直接磁共振（MR）肩关节造影术：超声引导下后入路和外展位（PAUGA）。

Direct magnetic resonance (MR) shoulder arthrography: posterior approach under ultrasonographic guidance and abduction (PAUGA).

机构信息

Department of Radiology, Campus Bio-Medico School of Medicine, University of Rome, Via Alvaro del Portillo 200, 00128, Rome, Italy.

出版信息

Radiol Med. 2013 Aug;118(5):806-15. doi: 10.1007/s11547-012-0879-6. Epub 2012 Sep 17.

DOI:10.1007/s11547-012-0879-6

PMID:22986699

Abstract

PURPOSE

This study was undertaken to assess the reliability of the posterior approach under ultrasonographic guidance (PAUGA), with the arm abducted, before performing direct magnetic resonance (MR) arthrography of the shoulder.

MATERIALS AND METHODS

A total of 111 (82 men, 29 women; mean age, 24 years) underwent direct MR arthrography of the shoulder. Patients were enrolled because of glenohumeral instability (n=71), chronic shoulder pain (n=25), suspicion of rotator cuff tear (n=13) and adhesive capsulitis (n=2). Patients were placed in the lateral position, on the contralateral side to that being examined; the arm of the shoulder undergoing the examination was placed in slight internal rotation with the hand under the contralateral armpit. A gadolinium-based solution was injected into the articular capsule under cryoanaesthesia and sonographic guidance. A posterior approach was systematically applied. For each patient, the number of injection attempts, room time, complications and pain, as recorded on a 10-point visual analogue scale (VAS), were noted. For quantitative parameters (room time and pain intensity), the mean and standard deviation (SD) were calculated.

RESULTS

Direct MR arthrographies were performed successfully in all patients; no immediate or late major complications were observed. Fourteen patients (12.6%) reported temporary and self-limiting compromise of arm movements, and 13 patients (11.7%) reported a vagal reaction not requiring medication. In 102 cases (92%), the injection was successful at the first attempt, whereas in the remaining nine cases (8%), needle repositioning without any additional puncture was required to obtain clear sonographic depiction of the position of the needle tip. Mean room time was 7.2±1.4 min. Mean pain intensity was 3.2±0.4 on the 10-point VAS scale.

CONCLUSIONS

PAUGA is a reliable and rapid technique that is well tolerated by patients and easy for the radiologist to perform.

摘要

目的

本研究旨在评估超声引导下后入路（PAUGA）在直接肩关节磁共振（MR）关节造影前的可靠性，同时手臂外展。

材料与方法

共 111 例（82 例男性，29 例女性；平均年龄 24 岁）接受了肩关节直接 MR 关节造影。因肩盂肱关节不稳定（n=71）、慢性肩部疼痛（n=25）、怀疑肩袖撕裂（n=13）和粘连性关节囊炎（n=2）而招募患者。患者取对侧卧位，检查侧手臂轻度内旋，手放在对侧腋窝下。在冷冻麻醉和超声引导下将钆基溶液注入关节囊内。系统地应用后入路。对于每个患者，记录注射次数、房间时间、并发症和疼痛（使用 10 分视觉模拟量表（VAS）记录）。对于定量参数（房间时间和疼痛强度），计算平均值和标准差（SD）。

结果

所有患者均成功进行了直接 MR 关节造影术，未观察到即刻或迟发性严重并发症。14 例（12.6%）患者报告暂时和自限性的手臂运动受限，13 例（11.7%）患者报告出现无需药物治疗的迷走神经反应。在 102 例（92%）病例中，首次尝试注射成功，而在其余 9 例（8%）病例中，需要重新定位针头而无需额外穿刺，以获得清晰的超声显示针尖位置。平均房间时间为 7.2±1.4 分钟。平均疼痛强度为 10 分 VAS 量表上的 3.2±0.4 分。