Department of Radiology, Uludag University Medical Faculty, Görükle Kampusu, 16059 Nilüfer, Bursa, Turkey.
Skeletal Radiol. 2010 Jun;39(6):575-9. doi: 10.1007/s00256-009-0793-8. Epub 2009 Sep 26.
Shoulder MR arthrography has an important role in the assessment of rotator cuff lesions, labral tears, glenohumeral ligaments, rotator interval lesions, and postoperative shoulder status. Injection in direct MR arthrography can be performed with palpation, fluoroscopy, ultrasonography (US), or MRI. Recently, the posterior approach is the preferred method due to the presence of fewer stabilizers, absence of important articular structures and less extravasation, has been advocated. Our aim was to assess the efficacy of US-guided MR arthrography via a posterior approach on the glenohumeral joint.
Thirty MR arthrographies were performed on 29 patients. Ultrasonography (Xario, Toshiba) examinations were conducted by a wide-band 5-12 Mhz linear array transducer set to muscle-skeleton. Diluted contrast medium (1 ml gadolinium chelate and 100 ml saline, approximately 15 ml) was delivered into the glenohumeral joint space from between the humeral head and posterior labrum with a 20-gauge spinal needle. MRI examination was conducted by a 1.5 T scanner. Fat-saturated T1-weighted spin echo was applied on coronal, axial, and sagittal planes within the first 30 min after contrast material injection.
One (3.3%) arthrography was not successful due to technical reasons associated with obesity. Contrast extravasation around the infraspinatus and teres minör muscles was depicted in twelve examinations. One (3.3%) patient developed vasovagal collapse.
Ultrasonography-guided posterior approach is an easy, reliable, fast, and comfortable method in experienced hands. It may be an alternative for fluoroscopy-guided shoulder MR arthrography.
肩关节磁共振关节造影术在评估肩袖病变、盂唇撕裂、肩盂肱韧带、旋转间隔病变以及术后肩部状况方面具有重要作用。直接磁共振关节造影的注射可以通过触诊、透视、超声（US）或 MRI 进行。最近，由于后入路较少涉及稳定器、不存在重要关节结构且外渗较少，因此被提倡作为首选方法。我们的目的是评估经后路超声引导下肩关节磁共振关节造影术的疗效。
对 29 名患者的 30 例磁共振关节造影术进行了研究。超声（东芝 Xario）检查采用宽频带 5-12MHz 线性阵列换能器套件，设置为肌肉骨骼模式。将稀释的造影剂（1 毫升钆螯合物和 100 毫升生理盐水，约 15 毫升）通过 20 号脊针注入肱骨头和后盂唇之间的肩盂肱关节间隙。MRI 检查采用 1.5T 扫描仪进行。在注射造影剂后 30 分钟内，通过冠状面、轴位和矢状面应用脂肪饱和 T1 加权自旋回波。
由于肥胖相关的技术原因，有 1 例（3.3%）关节造影术不成功。在 12 例检查中，显示了肩胛下肌和小圆肌周围的造影剂外渗。1 例（3.3%）患者出现血管迷走性晕厥。
在有经验的医生手中，超声引导下的后路方法是一种简单、可靠、快速且舒适的方法。它可能是透视引导下肩关节磁共振关节造影术的替代方法。
