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Arthroskopie

, Volume 32, Issue 2, pp 77–85 | Cite as

Schultergelenk

Wann ist eine MR-Arthrographie notwendig?
  • Achim H. KaimEmail author
  • David Haeni
Leitthema
  • 276 Downloads

Zusammenfassung

Die direkte Schulter-MR-Arthrographie ist eine einfache und sicher durchführbare Untersuchung, die Vorteile gegenüber der konventionellen Schulter-MRT bietet. Durch die intraartikuläre Flüssigkeitsgabe wird das Gelenklumen aufgeweitet, und eng benachbarte intraartikuläre Strukturen werden voneinander abgrenzbar. Anatomische Varianten und subtile Pathologien können anhand der Ausdehnung und Verteilung des Kontrastmittels zuverlässig diagnostiziert werden. Mit hoher Präzision werden Pathologien des Labrums, der Rotatorensehnen, des vorderen Gelenkkapselintervalls und der postoperativ rekonstruierten Rotatorenmanschette dargestellt.

Schlüsselwörter

Magnetresonanztomographie Glenohumeralgelenk Postoperative Bildgebung Labrum Rotatorenmanschette 

Shoulder joint

When is MR arthrography necessary?

Abstract

Direct MR arthography (MR: magnetic resonance) of the glenohumeral joint is an easy and safe procedure that offers obvious advantages over conventional MR imaging of the shoulder. The capsular distention due to the intra-articular administration of fluid allows separation of otherwise non-separable anatomical structures. Anatomic variants and subtle pathologies of the labrum, rotator cuff tendons, capsular interval and rotator cuff repairs can be defined with high accuracy.

