Browsing by Subject "Arthrography"

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    A simple technique for shoulder arthrography
    (SAGE Publications, 2006-09) Redondo, M.V.; Martínez Martínez, Francisco; Reus, M.; Alonso, J.; Parrilla, A.; Campos, P.A.; Berná Serna, Juan De Dios; Cirugía, Pediatría y Obstetricia y Ginecología
    Purpose: To present a systematic approach to teaching a technique for arthrography of the shoulder. Using an adhesive marker-plate with radiopaque coordinates, precise sites for puncture can be identified and the need for fluoroscopic guidance obviated. Material and Methods: Forty-six glenohumeral arthrograms were performed in 45 patients; in 1 case involving examination of both shoulders. The stages of the technique are described in detail, as are the fundamental aspects of achieving an effective glenohumeral injection. Pain intensity was measured in all patients using a verbal description scale.Results: Shoulder arthrography was successful in all cases. Average time taken for the procedure was 7 min, with no difference in the respective times required by an experienced radiologist and a resident. The procedure was well tolerated by most patients, with slight discomfort being observed in a very few cases.Conclusion: The arthrographic technique used in this study is simple, safe, rapid, and reproducible, and has the advantage of precise localization of the site for puncture without need for fluoroscopic guidance. The procedure described in this study can be of help in teaching residents and can reduce the learning curve for radiologists with no experience in arthrographic methods. It also reduces the time of exposure to fluoroscopy.
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    Evaluation of the triangular fibrocartilage in cadaveric wrists by means of arthrography, magnetic resonance (MR) imaging, and MR Arthrography
    (SAGE Publications, 2007-02) Martínez Martínez, Francisco; Reus, M.; Alonso, J.; Doménech Asensi, Guillermo; Campos, M.; Berná Serna, Juan De Dios; Cirugía, Pediatría y Obstetricia y Ginecología
    Purpose: To evaluate the diagnostic accuracy of arthrography, magnetic resonance (MR) imaging, and MR arthrography in the detection and localization of defects of the triangular fibrocartilage (TFC) in cadaveric wrists, using arthroscopy as a reference standard. Material and Methods: Twenty-four specimen wrists were evaluated. The different imaging modalities were blinded to reviewers and were interpreted independently. A classification of TFC defects was used for the evaluation of images in the different imaging modalities, thus permitting a more uniform correlation. Two cases were excluded from the MR imaging study because of poor image quality. Contingency tables with the chi-square test and Fisher's exact test were used for statistical analysis. Results: Defects of the TFC were identified in 17 of the 24 specimen wrists by means of arthroscopy, and 16 defects were observed when arthrography was carried out. With MR imaging 14 defects of the TFC were detected in the 22 specimen wrists evaluated, and with MR arthrography 16 defects were observed. Most defects were central or combined (two or more defects). In comparison to arthroscopy, the accepted diagnostic gold standard, the following results were found for arthrography in the detection of TFC defects: sensitivity 95%, specificity 100%, and accuracy 95% (P<0.0005); for MR imaging: sensitivity 86%, specificity 85%, and accuracy 70% (P<0.002); and for MR arthrography: sensitivity 100%, specificity 85%, and accuracy 95% (P<0.0005). Conclusion: The results of the study seem to indicate that both arthrography and MR arthrography have high accuracy, and either would be useful for evaluation of the TFC. The combined approach using both techniques would have a very high accuracy equivalent to that resulting from arthroscopy.
