Anatomy, anatomic variations, and pathology of the 11- to 3-o'clock position of the glenoid labrum: findings on MR arthrography and anatomic sections.
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Adult↗
Biomedical subjects
D Trudell
Publications and source records attributed to D Trudell.
Normal and abnormal medial meniscocapsular structures: MR imaging and sonography in cadavers.
OBJECTIVE: The purpose of this study was to develop imaging criteria for the diagnosis of meniscocapsular separation by correlating findings on MR imaging, MR arthrography, and sonography of normal and abnormal medial meniscocapsular structures with corresponding anatomic sections in cadavers. MATERIALS AND METHODS: Eight cadaveric knee specimens were examined with MR imaging, MR arthrography, and sonography before arthroscopy. In six specimens the following lesions were arthroscopically created: meniscocapsular separation (n = 3), medial collateral ligament (MCL) tear (n = 3), tear of the meniscofemoral extension of the deep MCL (n = 2), and coronary ligament tear (n = 2). After arthroscopy, all imaging studies were repeated. The specimens were sectioned for correlation with imaging studies. RESULTS: MR findings that correlated with meniscocapsular separation were interposition of fluid between the meniscus and the MCL, irregular meniscal outline, and increased distance between the meniscus and the MCL. On MR arthrography meniscocapsular separation correlated with interposition of contrast medium between the meniscus and the MCL. Tears of the meniscofemoral extension of the deep MCL were best shown on MR arthrography. Sonography showed deep and superficial MCL lesions but did not show meniscocapsular separations. CONCLUSION: In arthroscopically created meniscocapsular separation, the lesion is suggested on MR images when fluid is interposed between the meniscus and the MCL, when the meniscal outline is irregular, or when the distance between the meniscus and the MCL is increased. On MR arthrograms, a meniscocapsular separation is suggested when contrast medium is interposed between the meniscus and the MCL. Sonography does not allow accurate diagnosis of meniscocapsular separation.
Cadaver↗
Anterior labroligamentous structures of the glenohumeral joint: correlation of MR arthrography and anatomic dissection in cadavers.
OBJECTIVE: The purpose of this study was to establish the accuracy of MR arthrography in depicting the morphology of the glenohumeral ligaments and the superior portion of the glenoid labrum. MATERIALS AND METHODS: Findings on MR arthrography and those derived from careful dissection of gross specimens were compared in 15 cadaver shoulders, focusing on the morphology and size of the superior and middle glenohumeral ligaments and the morphology of the inferior glenohumeral ligament. The frequencies of sublabral recess and sublabral foramen seen on MR arthrography and at anatomic dissection were also compared. RESULTS: For the superior and middle glenohumeral ligaments, moderate correlation of size was found between measurements made on MR arthrograms and at anatomic dissection, with the Spearman's rank correlation coefficient calculated as .69990 and .71133, respectively. Morphologic descriptions of the inferior glenohumeral ligament based on MR arthrography and on anatomic dissection also showed good association (Cohen's kappa = .8936). Dissection revealed that the sublabral recess was present in 11 specimens. Of these, 10 recesses were identified on MR arthrograms. MR arthrography also revealed a sublabral recess that was not found at dissection. Four sublabral foramina were identified by both MR arthrography and dissection, and two were revealed only by MR arthrography. CONCLUSION: MR arthrography is useful in the evaluation of the glenohumeral ligaments and the superior portion of the labrum. Anatomic variations of these anterior intraarticular structures can be accurately shown by MR arthrography. In addition, estimation of the size of glenohumeral ligaments can be achieved with acceptable accuracy on MR arthrograms.
Aged↗
Collateral ligaments of the elbow: conventional MR imaging and MR arthrography with coronal oblique plane and elbow flexion.
PURPOSE: To determine the best plane and position of the elbow for optimal visualization of normal and abnormal collateral ligaments with conventional magnetic resonance (MR) imaging and MR arthrography, to determine the normal appearance of the collateral ligaments at MR arthrography and to assess use of MR arthrography in evaluation of collateral ligamentous lesions. MATERIALS AND METHODS: Nine cadaveric elbow specimens were imaged with and without intraarticular administration of gadolinium-containing solution in several planes that were identified as potentially useful in a pilot study in two specimens. MR imaging findings were compared with anatomic findings. RESULTS: Normal and abnormal ligaments were best depicted in a 20 degrees posterior oblique coronal plane in relation to the humeral shaft with the elbows extended and a coronal plane aligned with the humeral shaft with the elbows slightly flexed (20 degrees-30 degrees of flexion). Gadolinium enhancement improved the delineation of normal and abnormal ligaments on T1-weighted images in each case. CONCLUSION: The posterior oblique coronal plane with the elbows extended or the coronal plane aligned with the humeral shaft with the elbows slightly flexed allows accurate assessment of the collateral ligaments. Gadolinium-enhanced MR arthrography of the elbow seems to be a promising technique.
