Kopka L, Funke M, Fischer U, Keating D, Oestmann J, Grabbe E
Department of Radiology I, University Hospital, Goettingen, Germany.
AJR Am J Roentgenol. 1994 Sep;163(3):621-3. doi: 10.2214/ajr.163.3.8079856.
MR arthrography of the shoulder with gadopentetate dimeglumine has been proved to be valuable in the diagnosis of injuries of the rotator cuff and glenoid labrum. To date, no standard protocol for the concentration of gadopentetate dimeglumine and the volume of iodinated contrast material used for intraarticular injection exists. This study compared the intraarticular signal intensities achieved with three different MR arthrography protocols with respect to the volume of iodinated contrast material, the concentration of gadopentetate dimeglumine, and the interval between injection of contrast material and the MR study.
MR arthrography was performed with three different protocols in 38 patients (26 men, 12 women). Patients examined with protocol 1 received an intraarticular injection of 5 ml of iotrolan and 5 ml of a 5 mmol/l solution of gadopentetate dimeglumine, resulting in a gadopentetate dimeglumine concentration of 2.5 mmol/l. Patients in protocol 2 received only 0.5 ml of iotrolan plus 12 ml of a 10 mmol/l solution of gadopentetate dimeglumine, leading to a 10 mmol/l concentration. The interval between injection and MR imaging for patients in protocols 1 and 2 was 30-45 min. Patients in protocol 3 received an intraarticular injection of 10 ml iotrolan and 1 ml of a 500 mmol/l solution of gadopentetate dimeglumine, resulting in an intraarticular concentration of gadopentetate dimeglumine of 45 mmol/l. MR examinations were performed between 20 and 360 min after administration of contrast material. Patients in protocol 3 had additional conventional and CT arthrography within 30 min after injection. The contrast-to-noise ratio of the intraarticular signal intensity was calculated for all protocols.
The contrast-to-noise ratio (mean +/- SD) was 22.7 +/- 7.4 for the 2.5 mmol/l solution (protocol 1), 47.5 +/- 11.9 for the 10 mmol/l solution (protocol 2), and 9.9 +/- 3.1 for the 45 mmol/l solution (protocol 3) within 1 hr after injection. For protocol 3, an increase in contrast-to-noise ratio was observed after 90-180 min (53.5 +/- 12.7), followed by a decrease in contrast-to-noise ratio after 180 min (17.1 +/- 8.2). The image quality of conventional, CT, and MR arthrography (90-180 min after injection) was good in all cases of protocol 3.
For MR arthrography performed within 1 hr after injection, protocol 2 is sufficient. The optimal time frame for protocol 3 is between 1.5 and 3 hr after joint puncture. Protocol 3 allows the prior performance of conventional and CT arthrography. Therefore, the addition of 1 ml of a 500 mmol/l solution of gadopentetate dimeglumine to 10 ml of iodinated contrast material is advisable if a subsequent MR study is anticipated.
已证实钆喷酸葡胺肩关节磁共振关节造影在诊断肩袖和盂唇损伤方面具有重要价值。迄今为止，尚无关于钆喷酸葡胺浓度及关节内注射所用碘化造影剂体积的标准方案。本研究比较了三种不同磁共振关节造影方案在碘化造影剂体积、钆喷酸葡胺浓度以及造影剂注射与磁共振检查间隔时间方面所获得的关节内信号强度。
对38例患者（26例男性，12例女性）采用三种不同方案进行磁共振关节造影。采用方案1检查的患者关节内注射5 ml碘曲仑和5 ml 5 mmol/l钆喷酸葡胺溶液，钆喷酸葡胺浓度为2.5 mmol/l。采用方案2的患者仅注射0.5 ml碘曲仑加12 ml 10 mmol/l钆喷酸葡胺溶液，浓度为10 mmol/l。方案1和2的患者注射与磁共振成像间隔时间为30 - 45分钟。采用方案3的患者关节内注射10 ml碘曲仑和1 ml 500 mmol/l钆喷酸葡胺溶液，关节内钆喷酸葡胺浓度为45 mmol/l。造影剂注射后20至360分钟进行磁共振检查。采用方案3的患者在注射后30分钟内还进行了常规和CT关节造影。计算所有方案关节内信号强度的对比噪声比。
注射后1小时内，2.5 mmol/l溶液（方案1）的对比噪声比（均值±标准差）为22.7±7.4，10 mmol/l溶液（方案2）为47.5±11.9，45 mmol/l溶液（方案3）为9.9±3.1。对于方案3，90 - 180分钟后对比噪声比升高（53.5±12.7），随后180分钟后对比噪声比下降（17.1±8.2）。方案3所有病例中常规、CT和磁共振关节造影（注射后90 - 180分钟）的图像质量良好。
注射后1小时内进行磁共振关节造影，方案2即可。方案3的最佳时间范围是关节穿刺后1.5至3小时。方案3允许先进行常规和CT关节造影。因此，如果预计随后进行磁共振检查，建议在10 ml碘化造影剂中加入1 ml 500 mmol/l钆喷酸葡胺溶液。
