Click on any image below to see an enlargement of that image.

Case 1: 46 year-old man with history of rotator cuff tendon repair. Normal MR Arthrogram with intact rotator cuff (coronal image)	Case 2: 47 year-old man with history of rotator cuff tendon tear. Re-tear of the rotator cuff tendon (sagittal image)
Case 3: 17 year-old boy with shoulder pain and locking after injury. Tear inferior labrum (coronal image)	Case 4: 20 year-old man with nonspecific shoulder complaints. Partial tear inferior labrum (axial image)
Case 5: 35 year-old man with wrist pain after injury. Tear of the scapho-lunate ligament (coronal image)	Case 6: 49 year-old man with chronic wrist pain. Tear of the triangular fibrocartilage (TFCC) (coronal image)
Case 7: 40 year-old man with chronic hip pain. Normal MR hip arthrogram with normal appearing labrum (axial image)	Case 8: 51 year-old woman with knee pain and history of lateral meniscal repair. Re-tear of the lateral meniscus (coronal image)

Above images are all original MR scans performed at Parkside MR Center.

Discussion

Routine MR imaging is exquisitely sensitive in the detection of internal derangement of joints. Nonetheless, accuracy in detection of some pathological conditions can be enhanced by MR Arthrography with the intra-articular injection of a dilute contrast agent, gadolinium. This is usually performed under flouroscopic guidance just prior to the MRI exam. MR Arthrography of the knee and shoulder have been performed at Parkside MR Center for several years. More recently this technique has been applied to other joints such as the hip and wrist. Intra-articular contrast injection offers detailed visualization of cartilage and support structures not visible with standard spin echo imaging.

In imaging of the shoulder, for example, the addition of intra-articular contrast and the use of fat suppression sequences can result in 100% sensitivity and specificity in the detection of rotator cuff tendon tears¹. In evaluation of the post-operative shoulder, MR Arthrography can be especially helpful in the distinction between partial and full thickness tears. Contrast within the joint capsule along with ultrathin section imaging also allows better evaluation of the glenoid labra and glenohumeral ligaments.

In the post-operative evaluation of the menisci of the knee, routine MR imaging can be challenging due to variability in their appearance. In these cases, MR Arthrography of the knee can be extremely helpful distinguishing between a re-torn meniscus and a normal meniscal remnant after partial meniscectomy².

In the wrist, MR Arthrography can also provide enhanced evaluation of the primary carpal support structures, the scapho-lunate and luno-triquetral ligaments and the adjacent triangular fibrocartilage.

References:

1. Palmer, WE, Brown JH, and Rosenthal DI: Rotator cuff: evaluation with fat suppressed MR Arthrography, Radiology, 188(3):683, 1993.

2. Applegate, GR, Flannigan, BD, Tolin, BS, et al: MR diagnosis of recurrent tears in the knee: value of intra-articular contrast material, Am J Roentgenol 146(4):821, 1993.

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