Keywords

Magnetic resonance imaging Glenohumeral joint Postoperative imaging Labrum Rotator cuff 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A.H. Kaim und D. Haeni geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Beltran LS, Bencardino JT, Steinbach LS (2014) Postoperative MRI of the shoulder. J Magn Reson Imaging 40:1280–1297.  https://doi.org/10.1002/jmri.24570 CrossRefPubMedGoogle Scholar
  2. 2.
    Binkert CA, Zanetti M, Gerber C, Hodler J (2001) MR arthrography of the glenohumeral joint: two concentrations of gadoteridol versus Ringer solution as the intraarticular contrast material. Radiology 220:219–224.  https://doi.org/10.1148/radiology.220.1.r01jn03219 CrossRefPubMedGoogle Scholar
  3. 3.
    Binkert CA, Zanetti M, Hodler J (2001) Patient’s assessment of discomfort during MR arthrography of the shoulder. Radiology 221:775–778.  https://doi.org/10.1148/radiol.2213010277 CrossRefPubMedGoogle Scholar
  4. 4.
    De Coninck T, Ngai SS, Tafur M, Chung CB (2016) Imaging the Glenoid Labrum and Labral tears. Radiographics 36:1628–1647.  https://doi.org/10.1148/rg.2016160020 CrossRefPubMedGoogle Scholar
  5. 5.
    De Filippo M, Pesce A, Barile A et al (2017) Imaging of postoperative shoulder instability. Musculoskelet Surg 101:15–22.  https://doi.org/10.1007/s12306-017-0461-4 CrossRefPubMedGoogle Scholar
  6. 6.
    Dépelteau H, Bureau NJ, Cardinal E et al (2004) Arthrography of the shoulder: a simple fluoroscopically guided approach for targeting the rotator cuff interval. AJR Am J Roentgenol 182:329–332.  https://doi.org/10.2214/ajr.182.2.1820329 CrossRefPubMedGoogle Scholar
  7. 7.
    Dunn AS, Turpie AGG (2003) Perioperative management of patients receiving oral anticoagulants: a systematic review. Arch Intern Med 163:901–908.  https://doi.org/10.1001/archinte.163.8.901 CrossRefPubMedGoogle Scholar
  8. 8.
    Esenyel CZ, Ozturk K, Demirhan M et al (2010) Accuracy of anterior glenohumeral injections: a cadaver study. Arch Orthop Trauma Surg 130:297–300.  https://doi.org/10.1007/s00402-008-0811-7 CrossRefPubMedGoogle Scholar
  9. 9.
    Giaconi JC, Link TM, Vail TP et al (2011) Morbidity of direct MR arthrography. AJR Am J Roentgenol 196:868–874.  https://doi.org/10.2214/AJR.10.5145 CrossRefPubMedGoogle Scholar
  10. 10.
    Habermeyer P, Magosch P, Pritsch M et al (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13:5–12.  https://doi.org/10.1016/S1058274603002568 CrossRefPubMedGoogle Scholar
  11. 11.
    Hodler J (2008) Technical errors in MR arthrography. Skeletal Radiol 37:9–18.  https://doi.org/10.1007/s00256-007-0329-z CrossRefPubMedGoogle Scholar
  12. 12.
    Holzapfel K, Waldt S, Bruegel M et al (2010) Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation. Eur Radiol 20:666–673.  https://doi.org/10.1007/s00330-009-1593-1 CrossRefPubMedGoogle Scholar
  13. 13.
    Hugo PC, Newberg AH, Newman JS, Wetzner SM (1998) Complications of arthrography. Semin Musculoskelet Radiol 2:345–348.  https://doi.org/10.1055/s-2008-1080115 CrossRefPubMedGoogle Scholar
  14. 14.
    de Jesus JO, Parker L, Frangos AJ, Nazarian LN (2009) Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 192:1701–1707.  https://doi.org/10.2214/AJR.08.1241 CrossRefPubMedGoogle Scholar
  15. 15.
    Lafosse L, Jost B, Reiland Y et al (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89:1184–1193.  https://doi.org/10.2106/JBJS.F.00007 CrossRefPubMedGoogle Scholar
  16. 16.
    Magee T (2015) Usefulness of unenhanced MRI and MR arthrography of the shoulder in detection of unstable labral tears. AJR Am J Roentgenol 205:1056–1060.  https://doi.org/10.2214/AJR.14.14262 CrossRefPubMedGoogle Scholar
  17. 17.
    Matava MJ, Purcell DB, Rudzki JR (2005) Partial-thickness rotator cuff tears. Am J Sports Med 33:1405–1417.  https://doi.org/10.1177/0363546505280213 CrossRefPubMedGoogle Scholar
  18. 18.
    Meister K, Thesing J, Montgomery WJ et al (2004) MR arthrography of partial thickness tears of the undersurface of the rotator cuff: an arthroscopic correlation. Skeletal Radiol 33:136–141.  https://doi.org/10.1007/s00256-003-0688-z CrossRefPubMedGoogle Scholar
  19. 19.
    Mohana-Borges AVR, Chung CB, Resnick D (2003) Superior labral anteroposterior tear: classification and diagnosis on MRI and MR arthrography. AJR Am J Roentgenol 181:1449–1462.  https://doi.org/10.2214/ajr.181.6.1811449 CrossRefPubMedGoogle Scholar
  20. 20.
    Mohana-Borges AVR, Chung CB, Resnick D (2004) MR imaging and MR arthrography of the postoperative shoulder: spectrum of normal and abnormal findings. Radiographics 24:69–85.  https://doi.org/10.1148/rg.241035081 CrossRefPubMedGoogle Scholar
  21. 21.
    Morag Y, Bedi A, Jamadar DA (2012) The rotator interval and long head biceps tendon: anatomy, function, pathology, and magnetic resonance imaging. Magn Reson Imaging Clin N Am 20:229–259.  https://doi.org/10.1016/j.mric.2012.01.012 CrossRefPubMedGoogle Scholar
  22. 22.
    Morag Y, Jacobson JA, Miller B et al (2006) MR imaging of rotator cuff injury: what the clinician needs to know. Radiographics 26:1045–1065.  https://doi.org/10.1148/rg.264055087 CrossRefPubMedGoogle Scholar
  23. 23.
    Morag Y, Jacobson JA, Shields G et al (2005) MR arthrography of rotator interval, long head of the biceps brachii, and biceps pulley of the shoulder. Radiology 235:21–30.  https://doi.org/10.1148/radiol.2351031455 CrossRefPubMedGoogle Scholar
  24. 24.
