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Arthrography: Joint Imaging with Contrast—Technique and Applications

Arthrography is a radiographic examination of a joint after injection of contrast material (iodinated contrast, gadolinium, or air) to visualize internal derangements. It can be performed under fluoroscopy, CT, or MRI guidance.

Types of Arthrography

  • Conventional (fluoroscopic) arthrography: Real-time injection under fluoro; spot films obtained. Largely replaced by cross-sectional methods.
  • CT arthrography: Post-injection CT; excellent for osseous detail, labral tears, loose bodies.
  • MR arthrography (MRA): Post-injection MRI; gold standard for labral, cartilage, and ligament pathology due to superior soft-tissue contrast.

Contrast Agents

  • Iodinated (fluoro/CT): Low-osmolar non-ionic (e.g., iohexol 240–300 mgI/mL); diluted 1:1 to 1:10 with saline/local anesthetic.
  • Gadolinium (MR): Dilute gadolinium (1:200 to 1:250; 2–4 mM) in saline; ~10–20 mL per joint.
  • Air (historical/double-contrast): Pneumarthrography; limited current use.

Common Indications

Procedure Overview (MR Arthrography Example)

  1. Consent; allergy/renal function check (if IV gadolinium also planned).
  2. Skin prep, sterile drape; local anesthetic (1% lidocaine) at puncture site.
  3. Fluoroscopic/US-guided needle placement into joint capsule.
  4. Aspirate fluid (send for analysis if indicated); confirm intra-articular position with small contrast aliquot.
  5. Inject dilute gadolinium (volume per joint: shoulder 12–15 mL, hip 8–12 mL, wrist 3–5 mL).
  6. Patient exercises joint gently to distribute contrast.
  7. Immediate MRI (T1-weighted sequences with fat suppression).

Complications

  • Infection (septic arthritis): <0.1% with sterile technique.
  • Vasovagal reaction, transient pain/swelling.
  • Allergic reaction to iodinated contrast (rare with non-ionic).
  • Gadolinium retention (negligible at arthrography doses).

Contraindications

  • Overlying skin infection/cellulitis.
  • Known joint prosthesis (risk of periprosthetic infection; consult orthopedist).
  • Severe contrast allergy (premedication or alternative imaging).

MR arthrography remains the reference standard for many intra-articular pathologies, particularly when non-arthrogram MRI is equivocal.

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JointPrimary Indications
ShoulderLabral tears (SLAP, Bankart), rotator cuff tears, adhesive capsulitis, instability
HipLabral tears, FAI (femoroacetabular impingement), cartilage defects, loose bodies
WristTFCC tears, scapholunate ligament, cartilage lesions
ElbowUCL tears, loose bodies, osteochondritis dissecans
KneePost-surgical assessment (meniscal repair, ACL graft); limited role vs. standard MRI
AnkleOsteochondral lesions, syndesmotic injury, impingement