目的:直接磁共振关节造影(dMRA)通常被认为是评估关节内结构的最准确的成像方式,但利用率和性能差异很大,没有达成共识。本白皮书的目的是代表骨骼放射学学会(SSR)根据已发表的文献和专家意见制定共识建议。
方法:SSR的标准和指南委员会将dMRA的使用和性能指南确定为重要的研究主题,并邀请所有具有专业知识和兴趣的SSR成员自愿参加白皮书小组。这个小组的任务是确定一个轮廓,回顾相关文献,准备一份总结问题和争议的书面文件,并提供建议。
结果:12名具有dMRA专业知识的SSR成员组成了特设白皮书作者委员会。对已发表的有关dMRA的文献进行了回顾和总结,专注于临床适应症,技术考虑,安全,成像协议,并发症,争议,和知识上的差距。关于dMRA在肩部的使用和性能的建议,弯头,手腕,臀部,膝盖,和踝部/足部区域在小组共识中发展。
结论:尽管直接MR关节造影以前已用于多种临床适应症,作者小组建议更有选择性地应用这种微创手术。目前,直接MR关节造影在肌肉骨骼放射科医生的医疗设备中仍然是重要的程序,当常规MRI不确定或结果与临床评估不一致时尤其有价值。
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.
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.
CONCLUSIONS: 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.