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    MR and CT Arthrography of the Wrist
    (Thieme Gruppe, 2012-02-01) Cerezal Pesquera, Luis; Berná Mestre, Juan de Dios; Canga, Ana; Llopis, Eva; Rolon, Alejandro; Martín Oliva, Xavier; Piñal, Francisco del; Dermatología, Estomatología, Radiología y Medicina Física
    The study of the wrist represents a major diagnostic challenge because of its complex anatomy and the small size of individual structures. Recent advances in imaging techniques have increased our diagnostic capabilities. However, 3T magnets, multichannel specific wrist coils, and new MRI sequences have not restricted the indications of arthrographic imaging techniques (CT arthrography and MR arthrography). Distension of the different wrist compartments at CT arthrography and MR arthrography significantly improves the diagnostic accuracy for triangular fibrocartilage (TFC) complex injuries and carpal instability. Dedicated multichannel wrist coils are essential for an adequate study of the wrist, but the placement of these coils and the positioning of the wrist are also important for proper diagnosis. The development of dynamic multislice CT studies allows a diagnostic approach that combines dynamic information and the accurate assessment of ligaments and the TFC complex. New advances in arthroscopy have changed the anatomical description of the TFC with a functional division in the proximal and distal TFC complex, and they have allowed a better characterization of lesions of the TFC complex with subclassification of Palmer 1B and 1D lesions and description of new lesions not included in the Palmer classification, such as capsular injuries.
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    MR arthrography of the shoulder using an anterior approach: optimal injection site
    (American Roentgen Ray Society, 2012-11-23) Redondo, María V.; Campos, Pedro A.; Reus, Manuel; Martínez Martínez, Francisco; Campos, Matilde; Domenech, Ernesto; Berná Serna, Juan De Dios; Cirugía, Pediatría y Obstetricia y Ginecología
    OBJECTIVE. The purpose of our study was to optimize anterior MR arthrography of the shoulder by comparing three injection sites. MATERIALS AND METHODS. Seventy-eight patients were divided into three groups of 26 each, according to the injection site selected: the upper third of the medial part of the humeral head, the lower third of the medial part of the humeral head, or the area between the middle and lower thirds of the glenohumeral joint. A marker plate with radiopaque coordinates was used in performing the technique. Radiologist time and exposure time were recorded, and the intensity of the patient's pain was measured using a Visual Analogue Scale (VAS). Groups were compared using variance analysis and the least significant difference method. RESULTS. Shoulder arthrography was considered satisfactory for all three injection sites. Mean exposure time was 20.9 ± 7.8 (SD) milliseconds, and mean radiologist time was 6.4 ± 0.8 minutes. Mean pain intensity registered by the VAS was 1.7 ± 0.9, the lowest values tending to be those recorded by patients who received an injection in the upper third. Exposure and radiologist times were lower for these latter patients; differences between the upper third and the other two areas were statistically significant (p < 0.005). CONCLUSION. The optimal injection site for anterior MR arthrography of the shoulder is the upper third of the humeral head, a simple, rapid procedure that is well tolerated by patients and reduces the radiation dose administered.
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    Optimización de las dosis de radiación en la artrografía de hombro
    (Elsevier, 2009-05-01) Campos, P.A.; Redondo, M.V.; Reus, M.; Martínez Martínez, Francisco; Berná Serna, Juan De Dios; Cirugía, Pediatría y Obstetricia y Ginecología
    Objetivo: El objetivo de este estudio fue reducir la dosis de radiación recibida por los pacientes sometidos a una artrografía de hombro y en los que se utiliza como sistema de guiado una placa con coordenadas radiopacas situada sobre el área de interés. Material y métodos: La dosis a la entrada se obtuvo en 34 pacientes con edades comprendidas entre 15 y 75 años, media de 44 años. La dosis a órganos de riesgo y la dosis efectiva se estimaron mediante técnicas de Monte Carlo, donde los parámetros de entrada son: anatomía del paciente, geometría de la exploración y kerma en aire a la entrada del paciente sin retrodispersión. Las artrografías se realizaron en un equipo telemando y las imágenes se obtuvieron mediante adquisición digital sin fluoroscopia. Resultados: El espesor medio de los hombros estudiados fue 14,6±2,1 cm (9–20 cm). Las imágenes se obtuvieron con 80±10 kVp (60–85 kVp) y 6,5±3,5 mAs (1,4–17 mAs). El tiempo medio de irradiación para cada paciente fue 20±6 ms (6,9–47,9 ms). El kerma en aire calculado fue de 0,41±0,19 mGy y la dosis efectiva de 0,79±0,40 μ Sv. Conclusiones: La técnica descrita en este trabajo ha permitido reducir la dosis de radiación al paciente respecto a otros procedimientos descritos en la bibliografía y que el radiólogo que realiza la artrografía no se irradie durante el procedimiento.