The Utility of MR Imaging of the Shoulder Joint: Comparison of the MR Imaging between Conventional MR Imagingand Arthrographic MR Imaging

PURPOSE: To evaluate the diagnostic value of MRI of the shoulder. MATERIALS AND METHODS: Between January andJune 1997, shoulder MRI and arthroscopy were performed in a total of 48 patients with shoulder pain (n=30) orshoulder instability (n=18). Forty-five were males and three were females; their ages ranged from 16 to 67 (mean32.5) years. The period between shoulder MRI and arthroscopy was between one and 390 (mean, 42.2) days. Twenty-sixpatents underwent MR arthrography (AMR), and 22 conventional MRI(CMR). Each image was analyzed for rotator cuffinjury, glenoid labral injury, SLAP lesion, and biceps tendon injury. RESULTS: On arthroscopy, one disease wasfound in 34 patients, two were found in six, three diseases were found in seven, and one patient had fourdiseases. Arthroscopic diagnosis was as follows: rotator cuff injury, 29 ; SLAP lesion, 12 ; glenoid labralinjury, 10 ; biceps tendon injury, 4 ; subacromial bursitis, 2 ; chronic synovitis, 1 ; adhesive capsulitis, 1 ;superior glenohumeral ligament injury, 1 ; normal, 1. For rotator cuff injury, the sensitivity of MRI was 65.5%and specificity was 93.0% (AMR : 66.7%, 95.8%, CMR : 65.2%, 86.4%). For SLAP lesion, sensitivity was 58.3% andspecificity was 97.2% (AMR : 66.7%, 100%, CMR : 50%, 93.8%) ; for glenoid labral injury, sensitivity was 80.0% andspecificity was 89.5% (AMR : 85.7%, 84.2%, CMR : 66.7%, 94.7%), and for biceps tendon injury, the false negativerate was 100%. CONCLUSION: In cases involving glenoid labral injury, the diagnostic accuracy of shoulder MRI wasrelatively high ; in rotator cuff injury and SLAP lesion, however, diagnosis was limited, and in biceps tendoninjury was difficult. We suggest, however, that MR arthrography has certain diagnostic advantages overconventional MRI.

Splanchnic Artery Pseudoaneurysm: Transcatheter Embolization

PURPOSE: To evaluate the therapeutic effect and difficulty of embolization of pseudaneurysm of the splanchnic artery. MATERIALS AND METHODS: Between February 1988 and June 1996, we employed transcatheter embolization to treat a total of eleven patients with splanchnic artery pseudoaneurysm by transcatheter embolization. Eight were males and three were females ; their ages ranged from four to 70 years (mean 44). Three patients had previously been operated on, three had undergone biopsy, and on three, percutaneous transhepatic biliary drainage had been performed ; one had been involved in a traffic accident and one had suffered a gun-shot wound. All patients underwent diagnostic angiography and superselective embolization using a 3F microcatheter. We used Gelfoam with microcoil four times, microcoil twice, Gelfoam once, Gelfoam with ethanol once, a detachable balloon once, and Ivalon once. RESULTS: Arteries in which pseudoaneurysm had occurred were as follows: renal, four, hepatic, three; gastroduodenal, two ; superior mesenteric, one. Nine patients underwent one session of procedure and two underwent two session. Nine patients (82%) were treated successfully and without complication by embolization. Two patients failed to embolize due to vascular spasm and tortuosity in one and a wide aneurysmal neck in the other ; one of these died six days later and the other was operated on. CONCLUSION: Although there are therapeutic difficulties in cases of vascular spasm, tortuosity, or a wide aneurysmal neck, embolization of pseudoaneurysm of the splanchnic artery is a safe and effective life-saving procedure.

Sagittal MR Findings of L5 Spondylolysis: Changes of Spinal Canal

PURPOSE: To evaluate changes in the spinal canal in cases of L5 spondylolysis, as seen on sagittal MR images. MATERIALS AND METHODS: We retrospectively analysed the MR findings of 27 patients suffering from L5 spondylolysis without spondylolisthesis and compared them with 100 control subjects. Spondylolysis had been confirmed by conventional radiography. On midsagittal MR images, sagittal canal ratio (SCR) was defined as midsagittal canal diameter at L5 devided by that at L1. We analysed the frequency of posterior epidural fat deposition (posterior epidural fat between the posterior margin of the dural sac and the anterior cortical margin of the spinous process on the midsagittal line), and compared this with the frequency in 100 control subjects. RESULTS: Mean SCR value in 27 patients with L5 spondylolysis (1.22) was significantly greater than 100 control subjects (0.96, p<0.001). Mean SCR value in 17 patients with L5 spondylolysis and posterior epidural fat deposition (1.27) was significantly higher than in nine control subjects with posterior epidural fat deposition (0.97). Posterior epidural fat deposition was more frequently indentified in patients with L5 spondylolysis (63%) than in control subjects (9%). CONCLUSION: The possibility of L5 spondylolysis is suggested when on midsaggital MR imaging, the anteroposterior diameter of the L5 spinal canal is seen to be widened and posterior epidural fat deposition is noted.

Recurrent Pyogenic Cholangitis: Angiographic Findings and Its Significance

PURPOSE: To analyse the angiographic findings of recurrent pyogenic cholangitis. MATERIALS AND METHODS: Hepatic arteriography and portography were performed preoperatively in 34 patients with intrahepatic stones and recurrent cholangitis. Twenty five of these underwent partial resection of the liver and in nine, the biliary tract was drained. Hepatic arteriogram and portogram findings correlated with liver atrophy and were analysed retrospectively by two radiologists; angiographic and pathologic findings also correlated. RESULTS: In the arterial phase, abnormal stained areas, were seen in 17 of 34 cases, periarterial staining in 14, mass-like staining in two and a mixed pattern in one. The hepatic artery showed spastic change in 11 of 34 cases and tortuous change in 17. Arteriovenous shunting was not seen. In the portal phase, abnormal findings of the portal veins were noted in 16 cases; decreased size and nonvisualization were seen in eleven patients, and decreased size only, in five. Fifteen cases showed liver atrophy; in 13 of these, portal vein abnormalities were also present. CONCLUSION: In recurrent pyogenic cholangitis, angiographic findings may be normal or findings of abnormal periarterial staining, mass-like staining, spastic and tortuous change of the hepatic artery, and abnormal portal vein can be present. The differential diagnosis of hepatitis, hepatic mass and cirrhosis should be considered.