What type of articulation is evaluated in arthrography

By distending the capsule with contrast, these structures can be more fully evaluated Figure The use of MR or CT arthrography allows for better detection of capsulolabral abnormalities and partial thickness rotator cuff tears Figure Distension of the joint capsule allows differentiation between irregular tears of the labrum and normal anatomic variants such as the sublabral sulcus and foramen Figure The glenohumeral ligaments are routinely visualized on MR or CT arthrography exams owing to the joint distension.

Abnormalities of these ligaments can more easily be identified on MR or CT arthrography than on noncontrast studies Figure Table The normal shoulder joint capsule is smooth; irregularity or filling defects suggest synovitis.

Normally the biceps tendon sheath and axillary recess fill with contrast. A small joint volume and nonfilling of these structures can be seen in adhesive capsulitis. Adhesive capsulitis can be apparent on arthrography if the joint capacity is unusually small with absent filling of the biceps sheath and axillary recess and high injection pressure.

Articular-sided rotator cuff tears will show contrast extending from the joint into the substance of the rotator cuff partial tear or through the entire thickness of the cuff into the subacromial subdeltoid bursa full thickness, complete tears. Sometimes complete tears can allow contrast to communicate with the acromioclavicular AC joint termed the geyser sign Figure Not only can the tear be recognized, but the size of the tear, quality of the torn edges, and any atrophy or fatty replacement of the muscles can be assessed.

These are important surgical considerations. Some full-thickness rotator cuff tears are accompanied by chronic fluid extravasation into the AC joint. This produces a fluid mass on clinical examination that corresponds to the contrast extravasation seen on arthrography, termed the geyser sign.

Labral tears can be identified by abnormalities in the shape of the labrum or contrast extravasation into labral tissue. Sometimes additional maneuvers, such as having the patient imaged while in external rotation and abduction the ABER position , can be helpful for labral assessment.

These supplemental images may be added to the protocol at the MRI facility where the study is planned, depending on the clinical indications for examination.

The initial imaging for the evaluation of hip pain should be radiographs to exclude etiologies such as fractures and avascular necrosis AVN. Noncontrast MRI is effective in the evaluation of hip pain with normal radiographs, showing acute fractures as well as confirming cases of AVN that are not visible or are atypical on radiographic examination.

Unless a large joint effusion is present, evaluation of the intrinsic structures of the hip joint e. MR and CT arthrography are effective in the evaluation of these structures including the labrum, ligaments, and articular cartilage.

When performing hip arthrography, the patient should be lying supine on the fluoroscopy table with the hip to be injected in neutral position. External rotation of the femur should be avoided because this moves the femoral vessels and nerves laterally, potentially in the path of the needle. A small pillow may be placed under the knee to not only make the patient more comfortable but also to relax the anterior joint capsule.

Multiple injection approaches have been described. Initially, the femoral artery is palpated and marked to avoid injury during the needle placement. The overlying tissues are then prepared with alcohol and Betadine and draped in a sterile fashion. The skin and subcutaneous tissues are anesthetized. A common approach involves advancing a 22 G spinal needle under fluoroscopic guidance to the lateral aspect of the superolateral femoral head-neck junction until the cartilage is reached Figure A different technique involves advancing the needle straight down to the femoral neck at the midpoint between the base of the femoral head and the intertrochanteric line.

The latter approach has been shown to produce less patient discomfort but does have a higher rate of extravasation of contrast from the joint capsule.

After placing the needle within the joint, the joint should be aspirated, especially if administering gadolinium contrast to prevent its dilution. Joint fluid is sent for culture and crystals depending on the clinical circumstance. In all techniques, a small amount of non-ionic iodinated contrast material should be injected to confirm location of the needle within the joint capsule. Then between 8 and 20 mL of contrast should be injected into the joint for good distension. The administration of 0.

