MR Arthrogram Features That Can Be Used to Distinguish Between True Inferior Glenohumeral Ligament Complex Tears and Iatrogenic Extravasation

Wang, Wilbur; Huang, Brady K.; Sharp, Michael; Wan, Lidi; Shojaeiadib, Niloofar; Du, Jiang; Chang, Eric Y.

doi:10.2214/ajr.18.20090

Cited by 15 publications

(7 citation statements)

References 13 publications

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“…As reported in the literature, a number of signs can be useful to make this distinction. 6 In our experience, a true capsular lesion can often be diagnosed at the time of contrast injection under fluoroscopy. A true capsular avulsion will show leakage immediately.…”

Section: Discussionmentioning

confidence: 83%

“…A recent study describes a method to differentiate iatrogenic leakage from a true axillary ligament lesion. 6 Because contrast leakage can present a diagnostic dilemma and potentially have a negative impact on image quality, we decided to target the cause of leakage and a potential solution in this study (Figures 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

“…Leakage from these areas may negatively affect both the quality of the images and the interpretation of the images. 6 In our clinical experience, contrast extravasation, especially in the axillary area can render a diagnosis of glenohumeral ligament complex rupture difficult. Previous studies have not addressed how commonly contrast extravasation occurs, in this work we provide some information on this subject.…”

Section: Introductionmentioning

confidence: 94%

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Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?

et al. 2021

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Background: Contrast leakage after arthrography is common. We sought to investigate if immobilization could prevent it. Purpose: The purpose of this study was to determine the effects on contrast extravasation and image quality produced by strict immobilization of the shoulder between arthrography puncture and subsequent MR imaging. Material and methods: Fifty patients underwent shoulder MR arthrography using a standard shoulder puncture in the anteroinferior quadrant. Ten milliliters of contrast mixture of saline, iodinated contrast, and gadolinium contrast was injected by a senior musculoskeletal (MSK) radiologist using a 21G needle. Half of the patients were immediately immobilized using a shoulder sling, and the other half were allowed to move their shoulder and arm freely during the time before MR imaging. MR arthrography was performed with a 3 T system using standard T1 and PD weighted sequences. The MR images were reviewed independently by 2 MSK radiologists and graded for extravasation using a five-point scale (1: none, 2: less than 2 cm, 3: 2-5 cm, 4: 5-10 cm, 5: more than 10 cm) and for image quality using a 5 point scale (1: poor, 5: good). The Pearson correlation was calculated to assess the correlation between leakage and image quality. Results: There was no significant difference in amount of leakage between both groups, and global image quality was found equal in both groups. A negative correlation was found between leakage and quality assessment. Conclusion: This study shows that it cannot be avoided by strict shoulder immobilization and that it negatively affects image quality and interpretation.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

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Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?

et al. 2021

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“…The three discordant cases in this series illustrated the importance of critically scrutinizing subtle findings detected on MR arthorgrams to not overcall the injury. Other considerations of note have been explored by Wang et al 24 pertaining to true and false positive MR arthrograms with respect to IGHL integrity. Specifically, they reported that isolated extravasation of contrast from the posterior portion of the axillary pouch of the IGHL was seen only in cases of iatrogenic extravasation and never identified with a true tear.…”

Section: Discussionmentioning

confidence: 99%

Inferior Glenohumeral Ligament (IGHL) Injuries: A Case Series of Magnetic Resonance (MR) Imaging Findings and Arthroscopic Correlation

Glass¹,

Behzadpour²,

Peterson³

et al. 2020

kjm

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The inferior glenohumeral ligament (IGHL) complex is commonly assessed by both magnetic resonance imaging (MRI) and magnetic resonance (MR) arthrogram. Our study aimed to compare the accuracy of MR arthrogram compared to MRI using arthroscopic correlation as the gold standard. A retrospective review of cases reporting an IGHL injury was performed. 77 cases met inclusion criteria, while 5 had arthroscopic reports that directly confirmed or refuted the presence of IGHL injury. Two arthroscopic reports confirmed concordant IGHL injuries, while 3 arthroscopic reports mentioned discordant findings compared to MR. Interestingly, all three discordant cases involved MR arthrogram. Findings included soft tissue edema, fraying of the axillary pouch fibers, and cortical irregularity of the humeral neck. Of the two concordant cases, one was diagnosed by MRI, revealing an avulsion of the anterior band, while the second was diagnosed by MR arthrogram showing ill-defined anterior band fibers. Many cases involved rotator cuff or labral tears, which may have been the focus of care for providers, given their importance for shoulder stability. Additionally, a lack of diagnostic confidence in MR reports may have influenced surgeons in the degree to which they assessed the IGHL complex during arthroscopy. In conclusion, radiologists seemed more likely to make note of IGHL injuries when MR arthrograms were performed; meanwhile, all three discordant cases involved MR arthrogram reads. Therefore, additional larger studies are needed with arthroscopic correlation to better elucidate MR findings that confidently suggest injury to the IGHL complex, in order to avoid false positive radiology reports.

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“…MR arthrography is particularly helpful, but iatrogenic extravasation of contrast material can be mistaken for an inferior glenohumeral ligament tear. The findings of a torn anterior band, a thickened ligament (> 3 mm), reverse-tapered calibre, and scarred appearance of the torn margins suggest a tear, while isolated disruption of the posterior axillary pouch is found in iatrogenic extravasation [ 68 ]. Posterior HAGL may also occur during a shoulder dislocation, where contrast may dissect through a defect in the posterior band of the inferior glenohumeral ligament [ 69 ] ( Figure 18 ).…”

Section: Glenohumeral Instabilitymentioning

confidence: 99%

Magnetic resonance imaging of the shoulder

et al. 2020

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The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.

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MR Arthrogram Features That Can Be Used to Distinguish Between True Inferior Glenohumeral Ligament Complex Tears and Iatrogenic Extravasation

Cited by 15 publications

References 13 publications

Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?

Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?

Inferior Glenohumeral Ligament (IGHL) Injuries: A Case Series of Magnetic Resonance (MR) Imaging Findings and Arthroscopic Correlation

Magnetic resonance imaging of the shoulder

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