Blum A, Loeuille D, Iochum S, Kohlmann R, Grignon B, Coudane H
Service d'Imagerie Guilloz (Pr J Roland), Hôpital Central, CHU, 54035 Nancy.
J Radiol. 2003 Jun;84(6):639-57.
The recent approval by the French Ministry of Health of the use of intra-articular Gadolinium could promote the increasing use of MR-arthrography in France. Although useful in specific pathologies, it should not be overly prescribed and should be considered only if it provides a more accurate diagnosis than other less invasive techniques. The technical aspects and medico-legal implications of MR-arthrography as well as its various indications are reviewed in this article. There are three possible techniques: indirect MR-arthrography with IV Gadolinium injection, direct MR-arthrography with intra-articular Gadolinium injection and lastly, direct MR-arthrography with intra-articular injection of iodinated contrast media (or saline solution). Indirect MR-arthrography cannot be recommended because of insufficient contrast enhancement and the absence of joint filling. Conversely, direct MR-arthrography allows joint expansion which smooths out capsule and ligaments, better delineates articular surfaces and yields a homogeneous high intensity signal of the entire joint. Direct MR-arthrography with iodinated contrast media combines standard arthrography with conventional MRI. Direct MR-arthrography with intra-articular injection of dilute Gadolinium is associated with T1WI, usually of higher quality than T2WI, even though the latter remains part of the protocol. Although, the last two techniques yield higher image quality and are often performed for various articular pathologies, they should not be randomly carried out in the evaluation of joint pathology. However, they should be recommended as the first step in the diagnosis of painful shoulders or hips in young adults and athletes.
法国卫生部最近批准关节腔内使用钆剂，这可能会促使磁共振关节造影术在法国的使用增加。尽管它在特定病症中有用，但不应过度开具处方，只有在它能提供比其他侵入性较小的技术更准确的诊断时才应考虑使用。本文回顾了磁共振关节造影术的技术方面、医疗法律问题及其各种适应症。有三种可能的技术：静脉注射钆剂的间接磁共振关节造影术、关节腔内注射钆剂的直接磁共振关节造影术，以及最后一种，关节腔内注射碘化造影剂（或生理盐水）的直接磁共振关节造影术。由于对比增强不足和关节未充盈，间接磁共振关节造影术不推荐使用。相反，直接磁共振关节造影术可使关节扩张，使关节囊和韧带变平滑，更好地勾勒关节表面，并在整个关节产生均匀的高强度信号。使用碘化造影剂的直接磁共振关节造影术将标准关节造影术与传统磁共振成像相结合。关节腔内注射稀释钆剂的直接磁共振关节造影术与T1加权成像相关，其质量通常高于T2加权成像，尽管后者仍是检查方案的一部分。虽然最后两种技术产生的图像质量更高，并且常用于各种关节疾病，但在评估关节疾病时不应随意进行。然而，它们应被推荐为诊断年轻成年人和运动员肩部或髋部疼痛的第一步。
