arthrografi

MR ARTHROGRAPHY

Adam D. Olsan, MDMedical Director of Advanced MRI

Vice‐President of the Radiological Society of

Louisiana

MR Arthrography

• Learning Objectives– Know what an MR Arthrogram is.

– Why we perform MR Arthrograms.

– How we perform MR Arthrogams.

– What MR Arthrogram images look like.

What is an MR Arthrogram?


• Arthrogram– Imaging of a joint after the injection of contrast

into the joint.



into the joint.

• Traditional Arthrogram– X‐ray imaging of a joint after the injection of

iodinated

contrast into the joint.



into the joint.

• Traditional Arthrogram– X‐ray imaging of a joint after injection of iodinated


• MR Arthrogram– MR imaging of a joint after injection of gadolinium


Why do an MR Arthrogram?

Indications for MR Arthrography

– Shoulder• Glenoid labral tears (SLAP injuries)• Rotator cuff tendon tears

– Hip• Acetabular labral tears• Surgical planning

– Wrist• Ligament tears • Triangular fibrocartilage complex tears

– Elbow• Collateral ligaments

How do we perform an MR Arthrogram?

How are MR Arthrograms performed?

MR Arthrography Procedure

• Contrast solution varies– 5cc Normal Saline

– 5cc Iodinated contrast – +/‐

10cc Anesthetic and

steroid

– 0.1cc Gadolinium• Lidocaine 1% without

Epi. for skin and soft tissues

MR Arthrography Procedure

MR Arthrography

Some Anatomy and Common Pathologies

Shoulder

Normal Shoulder Coronal

Normal Shoulder Sagittal

Normal Shoulder Axial

Shoulder Case #1

Normal Abnormal

Glenoid Labral Tear

Superior Labrum Anterior to Posterior (SLAP)

SLAP Lesions

• Tear of the superior glenoid labrum at the bicipital‐labral complex.

• Lesions can vary from simple fraying and fragmentation of the bicipital‐labral complex

to a bucket‐handle tear.• Can extend into Surrounding structures

– Anterior Labrum– Middle Glenohumeral Ligament– Posterior Labrum

Next Case

Normal Abnormal

Glenoid Cartilage Fracture

Normal Abnormal

Glenoid Cartilage Fracture

Next Case

Normal Abnormal

Rotator Cuff Tendon Tear

Next Case

Normal Abnormal

Normal Hip Coronal

Normal Hip Axial

Normal Hip Sagittal

Acetabular

Labrum

• Fibrocartilaginous rim which deepens acetabulum.

• Attaches to osseous acetabular rim and transverse acetabular ligament.

• Joint capsule attaches to the acetabular rim adjacent to labrum

Hip Case #1

Normal Abnormal

Next Case

Normal Abnormal

Acetabular Labral Tears

•

Anterosuperior + posterosuperior labrum are most common locations.

•

Base of labrum (detachments) or along long axis.

•

Intraarticular contrast fills tear and distention of capsule promotes uplifting or separation of torn labrum from acetabular cartilage.

Causes

of Acetabular Labral Tears

•

Osteoarthritis

•

Hip Dysplasia

•

Femoral Acetabular Impngement (FAI)

Femoroacetabular Impingement: FAI

•

Cause of early osteoarthritis of the hip especially in young and active people.

•

Contact between skeletal prominences of the acetabulum and femur limits physiologic hip

range of motion.

•

Occurs typically during flexion and internal rotation.

•

Patients are typically aware of limited hip mobility long before surgery.

CAM impingement

•

Femoral cause of FAI

•

Aspherical femoral head‐neck junction (usually antero‐lateral portion of the femoral

neck) contacts the acetabulum.

•

Results in abrasion of the acetabular cartilage or its avulsion from the labrum and

subchondral bone.

•

Chondral avulsion in turn leads to tear or detachment of the adjacent labrum.

FAI ‐

CAM

Pincer impingement

•

Acetabular cause of FAI

•

Focal or generalized over coverage of the femoral head

•

Too large wall of the acetabulum or retroversion of the acatebulum.

FAI ‐

Pincer

FAI – Os acetabuli

Next Case

Normal Abnormal

Next Case

Normal Abnormal

Avascular Necrosis

Avascular Necrosis

• Necrosis of the bone secondary to ischemia

• Etiologies– Post‐traumatic

– Corticosteroid use– Alcohol abuse– Lupus– Sickle cell anemia

– Caissson disease

Wrist MR Arthrography

•

Triangular Fibrocartilage Complex (TFCC)

•

Intrinsic Ligaments–

Scapholunate and Lunotriquetral

TFCC

•

Triangular fibrocartilage

•

Volar and Dorsal radioulnar ligaments

•

Meniscus homologue – thickening of the ulnar joint capsule; inconsistent

•

Ulnar collateral ligament

•

Tendon sheath of the extensor carpi ulnaris (ECU)

Abnormal TFCC

•

Triangular fibrocartialge (TFC) is most commonly abnormal

•

High signal extending through the TFC indicates a tear

•

Tears can be partial or full thickness

•

TFC can have myxoid degeneration

Scapholunate Ligament

•

Origin/Insertion: Ulnar scaphoid to radial lunate; hyaline cartilage attachment

•

Action: Dorsal portion resists volar‐dorsal translation; Volar portion limits

flexion/extension; proximal accomodates compression and shear forces across

radiocarpal joint

Scapholunate Ligament

•

U‐shaped ligament with dorsal, proximal and volar components

–

Dorsal component thicker (5mm) than volar (1‐ 2mm); functionally more important that proximal

portion

–

Proximal component is mescus‐like avascular fibrocartilage; triangular shape

•

Attritional tears with age

Lunotriquetral Ligament

•

Origin/insertion: Ulnar lunate to radial triquetrum; hyaline cartilage attachment

•

Action: Volar portion limits translation of lunate and triquetrum; dorsal portion

stabilizes joint

Lunotriquetral Ligament

•

U‐shaped ligament with dorsal, proximal and volar components

–

Volar component thicker (2‐3mm) than dorsal (1mm); functionally more important than

proximal portion

–

Proximal component is mesiscus‐like avascular fibrocartilage; triangular shape

•

Attritional tears with age

Wrist Case #1

Wrist Case #2

Normal Elbow Axial

Normal Elbow Sagittal

Normal Ulnar Collateral Ligament (UCL)

Normal Radial Collateral Ligament (RCL)

Normal Abnormal

Torn Ulnar Collateral Ligament (UCL)

Normal Abnormal

Normal Abnormal

Torn Radial Collateral Ligament

Normal Abnormal

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