Aged↗
Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation.
OBJECTIVE: The purpose of our study was to define retinacular anatomy with MR imaging and sonography. MATERIALS AND METHODS: Five cadaveric knee specimens underwent sonography and MR imaging using the following sequences: T1-weighted axial, sagittal, coronal, and five oblique planes and axial three-dimensional gradient-echo imaging. Three knees were injected with gelatin gadolinium solution before imaging. All five specimens were sectioned. Correlation was made between findings derived from MR imaging, sonography, and cadaveric sections. RESULTS: T1-weighted axial images without intraarticular gadolinium were most useful for revealing the superficial layer and deep ligaments of the retinacula; however, the oblique sagittal and oblique coronal planes showed the deep ligaments more clearly in their craniocaudal dimensions. Sonography revealed the retinacula as bilaminar structures with discrete superficial and deep layers but failed to distinguish the deep ligaments from one another. CONCLUSION: Conventional T1-weighted axial MR images showed the various components of the retinacula including the medial patellofemoral ligament, which is an important stabilizing structure. Oblique imaging planes may be a helpful adjunct to axial imaging planes. Sonography can consistently identify the retinacula and may be useful in their assessment.
Aged↗
Measurements of cortical thickness in experimentally created endosteal bone lesions: a comparison of radiography, CT, MR imaging, and anatomic sections.
OBJECTIVE: The purpose of this study was to evaluate the accuracy of cortical measurements of experimentally created endosteal cortical lesions and to assess the sensitivity of radiography, CT, and MR imaging in the detection and measurement of such lesions. MATERIALS AND METHODS: Thirty-six cortical lesions were created in three fresh cadaveric femurs. After performing radiography, CT, and MR imaging, we sectioned the specimens in the axial plane. We then measured the remaining cortex at the lesions and the normal cortex adjacent to the lesions on all images and corresponding anatomic sections. The measurements of thickness of the cortex as seen with the different imaging methods and the anatomic sections were compared. Measurements were repeated to evaluate the influence of different window settings on the MR imaging measurements. RESULTS: When measured on radiographs, cortical thickness was overestimated in 58% of lesions. With CT, cortical thickness was overestimated by 0-15% in 94% of all lesions. With MR imaging, cortical thickness was uniformly underestimated by 3-17%. Measurements made on MR images varied according to different window settings. The proton density-weighted sequence yielded the highest sensitivity in the detection of shallow cortical lesions; the T1-weighted spin-echo sequence was the least sensitive of the MR sequences. CONCLUSION: In our cadaveric study, cortical thickness in the presence of endosteal lesions was overestimated on radiographs and CT scans and underestimated on MR images. Measurements derived from MR imaging are strongly influenced by the window setting. MR imaging with the proton density-weighted sequence is the most sensitive for detection of shallow cortical lesions and is more sensitive than CT.
Bone Neoplasms↗
Sternoclavicular joint: MR imaging--anatomic correlation.
PURPOSE: To correlate magnetic resonance (MR) images of the sternoclavicular joint with anatomic sections. MATERIALS AND METHODS: MR imaging was performed on 14 sternoclavicular joints in seven specimens from cadavers (three men and four women 64-94 years of age at death; mean, 84 years). MR arthrography was performed in four specimens (eight joints), after injection of gadopentetate dimeglumine. After imaging, the specimens were frozen and cut into 3-mm-thick slices along the MR imaging planes. Images were correlated with the anatomic slices. RESULTS: MR imaging depicted the anatomy of the sternoclavicular joint and surrounding soft tissue. T2-weighted and proton-density-weighted images were superior to T1-weighted images in depiction of the intraarticular disk. MR arthrography depicted best the intraarticular disk and four of five perforations and delineated the joint capsule. All perforations also were depicted on T2-weighted images. CONCLUSION: MR imaging allows delineation of all structures of the sternoclavicular joint. MR arthrography allows delineation of perforations of the intraarticular disk.
Aged↗
Posterolateral aspect of the knee: improved MR imaging with a coronal oblique technique.
