Optimización de la técnica de artrosonografía de hombro

Laburpena

Magnetic resonance imaging (MR arthrography) of the shoulder is a radiological technique that allows the visualization of intra-articular structures involved in the stability of the glenohumeral joint, after infiltration of diluted intra-articular contrast (gadolinium with or without iodinated contrast). Compared to fluoroscopy or computed tomography (CT), contrast infiltration by ultrasound guidance allows real-time visualization of the needle and prevents damage to neurovascular and tendon structures. In addition, it is an accessible and radiation-free technique. In the literature, a quantity of 12-16 ml is recommended to achieve adequate joint distension, and the ultrasound-guided posterior approach that has been described presents a lateromedial course. In our study, a posterior mediolateral approach is described, so that the humeral cartilage is punctured, and we also present a new anatomical landmark: posteroinferior humeral recess (RHPI), which allows the amount of contrast to be monitored for optimal joint distension, by measure a distention of the RHPI between 0.3 and 0.5cm, after introducing 14-18 ml. An LHRT distention> 0.5cm is related to contrast extravasation due to capsular rupture, and a distention <0.3cm, with insufficient joint distention. Finally, the present study describes the "triple contrast" technique, by adding 1ml of ultrasound contrast to the gadolinium and iodine solution, which has not been previously described in the literature. This solution does not produce artifact according to our results in MRI or CT images, and it could be useful to help infiltration in obese patients or those with poor acoustic windows.