Indirect MR arthrography: techniques and applications

Abstract

Indirect MR arthrography is a relatively new MR technique improving articular and periarticular contrast. It is achieved by injection of paramagnetic MR contrast media intravenously instead of intra-articular injection as in direct MR arthrography. After the injection exercising the joint results in considerable signal intensity increase within the joint cavity. Fat saturated MR sequences then yield arthrographic images. The method is less invasive than direct MR arthrography and first results showed comparable sensitivities and specificities for rotator cuff and glenoid labrum pathology. In this article the technique, established and potential future indications, drawbacks and limitations of the method are reviewed.

Rotator cuff tears noncontrast MRI compared to MR arthrography

“…In the present study, however, the specificities for diagnosing rotator cuff tendon tears were not significantly different between both groups. Since the two readers were well experienced with the indirect MR arthrography technique, this potential drawback was considered to be overcome through the recognition of different signal intensities, morphology, and the location of the enhancing area between normal anatomy and rotator cuff pathology, in accordance with Vahlensieck et al [3]. In one of the readers, indirect MR arthrography enabled a more specific diagnosis of SSC tendon tears and a more accurate prediction of tear grades with statistical significance when compared with noncontrast MRI.…”

“…Indirect MR arthrography, as described by Vahlensieck et al [3,8], is a technique which utilizes intravenous injection of paramagnetic contrast material to achieve arthrogram-like images similar to those obtained in direct MR arthrography. Several investigators have described indirect MR Fig.…”

“…There are several drawbacks of indirect MR arthrography such as the enhancement of extra-articular, synovial, vascularized structures, lack of joint capsule distension, and the risk of side effects due to intravenously administered contrast medium [3,5,8]. Among these, enhancement of extra- [4], although it can be helpful in detecting inflamed tissue such as adhesive capsulitis [26].…”

“…Since it produces arthrogram-like effects, several investigators have emphasized that indirect MR arthrography may have the potential to replace direct MR arthrography for the evaluation of shoulder pathologies [3,8]. A comparison study revealed that there was no significant difference between indirect and direct MR arthrography with regard to rotator cuff, labral, and long head of biceps tendon tears [9].…”

“…Following its initial description by Winalski [1] and Drape [2] in 1993, indirect magnetic resonance (MR) arthrography has been used for the diagnosis of intra-articular abnormalities without invasive procedures and coordination of additional scheduling [3][4][5][6][7][8]. Since it produces arthrogram-like effects, several investigators have emphasized that indirect MR arthrography may have the potential to replace direct MR arthrography for the evaluation of shoulder pathologies [3,8].…”