PURPOSE: To determine if angling the coronal plane in magnetic resonance (MR) imaging of the knee increases the conspicuity of the posterolateral structures. MATERIALS AND METHODS: A coronal oblique MR imaging sequence performed parallel to the popliteal tendon proximally was added to our routine study in patient knee examinations. One hundred patients (age range, 12-72 years) underwent MR imaging. RESULTS: Coronal oblique images depicted the arcuate ligament in 46%, the fabellofibular ligament in 48%, and the fibular origin of the popliteal muscle in 53% of the patients, whereas standard coronal images depicted these in 10%, 34%, and 8% of the patients, respectively. Sagittal oblique images did not adequately depict these structures. CONCLUSION: Depiction of the structures in the posterolateral aspect of the knee was optimal on coronal oblique images. We advocate obtaining coronal oblique T2-weighted images in patients with either posterolateral knee pain or suspected injury to the posterolateral ligamentous structures.
Adolescent↗
Tarsometatarsal joint: anatomic details on MR images.
PURPOSE: To evaluate the diagnostic capabilities of magnetic resonance (MR) imaging in the tarsometatarsal ([TMT] Lisfranc) joint with close anatomic correlation. MATERIALS AND METHODS: Six normal cadaveric feet were imaged by using T1-weighted spin-echo (oblique axial) and three-dimensional spoiled gradient-recalled acquisition in the steady state ([SPGR] coronal, sagittal) sequences. Subsequently, gadolinium-enhanced arthrography was performed in three specimens followed by T1-weighted spin-echo and SPGR MR imaging. Specimens were sectioned in all three planes followed by correlation of the MR imaging results with gross anatomic findings. RESULTS: In all specimens, the oblique axial and, less effectively, the coronal and sagittal planes allowed visualization of the Lisfranc ligament. Intermetatarsal ligaments were seen almost exclusively on the coronal images, and TMT ligaments on the sagittal images. Bone alignment could be assessed on the oblique axial images. CONCLUSION: MR imaging reliably depicts the anatomy of the TMT joint including ligamentous and osseous structures.
Cadaver↗
Imaging of osseous and cartilaginous intraarticular bodies in the knee: comparison of MR imaging and MR arthrography with CT and CT arthrography in cadavers.
PURPOSE: To compare magnetic resonance (MR) imaging and MR arthrography with computed tomography (CT) and CT arthrography in the detection of intraarticular bodies in the knee. MATERIALS AND METHODS: Cuboid (3- or 6-mm-long sides) osseous and cartilaginous bodies were implanted in 16 cadaveric knee specimens. MR imaging was performed with T1-weighted spin-echo (SE), T2-weighted SE, proton-density-weighted SE, gradient recalled acquisition in the steady state (GRASS), and spoiled GRASS sequences. MR arthrography was performed in two phases with saline and 2 mmol/L gadopentetate dimeglumine. CT and CT arthrography were performed in the transaxial plane. RESULTS: MR arthrography yielded the highest accuracy for the detection of osseous and cartilaginous bodies combined (92%) and was significantly (P < .01) better than MR imaging (57%-70%), CT arthrography (80%), and CT (74%). Accuracy of CT arthrography was significantly better than that of MR imaging and that of CT. Accuracy of saline-enhanced MR arthrography was significantly inferior (P < .001) to that of gadolinium-enhanced MR arthrography. CONCLUSION: MR arthrography is the best imaging technique for detection of individual intraarticular bodies. CT arthrography is the second most accurate method. Spoiled GRASS and T2-weighted SE sequences are the most accurate at MR imaging. The presence of intraarticular fluid and performance of saline-enhanced MR arthrography improve detectability of intraarticular bodies.
Arthrography↗
Shoulder impingement syndrome: influence of shoulder position on rotator cuff impingement--an anatomic study.
OBJECTIVE: The purpose of the study was to investigate the relationship of the distal supraspinatus tendon to the coracoacromial arch on radiographs and MR imaging at various shoulder positions. MATERIALS AND METHODS: Radiopaque and gadolinium-impregnated markers were sutured to the distal aspect of the supraspinatus tendon and along the coracoacromial ligament in three cadavers. While varying positions of the shoulder, we obtained gross anatomic visualization, radiographs, and MR images. RESULTS: Impingement of the distal aspect of the supraspinatus tendon between the acromion and the greater tuberosity of the humerus was well visualized during forward flexion and abduction of more than 30 degrees. Shoulder impingement was best seen at 60 degrees forward flexion, 60 degrees abduction, and internal rotation. CONCLUSION: MR imaging of different shoulder positions may help reveal the pathogenesis of shoulder impingement syndrome.
