 12 to 24 months with an average of (16.56±6.34) months. Operative time and intraoperative fluoroscopy times of elastic nail group were (56.64±19.27) min and (21.13±7.87) times, while those of joint angiography with elastic nail group were (40.33±11.50) min and (12.10±3.52) times;there were difference between two groups ( P <0.05). According to Metaizeau evaluation, 11 patients got excellent result, 9 good and 3 fair in joint angiography with elastic nail group, while in elastic nail group, 5 excellent, 13 good, 4 acceptable, and 1 poor;the difference between two groups was statistically significant ( P <0.05). According to Tibone-Stoltz criteria, 14 patients got excellent result, 8 good, and 1 fair in joint arthrography with elastic nail group;while in elastic nail group, 12 patients got excellent result, 9 good, 1 fair and 1 poor;there was no significant difference between two groups ( P >0.05)., Conclusion: Compared to percutaneous elastic intramedullary nail fixation, closed reduction assisted by arthrography has advantages of reduced operation time, decreased intraoperative fluoroscopy frequency, and improved fracture reduction. Arthrography enables clear visualization of the anatomical structures of radius, head, neck, bone, and cartilage in children, facilitating comprehensive display of fracture reduction and brachioradial joint alignment. This technique more precisely guides the depth of elastic intramedullary nail implantation in radius neck, thereby enhancing surgical efficiency and success rate.