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Chang EY, Bencardino JT, French CN, Fritz J, Hanrahan CJ, Jibri Z, Kassarjian A, Motamedi K, Ringler MD, Strickland CD, Tiegs-Heiden CA, Walker REA. SSR white paper: guidelines for utilization and performance of direct MR arthrography. Skeletal Radiol 2024; 53:209-244. [PMID: 37566148 PMCID: PMC10730654 DOI: 10.1007/s00256-023-04420-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. MATERIALS AND METHODS The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. RESULTS Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. CONCLUSION Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.
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Affiliation(s)
- Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA, USA
| | - Jenny T Bencardino
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Cristy N French
- Department of Radiology, Penn State Hershey Medical Center, Hummelstown, PA, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Zaid Jibri
- GNMI in Mississauga, Greater Toronto Area, Toronto, ON, Canada
| | - Ara Kassarjian
- Department of Radiology, Division of Musculoskeletal Imaging, Olympia Medical Center, Elite Sports Imaging, Madrid, Spain
| | - Kambiz Motamedi
- Department of Radiology, University of California, Los Angeles Medical Center, Los Angeles, CA, USA
| | | | - Colin D Strickland
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Richard E A Walker
- McCaig Institute for Bone and Joint Health, Calgary, Canada.
- Cumming School of Medicine, University of Calgary, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
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Vora PH, Bhavsar NM, Musa R, Trivedi A, Amin P. A case report on rare occurrence of periosteal ganglion cyst in femoral intercondylar region. J Clin Orthop Trauma 2018; 9:S44-S48. [PMID: 29928104 PMCID: PMC6008608 DOI: 10.1016/j.jcot.2017.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/23/2017] [Accepted: 09/28/2017] [Indexed: 11/24/2022] Open
Abstract
Ganglions are the cysts derived from myxomatous degeneration of periarticular tissue, commonly found around wrist and foot. Ganglion cysts are uncommon in Knee region and if present their occurrence is mostly incidental and benign. Based on their location, this could be extraarticular or intraarticular. Lesions with similar pathology in subchondral region around joints are lesser common entity called Intraosseous ganglions. Rarer still is the lesion produced by myxomatous degeneration of periosteum of long bone, called periosteal ganglion. We here present a case of 35 year old Male with gradual onset, poorly localised pain behind left knee which was radiologically suggestive of periosteal ganglion, eroding the posterior aspect of femur and confirmed histopathologically following the excision of a lesion from posterior aspect of femoral condyles.
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Affiliation(s)
- Padmanabh H. Vora
- Corresponding author at: 302, Maanibhadra Appt., B/h ANURAG, Shantivan, N.N. Road, Paldi, Ahmedabad 380007, India.
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Samuel LKK, Hon-Wah Y, Tun-Hing L, Wai-Kit N. Recurrence of a Periosteal Ganglion in the Tibia. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2013. [DOI: 10.1016/j.jotr.2013.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Periosteal ganglion is a rare type of ganglia most commonly located in the tibia. The clinical outcomes after surgical excision have not been documented in literature. We report a case of a periosteal ganglion in the proximal tibia with repeated recurrences despite surgical excisions. Magnetic resonance imaging (MRI), contrast arthrogram, and arthroscopy may have their values, especially for the detection of intra-articular communication in juxta-articular lesions.
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Affiliation(s)
- Ling Ka-Kin Samuel
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
| | - Yiu Hon-Wah
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
| | - Lui Tun-Hing
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
| | - Ngai Wai-Kit
- Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong, China
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Spinner RJ, Scheithauer BW, Amrami KK. THE UNIFYING ARTICULAR (SYNOVIAL) ORIGIN OF INTRANEURAL GANGLIA. Neurosurgery 2009; 65:A115-24. [DOI: 10.1227/01.neu.0000346259.84604.d4] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
THE PATHOGENESIS OF intraneural ganglia has been an issue of curiosity, controversy, and contention for 200 years. Three major theories have been proposed to explain their existence, namely, 1) degenerative, 2) synovial (articular), and 3) tumoral theories, each of which only partially explains the observations made by a number of investigators. As a result, differing operative strategies have been described; these generally meet with incomplete neurological recoveries and high rates of recurrence. Recent advances in magnetic resonance imaging and critical analysis of the literature have clarified the mechanisms underlying the formation and propagation of these cysts, thereby confirming the unifying articular (synovial) theory. By identifying the shared features of the typical cases and explaining atypical examples or clinical outliers, several fundamental principles have been described. These include: 1) a joint origin; 2) dissection of fluid from that joint along an articular nerve branch, extension occurring via a path of least resistance; and 3) cyst size, extent, and directionality being influenced by pressures and pressure fluxes. We believe that understanding the pathogenesis of these cysts will be reflected in optimal surgical approaches, improved outcomes, and decreased frequency, if not elimination, of recurrences. This article describes the ongoing process of critically analyzing and challenging previous observations and evidence in an effort to prove a concept and a theory.
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Affiliation(s)
- Robert J. Spinner
- Departments of Neurologic Surgery, Orthopedics, and Anatomy, Mayo Clinic, Rochester, Minnesota
| | | | - Kimberly K. Amrami
- Departments of Neurologic Surgery and Radiology, Mayo Clinic, Rochester, Minnesota
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Spinner RJ, Edwards PK, Amrami KK. Application of three-dimensional rendering in joint-related ganglion cysts. Clin Anat 2006; 19:312-22. [PMID: 16506241 DOI: 10.1002/ca.20292] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The origin of para-articular cysts is poorly understood and controversial. The relatively common, simple (extraneural) cysts are presumed to be derived from joints, although joint connections are not always established. Rarer complex cysts are thought by many to form de novo within nerves (intraneural ganglion cysts) or within vessels (adventitial cysts) (degenerative theory). We believe that these simple and complex ganglion cysts are joint-related (articular theory). Joint connections are often not readily appreciated with routine imaging or at surgery. Not identifying and/or treating joint connections frequently leads to cyst recurrence. More sophisticated imaging may enhance visualization of these joint connections. We created a 3D rendering technique to assess potential joint connections of simple and complex cysts localized to the knee and superior tibiofibular joints in patients with fibular (peroneal) neuropathy. Two- and three-dimensional data sets from MRI examinations were segmented semiautomatically by signal intensity with further refinement based on interaction with the user to identify specific anatomic structures, such as small nerves and vessels on serial images. The bone, cysts, nerves, and vessels were each assigned different color representations, and 3D renderings were created in ANALYZE using the data sets closest to isotropic (voxel with equal length in all dimensions) resolution as the primary background rendering. We selected four cases to illustrate the spectrum of pathology. In all of these cases, we demonstrated joint connections and correlated imaging and operative findings. Surgery addressing the cyst and the joint connection resulted in excellent outcomes; postoperative MRIs done more than 6 months later confirmed that there was no recurrence. In addition to highlighting the important relationship of these cysts to neighboring anatomic structures, this 3D technique allows visualization of "occult" connections not readily appreciated with standard MR imaging. We believe that these joint-related cysts have a common pathogenesis; they dissect through a capsular rent and follow the path of least resistance; they may form simple cysts by dissecting out into the soft tissue, or more complex cysts by dissecting within the epineurium of nerves or adventitia of vessels (along an articular branch), or various combinations of all of these types of cysts. Understanding the pathogenesis for cyst formation will improve surgical management and outcomes. We have adapted this 3D technique to enhance the visualization of cysts occurring at other joints.
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Affiliation(s)
- Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
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