Aged↗
Glenoid labrum: MR imaging with histologic correlation.
PURPOSE: To document the histopathologic basis of altered intralabral and sublabral signal intensity on magnetic resonance (MR) images. MATERIALS AND METHODS: Ten fresh cadaveric shoulder specimens underwent transaxial MR imaging with T1-weighted, proton-density-weighted, and T2-weighted spin-echo; multiplanar gradient-recalled echo (MPGR); three-dimensional Fourier transform gradient-recalled echo (GRE); spoiled gradient-recalled echo (SPGR); and T1-weighted, fat-suppressed sequences before and after intraarticular injection of gadolinium. Shoulders were then frozen and transversely sectioned, and histologic analysis of the labrum was performed. RESULTS: Altered intralabral signal intensity correlated with fibrovascular tissue, mucoid or eosinophilic degeneration, calcification, ossification, synovial tissue, or combinations of these findings. A sublabral transitional band of intermediate signal intensity correlated with a transitional zone of fibrocartilage. CONCLUSION: There are several causes of altered intralabral signal intensity. A transitional fibrocartilaginous zone correlates with sublabral increased signal intensity. Intraarticular administration of gadolinium improves evaluation of the glenoid labrum.
Aged↗
Assessment of articular cartilage thickness of the humeral head: MR-anatomic correlation in cadavers.
OBJECTIVE: The purpose of our study was to evaluate several commonly used MR sequences to determine how accurately each demonstrates the thickness of the articular cartilage of the humeral head. MATERIALS AND METHODS: Ten cadaveric shoulders (age at death, 58-92 years; mean, 79 years) were imaged with fat-suppressed transaxial T1-weighted spin-echo three-dimensional gradient-recalled sequences, both before and after injection of 12 ml of diluted gadopentetate dimeglumine. Articular cartilage was measured to the nearest 10th of a millimeter on the MR images and corresponding anatomic sections. RESULTS: Cartilage could not be differentiated from surrounding structures in 14 of 112 locations (13%) on the spin-echo images obtained without contrast material, in 4 of 112 locations (4%) on the spin-echo images obtained with contrast material, in 4 of 112 locations (4%) on the gradient-echo images obtained without contrast material, and in 6 of 112 locations (5%) on the gradient-echo images obtained with contrast material. Mean true cartilage thickness was 1.23 mm (SD, 0.52 mm). The mean MR-anatomic differences (absolute values) were 0.38 mm for the spin-echo images obtained without contrast material, 0.42 mm for the spin-echo images obtained with contrast material, 0.49 mm for the gradient-echo images obtained without contrast material, and 0.37 mm for the gradient-echo images obtained with contrast material. There was a tendency to overestimate thin cartilage and to underestimate thick cartilage. CONCLUSION: Several of the routinely used MR sequences, with and without intraarticular contrast medium, may cause errors in the assessment of the articular cartilage of the humeral head. Some of these errors result from either insufficient contrast between cartilage and surrounding structures or inadequately concentrated contrast medium.
Aged↗
MR arthrography of the hip: improved imaging of the acetabular labrum with histologic correlation in cadavers.
OBJECTIVE: The objective of this study was to correlate findings on conventional MR imaging and MR arthrography of the hip with pathologic findings in cadavers with abnormal labra to determine (1) the efficacy of MR imaging in assessing labral degeneration, (2) whether delineation of the labrum from the joint capsule is possible, and (3) if the conspicuity of surface abnormalities of the labrum is improved by administering intraarticular contrast material. MATERIALS AND METHODS: Twelve cadaveric hip joints were obtained from elderly cadavers. Each hip was examined using fat-suppressed three-dimensional spoiled GRASS (gradient-recalled acquisition in the steady state) (SPGR) imaging and T1-weighted spin-echo imaging before and after intraarticular injection of contrast material. Thirty-six labral sections (three from each hip joint) were evaluated histologically to determine the labral-capsular relationship, the presence of degeneration, and the configuration of the labral base. These findings were correlated with the results of a blinded MR evaluation of these sections. RESULTS: Delineation of the labrum from the adjacent joint capsule was possible on SPGR and T1-weighted MR arthrographic images (34 of 36 and 33 of 36 specimens, respectively), but was not consistently possible on standard SPGR and T1-weighted MR images (7 of 36 and 4 of 36 specimens, respectively). The sensitivities and specificities of the various MR sequences in evaluating labral degeneration varied from 50% to 67%, and from 25% to 94%. Increased signal at the base was common in both the normal (n = 12) and the abnormal (n = 24) labrum. CONCLUSION: Conspicuity of the acetabular labral complex is enhanced with the intraarticular administration of contrast material. Although MR arthrography did not improve our specificity for diagnosing labral degeneration, the detection of surface abnormalities, particularly those near the base, was significantly improved.
