A motive for the use of a posterior approach in shoulder arthography: ventral leakage of contrast medium.
BACKGROUND
Some orthopedic surgeons request a posterior approach for shoulder magnetic resonance (MR) arthrography, especially in patients with anterior shoulder instability, to avoid interpretive difficulties in differentiating anterior extraarticular contrast injection when using an anterior approach from ventral leakage of contrast.


OBJECTIVE
To determine the occurrence of ventral leakage of contrast in shoulder MR arthrography when using a posterior approach.


METHODS
Retrospectively, we included 73 consecutive patients who underwent shoulder MR arthrography (1.0 Tesla) using the posterior approach. Three unsuccessful procedures were excluded. Ventral leakage of contrast, defined as contrast seen around the musculus subscapularis without distention of the posterior capsule, was recorded. Descriptive statistics were used.


RESULTS
Seventy shoulders were included. Forty-one left shoulders were involved (59%). Mean age of patients was 49 years (range, 17-76 years). Thirty-five patients were women (50%). Ventral leakage of contrast was seen in 12 shoulders (17%).


CONCLUSIONS
As ventral leakage of contrast was seen in a substantial number of cases when using a posterior approach in shoulder MR arthrography, the use of a posterior approach is advised to avoid misinterpretation of ventral contrast leakage with accidental extra articular contrast injection, and to increase confidence in the final radiological diagnosis.
Department of Radiology, Atrium Medical Center Parkstad, Heerlen, the Netherlands.
Miraude E A P M
ME
Adriaensen
Oliver T
OT
Ertl
Peter-Jan van
PJ
Laar
Maarten
M
Nix
Filip M
FM
Vanhoenacker
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D007593:Joint Instability / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine; D008875:Middle Aged; D009942:Organometallic Compounds; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000473:pathology*
D003287:Contrast Media; D009942:Organometallic Compounds; C093233:iobitridol; D007472:Iohexol; D008536:Meglumine; C072417:gadoterate meglumine
MRI (magnetic resonance imaging); arthrography; posterior; shoulder; technique