견관절 자기공명관절조영술 시행을 위한 초음파유도하 침천자의 유용성

초록

PURPOSE: To evaluate the usefulness of sono-guided needle puncture for MR arthrography of the shoulder to locate the path of access and to control the correct placement of the needle into the shoulder. MATERIALS AND METHODS: Fifteen patients with suspicion of shoulder pathology were included in this study. Patients were laid in supine positions with the arm extended and slightly abducted, the palm of the hand facing upward. A sonographic unit with a high resolution transducer with 7.5-MHz linear array was used. Axial images in the anterior aspect of the shoulder were obtained to localize the coracoid process and the anteromedial portion of the humerus. Using an aseptic technique, a 21-gauge needle was advanced into the shoulder joint under ultrasono-graphic guidance. When the needle made contact with the articular cartilage of the humeral head, the needle was tilted to position its point in the articular cavity. Solution of 0.1ml gadopentetate dimeglumine in 25ml of normal saline was prepared and 12-16ml was injected into the joint cavity. The intra-articular position of the needle and the compete distention of the shoulder joint were again confirmed by sonography. RESULTS: The needle was accurately placed in 14 out of 15 patients without damage to neighboring structures. It took 10 to 15 minutes to complete the procedure in 14 patients. No side effects attributable to gadopentetate dimeglumine were found. CONCLUSION: Sono-guided needle puncture for the shoulder MR arthrography can be a substitutable method for fluoroscopic guidance, with easy access, advantages of lacking radiation hazard and eliminating the need for iodized contrast agents.

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