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Abstract
Purpose
To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance (MR) arthrography.
Materials and Methods
Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedure-related pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test.
Results
There was no significant difference in VAS scores between the anterior and posterior groups (1.77 ± 1.10 vs. 1.80 ± 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 ± 0.8 cm and 1.8 ± 0.3 cm vs. 6.6 ± 0.9 cm and 2.8 ± 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003).
Figures and Tables
Fig. 1
Position and puncture site of anterior and position approach in shoulder magnetic resonance arthrography. The puncture site of the anterior approach (A) is targeted on the inferior portion of the joint space and the punctural tract (arrow and broken line) on CT (B) is penetrated through pectoralis major and minor and subscapularis muscles. The puncture site of the posterior approach (C) is targed on the posteromedial portion of the humeral head just lateral to joint space and the punctural tract (arrow and broken line) on CT (D) is through deltoid and infraspinatus muscles.
Fig. 2
Contrast leakage on shoulder magnetic resonance arthrography with fat suppressed T1-weighted images with axial plane.
A. Grade 0 presented no contrast leakage.
B. Grade 1 is defined as contrast leakage along the puncture tract which is localized within the only one muscle bundle.
C. Grade 2 is defined as contrast leakage beyond a muscle bundle extending to the intermuscular fascial plane or other adjacent muscle bundles.
D. Grade 3 shows separation of the muscle from scapula owing to the deep penetration of the contrast.
Fig. 3
Frequency of visual analogue scale (VAS) score on both anterior and posterior approach for magnetic resonance arthrography. VAS of the anterior approach group shows grade 1 is most frequent, but VAS of the posterior approach group is most frequent on grade 2. There is not statistically different between two groups.
References
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