    Mutlu S, Mahıroğullari M, Güler O et al (2013) Anterior glenohumeral instability: classification of pathologies of anteroinferior labroligamentous structures using MR arthrography. Adv Orthop.  https://doi.org/10.1155/2013/473194 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Nakata W, Katou S, Fujita A et al (2011) Biceps pulley: normal anatomy and associated lesions at MR arthrography. Radiographics 31:791–810.  https://doi.org/10.1148/rg.313105507 CrossRefPubMedGoogle Scholar
  26. 26.
    Newberg AH, Munn CS, Robbins AH (1985) Complications of arthrography. Radiology 155:605–606.  https://doi.org/10.1148/radiology.155.3.4001360 CrossRefPubMedGoogle Scholar
  27. 27.
    Patte D (1990) Classification of rotator cuff lesions. Clin Orthop 254:81–86Google Scholar
  28. 28.
    Pierce JL, Nacey NC, Jones S et al (2016) Postoperative shoulder imaging: rotator cuff, labrum, and biceps tendon. Radiographics 36:1648–1671.  https://doi.org/10.1148/rg.2016160023 CrossRefPubMedGoogle Scholar
  29. 29.
    Powell SE, Davis SM, Lee EH et al (2015) Accuracy of palpation-directed intra-articular glenohumeral injection confirmed by magnetic resonance arthrography. Arthroscopy 31:205–208.  https://doi.org/10.1016/j.arthro.2014.08.013 CrossRefPubMedGoogle Scholar
  30. 30.
    Probyn LJ, White LM, Salonen DC et al (2007) Recurrent symptoms after shoulder instability repair: direct MR arthrographic assessment – correlation with second-look surgical evaluation. Radiology 245:814–823.  https://doi.org/10.1148/radiol.2453061329 CrossRefPubMedGoogle Scholar
  31. 31.
    Redondo MV, Berná-Serna JD, Campos PA et al (2008) MR arthrography of the shoulder using an anterior approach: optimal injection site. AJR Am J Roentgenol 191:1397–1400.  https://doi.org/10.2214/AJR.08.1014 CrossRefPubMedGoogle Scholar
  32. 32.
    Rhee RB, Chan KK, Lieu JG et al (2012) MR and CT arthrography of the shoulder. Semin Musculoskelet Radiol 16:3–14.  https://doi.org/10.1055/s-0032-1304297 CrossRefPubMedGoogle Scholar
  33. 33.
    Robbins MI, Anzilotti KF, Katz LD, Lange RC (2000) Patient perception of magnetic resonance arthrography. Skeletal Radiol 29:265–269CrossRefGoogle Scholar
  34. 34.
    Rowbotham EL, Grainger AJ (2015) Superior labrum anterior to posterior lesions and the superior labrum. Semin Musculoskelet Radiol 19:269–276.  https://doi.org/10.1055/s-0035-1549320 CrossRefPubMedGoogle Scholar
  35. 35.
    Rutten MJCM, Collins JMP, Maresch BJ et al (2009) Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography. Eur Radiol 19:722–730.  https://doi.org/10.1007/s00330-008-1200-x CrossRefPubMedGoogle Scholar
  36. 36.
    Saupe N, Zanetti M, Pfirrmann CWA et al (2009) Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients. Radiology 250:830–838.  https://doi.org/10.1148/radiol.2503080276 CrossRefPubMedGoogle Scholar
  37. 37.
    Schaeffeler C, Waldt S, Holzapfel K et al (2012) Lesions of the biceps pulley: diagnostic accuracy of MR arthrography of the shoulder and evaluation of previously described and new diagnostic signs. Radiology 264:504–513.  https://doi.org/10.1148/radiol.12112007 CrossRefPubMedGoogle Scholar
  38. 38.
    Schneider R, Ghelman B, Kaye JJ (1975) A simplified injection technique for shoulder arthrography. Radiology 114:738–739.  https://doi.org/10.1148/114.3.738b CrossRefPubMedGoogle Scholar
  39. 39.
    Sebro R, Oliveira A, Palmer WE (2014) MR arthrography of the shoulder: technical update and clinical applications. Semin Musculoskelet Radiol 18:352–364.  https://doi.org/10.1055/s-0034-1384825 CrossRefPubMedGoogle Scholar
  40. 40.
    Sethi PM, Kingston S, Elattrache N (2005) Accuracy of anterior intra-articular injection of the glenohumeral joint. Arthroscopy 21:77–80.  https://doi.org/10.1016/j.arthro.2004.09.009 CrossRefPubMedGoogle Scholar
  41. 41.
    Snyder SJ, Karzel RP, Del Pizzo W et al (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279CrossRefGoogle Scholar
  42. 42.
    Stetson WB, Phillips T, Deutsch A (2005) The use of magnetic resonance arthrography to detect partial-thickness rotator cuff tears. J Bone Joint Surg Am 87(Suppl 2):81–88.  https://doi.org/10.2106/JBJS.E.00509 CrossRefPubMedGoogle Scholar
  43. 43.
    Symanski JS, Subhas N, Babb J et al (2017) Diagnosis of superior labrum anterior-to-posterior tears by using MR imaging and MR arthrography: a systematic review and meta-analysis. Radiology 285:101–113.  https://doi.org/10.1148/radiol.2017162681 CrossRefPubMedGoogle Scholar
  44. 44.
    Waldt S, Bruegel M, Mueller D et al (2007) Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 17:491–498.  https://doi.org/10.1007/s00330-006-0370-7 CrossRefPubMedGoogle Scholar
  45. 45.
    Zanetti M, Hodler J (1997) Contrast media in MR arthrography of the glenohumeral joint: intra-articular gadopentetate vs saline: preliminary results. Eur Radiol 7:498–502.  https://doi.org/10.1007/s003300050191 CrossRefPubMedGoogle Scholar
  46. 46.
    Zwar RB, Read JW, Noakes JB (2004) Sonographically guided glenohumeral joint injection. AJR Am J Roentgenol 183:48–50.  https://doi.org/10.2214/ajr.183.1.1830048 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Institut für RadiologieHirslanden Klinik BirshofMünchensteinSchweiz
  2. 2.LEONARDO – Ärzte für Orthopädie und Traumatologie Schulter- und Ellenbogenchirurgie SchulterzentrumHirslanden Klinik BirshofMünchensteinSchweiz

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