Magnetic Resonance Arthrography

MR arthrography offers superior detailed information about the normal and pathologic anatomy of joints, especially of the shoulder (35,36). Since the introduction of MR arthrography, several groups demonstrated that direct arthrography leads to a better delineation of labral tears and rotator cuff lesions in acute and chronic injuries. Normally, the diluted contrast agent is injected under fluoroscopic guidance outside the MR scanner before the patient is transferred to the MR unit. However, successful direct puncture of the shoulder joint under MR guidance has been reported in a series of three patients in an open 0.5 T scanner using a three-dimensional digitizer system (37,38). No complications were reported and all punctures were diagnostic,

FIGURE 5 (A) Magnetic resonance (MR)-guided core decompression of an avascular necrosis of the femoral head using a MR compatible hollow auger. For the procedure, a paracoronal approach has been chosen. For control, a Tl-weighted sequence has been applied. (B) Fluoroscopical control of the MR-guided procedure.

FIGURE 5 (A) Magnetic resonance (MR)-guided core decompression of an avascular necrosis of the femoral head using a MR compatible hollow auger. For the procedure, a paracoronal approach has been chosen. For control, a Tl-weighted sequence has been applied. (B) Fluoroscopical control of the MR-guided procedure.

FIGURE 6 (A) Magnetic resonance (MR)-guided biopsy of a large chondrogenous tumor, proved to be a low-grade chondrosarcoma on pathohistology. Patient in prone position. For biopsy, a Tru-Cut needle has been used. Biopsy was performed using a T1-w fast gradient echo sequence. (B) Biopsy of a metaphyseal lesion of the proximal femur, verified as bone infarction on histology. Note the large artifact of the hollow auger. The needle is perpendicular to the frequency-encoding gradient in the axial slice orientation on this Tl-weighted gradient echo image. (C) After the biopsy probe has been taken, the biopsy channel is well visualized on MR.

FIGURE 6 (A) Magnetic resonance (MR)-guided biopsy of a large chondrogenous tumor, proved to be a low-grade chondrosarcoma on pathohistology. Patient in prone position. For biopsy, a Tru-Cut needle has been used. Biopsy was performed using a T1-w fast gradient echo sequence. (B) Biopsy of a metaphyseal lesion of the proximal femur, verified as bone infarction on histology. Note the large artifact of the hollow auger. The needle is perpendicular to the frequency-encoding gradient in the axial slice orientation on this Tl-weighted gradient echo image. (C) After the biopsy probe has been taken, the biopsy channel is well visualized on MR.

with the pathology confirmed on arthroscopy. Petersilge et al. (39) reported successful joint puncture on a 0.2 T system using an anterior or a modified anterosuperior approach. In these series no adverse events were reported, except inadvertent injection of the contrast agent into the subacromial or subdeltoidal bursa.

In our institution, we perform the puncture of the shoulder under fluoroscopic control inside the magnet room, with the patient moved directly to the MR scanner via the floating tabletop. For interventional-arthrographic purposes, the gadolinium chelate solution (e.g., gadpentetate dimeglumine, Magnevist, Schering, Berlin, Germany) is diluted 1:100 or 1:200 in saline solution. None of the commercially available gadolinium chelates have been approved for intra-articular injection.

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