Acetabulum↗
Patterns of central acetabular osteophytosis in osteoarthritis of the hip.
RATIONALE AND OBJECTIVES: The frequency and morphology of central acetabular osteophyte formation were evaluated in patients with osteoarthritis. METHODS: One hundred preserved acetabular specimens were evaluated for the occurrence of central osteophytes (excrescences present in the articulation of the hip joint), their relationship to marginal and femoral osteophytes of the hip, and their radiographic appearance. RESULTS: In both specimen and patient analysis, the authors found that central excrescences occur commonly and appear to be related temporally to osteophytes of the femur and the margin of the acetabulum. CONCLUSIONS: The authors demonstrated a close relationship between the degree of marginal and femoral osteophytes with those found centrally, indicating a temporal relationship. The new radiographic signs discussed are: 1) a fine linear density associated with early osteoarthritis; 2) larger, more irregular densities associated with a more advanced stage of osteoarthritis; and 3) obliteration of the acetabular fossa by excrescences as found in severe osteoarthritis.
Acetabulum↗
Abnormalities of articular cartilage in the knee: analysis of available MR techniques.
In an attempt to improve the detection of chondral abnormalities with magnetic resonance imaging, a fat-suppressed three-dimensional gradient-recalled acquisition in the steady state (GRASS) and spoiled GRASS (SPGR) sequence was optimized by study of five cadaveric knee specimens. Results with this optimized sequence then were compared with results with three spin-echo (T1-, proton-density-, and T2-weighted) and two three-dimensional gradient-recalled echo sequences (GRASS and non-fat-suppressed SPGR) in the assessment of naturally occurring abnormalities of the patellofemoral compartment in 10 cadaveric knees. Results with the optimized fat-suppressed SPGR sequence were significantly better (P < .02) than results with the other five sequences and had a sensitivity of 96%, a specificity of 95%, and an accuracy of 95%. In addition, normal cartilage consistently appeared as a trilaminar structure with the fat-suppressed SPGR sequence, a feature that appeared to help in identification of chondral lesions.
Aged↗
Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress.
Ulnar collateral ligament (UCL) injury of the first metacarpophalangeal joint (gamekeeper thumb) is common. If the UCL becomes displaced superficially to the adductor pollicis aponeurosis, surgical treatment has been advocated. Radiography cannot help differentiate between displaced and nondisplaced tears. The authors investigated the use of magnetic resonance (MR) imaging in the evaluation of UCL injury. Ten displaced and six nondisplaced UCL tears were surgically created in 16 nonembalmed cadaveric specimens. Twelve unaltered specimens served as controls. Coronal MR images were obtained and interpreted by two observers. The MR images were compared with corresponding anatomic slices. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. Although MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement and, therefore, may be useful for evaluating gamekeeper thumb.
Adult↗
Degenerative changes of the menisci of the knee. Value of different MR pulse sequences.
Increased meniscal MR signal attributable to meniscal degeneration is a common finding. The role of different MR sequences in the analysis of the extent and distribution of meniscal degeneration in middle-aged and elderly patients has not been thoroughly evaluated. We retrospectively studied the role of different MR sequences in 175 anatomic meniscal sections originating from 20 freshly frozen knees from 10 cadavers using MR-anatomic correlation. T1-weighted and proton-density spin-echo images as well as postprocessed meniscal windows based on T1-weighted spin-echo images proved to be the most reliable in this diagnosis (53.7%, 54.9%, and 53.1% correctly diagnosed meniscal sections, respectively). T2-weighted spin-echo images and gradient-echo images proved to be less reliable (37.1% and 40.0% correctly diagnosed meniscal sections). While the T2-weighted spin-echo images commonly underestimated the extent of meniscal degeneration, gradient-echo images commonly overestimated the extent of such changes. These last two types of sequences should not be used alone in the description of meniscal degeneration.
Aged↗