The distribution in joint recesses and adjacent synovial compartments of loose bodies determined on MR and CT arthrographies of ankle joint

Loose bodies (LBs) are intraarticular free bodies that result from various pathological processes and cause synovial inflammation. Timely and complete identification of LBs is important for appropriate treatment and prevention of possible complications such as osteoarthritis. LBs in the ankle joint can reach all the compartments that are adjacent to the joint via physiological or pathological connections. The presence, localisation, and number of LBs in the ankle joint and adjacent synovial compartments can be optimally evaluated using high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA). On this review article, we aimed to determine the LB location and distribution using high-resolution MRA and CTA of the ankle joint, and to demonstrate that it may be used as a complementary examination to guide interventional arthroscopy in difficult-to-reach areas during treatment. Advances in knowledge Loose bodies (LBs) are intraarticular free bodies and may cause synovial inflammation. Accurate and complete determination of the number and location of LBs before surgery are very important for effective treatment. The location, number and distribution of LBs in the ankle joint may be determined successfully by high-resolution magnetic resonance arthrography (MRA) and computed tomography arthrography (CTA). For this purpose, MRA and CTA may increase the diagnostic and therapeutic success of the arthroscopy.

An assessment of SLAP type 5 lesions using proton density oblique sagittal imaging in magnetic resonance arthrography

Background Bankart lesions accompany superior labrum anteroposterior (SLAP) lesions; these are called SLAP type 5. Purpose To compare SLAP type 5 lesions using routine magnetic resonance arthrography (MRA) and thin-slice oblique sagittal proton density (PDW) sequences and correlation operation results. Material and Methods In total, 181 patients were admitted with shoulder instability. The study was completed with 44 patients. The presence or absence of isolated Bankart and SLAP type 5 lesions in routine MRA and PDW oblique sagittal images were evaluated separately. Absence of rupture scored 0 points, suspected ruptures scored 1 point, and apparent ruptures scored 2 points. The two scores were compared with the shoulder arthroscopy findings. Results According to the findings in the shoulder arthroscopy, 40 patients had Bankart lesions and 17 patients had accompanying SLAP type 5 lesions. To detect a Bankart lesion, there was no significant difference between routine MRA sequences and PDW oblique sagittal images ( P = 0.061). Routine MRA sensitivity was 95%, specificity 25%, positive predictive value (PPV) 92%, negative predictive value (NPV) 33%, while for PDW oblique sagittal images, sensitivity was 75%, specificity 100%, PPV 100%, and NPV 28.5%. In 8/17 type 5 SLAP lesions, routine MRA detected sensitivity 47%, specificity 92.6%, PPV 80%, and NPV 73.5%; in 14/17 SLAP type 5 lesions, PDW oblique sagittal images detected sensitivity 82%, specificity 100%, PPV 100%, and NPV 90% ( P = 0.015). Conclusion The PDW oblique sagittal images may play a significant role in assessing the anterior and superior extent of the tears.

Magnetic Resonance Arthrography of the Wrist: The Impact on Operative Management of Wrist Injuries

Background There is no consensus on the utility of arthrography in the evaluation of wrist injuries. This study evaluates ordering trends of different types of magnetic resonance imaging (MRI) of the wrist and compares rates of surgery following these imaging modalities. Methods A national claims-based database was used to identify patients who underwent MRI within 90 days of a first-instance diagnosis of wrist injury from 2010 to 2018. The utilization of MRI without intravenous (IV) contrast, MRI with IV contrast, and MRI with arthrogram was investigated. The instances of operative procedures of the wrist within 1 year of MRI study were recorded. Patient demographics, comorbidities, type of operative procedure, and ordering physician specialty were obtained. Logistic regression analysis was used to evaluate the utilization of MRI and subsequent 1-year operative intervention rates as well as association of patient-related factors. Results Magnetic resonance arthrography use was associated with higher rates of subsequent operative treatment. Surgeons were more likely to order an arthrogram at the time of MRI. Younger patients were more likely to undergo MRI-based advanced imaging. Conclusion Surgeons may perceive MRA of the wrist to play an important role in operative decision-making following wrist injury. Level of Evidence This is a Level III, retrospective cohort study.

Evaluation of variations of the glenoid attachment of the inferior glenohumeral ligament by magnetic resonance arthrography

Objective: To evaluate the anatomical variations of the attachment of the inferior glenohumeral ligament (IGHL) to the anterior glenoid rim. Materials and Methods: This was a retrospective review of 93 magnetic resonance arthrography examinations of the shoulder. Two radiologists, who were blinded to the patient data and were working independently, read the examinations. Interobserver and intraobserver agreement were evaluated. The pattern of IGHL glenoid attachment and its position on the anterior glenoid rim were recorded. Results: In 50 examinations (53.8%), the glenoid attachment was classified as type I (originating from the labrum), whereas it was classified as type II (originating from the glenoid neck) in 43 (46.2%). The IGHL emerged at the 4 o’clock position in 58 cases (62.4%), at the 3 o’clock position in 14 (15.0%), and at the 5 o’clock position in 21 (22.6%). The rates of interobserver and intraobserver agreement were excellent. Conclusion: Although type I IGHL glenoid attachment is more common, we found a high prevalence of the type II variation. The IGHL emerged between the 3 o’clock and 5 o’clock positions, most commonly at the 4 o’clock position.