Fluoroscopic images will be obtained throughout the procedure to confirm needle placement and immediately after injection of the contrast into the joint to document intraarticular injection and delineate gross joint anatomy. Following this, the patient will be transferred to the MRI or CT suite via wheelchair for the completion of the examination. Hip pain has numerous etiologies including both intrinsic abnormalities and pain referred from remote sites. When encountered in the young patient or athlete, concern for the intrinsic structures should be the primary consideration.

The use of conventional radiographs is not reliable in identifying all abnormalities, but radiographs should be obtained prior to other imaging tests.

As in the shoulder, the joint capsule of the hip has intrinsic redundancy that limits evaluation of the internal structures. In the absence of preexisting joint fluid, the evaluation of the acetabular labral complex is difficult on conventional MR and CT examinations.

Distension of the joint capsule following the addition of contrast into the joint allows for easier evaluation of the intrinsic structures Figures and In addition, intraarticular bodies and the articular cartilage can be evaluated Figure Patients with a history of acetabular dysplasia can be routinely evaluated utilizing MR or CT arthrography to monitor the progression of osteoarthritis and to determine when surgical treatment should be considered Table Detailed imaging of the joint may be difficult with MR arthrography in those patients who are large or obese; in these situations, CT arthrography should be considered as an alternative imaging modality.

Arthrography and Injection Procedures. BOX Prior allergic reaction to contrast or anesthetic another contrast can sometimes be substituted Inability to lie flat or remain still. Arthrography Technique The intraarticular injection of contrast is usually performed under fluoroscopic guidance. Normal positioning of shoulder prior to arthrography.

The right humerus is externally rotated to maximize to exposure of the anterior articular surface of the humeral head. The planned site for needle placement in this case is in the medial aspect of the upper third of the humeral head.

A BB arrow placed on the skin marks the desired location. Use restraint only when necessary. Always use physical or mechanical restraint. Use physical restraint only. Use mechanical restraint only. Which of the following is a condition in which an occluded blood vessel stops blood flow to a portion of the lungs?

Pneumothorax B. Atelectasis C. Pulmonary embolism D. The CR will parallel the intervertebral foramina in which of the following projections? Lateral cervical spine Lateral thoracic spine Lateral lumbar spine A. Patients are instructed to remove all jewelry, hair clips, metal prostheses, coins, and credit cards before entering the room for an examination in A.

All the following statements regarding pediatric positioning are true except A. Arteries and veins enter and exit the medial aspect of each lung at the A. Which of the following statements regarding knee x-ray arthrography is are true?

Ligament tears can be demonstrated. Sterile technique is observed. MRI can follow x-ray. Which of the following is represented by the number 3 in Figure 2—36? Figure 2— Courtesy of Stamford Hospital, Department of Radiology. Inferior vena cava B. Aorta C. Gallbladder D. Psoas muscle.

Which of the following blood chemistry levels must the radiographer check prior to excretory urography? Which of the following statements regarding myelography is are correct? Spinal puncture may be performed in the prone or flexed lateral position. Contrast medium distribution is regulated through x-ray tube angulation. The patient's neck must be in extension during Trendelenburg positions. Shoulder arthrography is performed to evaluate humeral luxation demonstrate complete or partial rotator cuff tear evaluate the glenoid labrum A.

Which of the following statements is are true regarding lower-extremity venography? The patient is often examined in the semierect position. Contrast medium is injected through a vein in the foot.

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Retrograde urography. What type of articulation is evaluated in arthrography? Myelography is radiologic examination of The structures within the spinal canal. The contraction and expansion of arterial walls in accordance with forceful contraction and relaxation of the heart are called: 1 hypertension 2 elasticity 3 pulse 4 pressure.

Shoulder arthrography is performed to: 1 evaluate humeral luxation 2 demonstrate complete or partial rotator cuff tear 3 evaluate the glenoid labrum.

Humeral luxation is Humeral dislocation. Where does the CR enter for an AP projection of the knee? What are the CR angles for an AP knee on a patient with the following pelvic thicknesses: 1 18 cm and below 2 19 - 24 cm 3 25 cm and above.

The lateral oblique projection of the foot is used to demonstrate