Arthrogram
 | This April 2009 needs additional citations for verification. (May 2009) |
| Arthrogram | |
|---|---|
 | |
| ICD-9-CM | 88.32 |
| OPS-301 code | 3-13k |
An arthrogram is a series of images of a joint after injection of a contrast medium, usually done by fluoroscopy or MRI. The injection is normally done under a local anesthetic.The radiologist or radiographer performs the study using fluoroscopy or ultrasound to guide the placement of the needle into the joint and then injects an appropriate amount of contrast.
Related technologies
The physician or radiographer then obtains a series of X-rays, or alternatively Computed Tomography (CT) scans or Magnetic Resonance Imaging (MRI) scans. The joint can be imaged from many angles in fluoroscopy, or on a slice by slice basis in CT and MRI scans.
Use
Shoulder arthrography can be used to study tears of the rotator cuff, glenoid labrum and biceps.[1]
The type of contrast injected into the joint depends on the subsequent imaging that is planned, for pneumoarthrography, gas is used, for CT or radiographs, a water-soluble radiopaque contrast is utilized, and for MRI, gadolinium based solutions are inject. A combination of both has been used in double-contrast arthrography for more anatomically complex cases. The needle is radiographically guided into the glenohumeral joint space, after which the patient is evaluated by fluoroscopy, CT or MRI. The gadolinium in the contrast fluid yields a bright signal on T1 weighted images allowing for better evaluation of the joint capsule, the articular surface of the bones and, in particular, the labral cartilage. MR arthrography is most often used in evaluation of the hip and acetabular labrum, of the shoulder rotator cuff and glenoid labrum, and less often in the wrist.[1] Arthrograms can be diagnostic and therapeutic. Therapeutic arthrograms often distend the joint with cortisone and lidocaine, with a common site being the shoulder. Diagnostic arthrograms can be direct, as described above with penetration of the joint, or indirect, by a venous injection of contrast material and delayed imaging with CT or MRI.[1]
Risks
Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, or latex should not have this procedure. Potential risks are infections at the puncture site where the radiopaque substance and/or air are injected. Bleeding is also a small risk.
Reports have arisen of gadolinium contrast agents causing nephrogenic systemic fibrosis (NSF), a debilitating and potentially fatal disease affecting skin, muscle, and internal organs.[2] These cases have only occurred in people with moderate-to-end-stage kidney disease; there have been zero reports of gadolinium leading to health problems in individuals with healthy kidneys. The mechanism linking gadolinium, kidney dysfunction, and NSF is currently unknown. The U.S. Food and Drug Administration (FDA) has recommended that physicians refrain from using gadolinium contrast agents on patients with kidney disease "unless the diagnostic information is essential and can not be obtained with non-contrast-enhanced MRI or other diagnostic procedures."[3]
Aside from the risk of NSF in people with kidney disease, arthrograms carry the same risks as ordinary X-rays or MRI scans.
See also
Medical Imaging Radiographer Radiologist
References
- ^ a b c R. Crim, Julia, Specialty Imaging: Arthrography: Principles and Practice in Radiology, Lippincott Williams & Wilkins, ISBN 978-1-931884-15-0
{{citation}}: Cite has empty unknown parameter:|coauthors=(help) - ^ Bloom, Mark (22 December 2006), Medical News: FDA Issues Alert on Gadolinium-Based Contrast Agent for Kidney Patients, vol. Nephrology, General Nephrology, MedPage Today, retrieved 2009-05-05
- ^ Gadolinium-Based Contrast Agents for Magnetic Resonance Imaging, FDA ALERT, US Food and Drug Administration, 6/2006, updated 12/2006 and 5/23/2007, retrieved 2009-05-05
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