MR Arthrography
MR arthrography (arthrogram) is a contrast-enhanced study used to visualize the interior of joints in more detail. An arthrogram helps to diagnose problems with bones, cartilage, ligaments, and tendons within a joint. Arthrograms are especially useful for determining the cause of unexplained joint pain.
Contrast material (gadolinium based) is injected directly into the joint. The fluid expands the joint and provides a better view of internal joint structures. Joint injections are done immediately before the MRI exam using fluoroscopic guidance.
When is MR arthrography recommended?
An arthrogram is recommended when a physician, typically an orthopedic surgeon, requires visualization of the interior of a joint. If a patient is suffering from a joint injury, an arthrogram might be recommended to determine the extent of the injury. Arthrograms are used to evaluate problems in a variety of joints, such as the shoulder, elbow, wrist, hip, knee, and ankle.
Arthrograms are a diagnostic tool which may also determine whether there is a ligament tear that could require surgery.
What are the benefits and risks?
Benefits
- Arthrograms are a minimally invasive way for doctors to evaluate the interior of a joint. This could avoid the need for surgical exploration of the joint.
- Even if joint surgery is eventually required, MR arthrography gives surgeons more detailed information about the joint prior to surgery. This may improve the outcome or shorten the length of recovery.
- A variety of problems can be evaluated by MR arthrogram. For example, doctors can evaluate the shoulder for labral tears. Knees can be examined for damage to cartilage and ligaments.
- No ionizing radiation is used in MRI exams. If you get a gadolinium injection into the joint being imaged, fluoroscopy will be used to guide the needle to the proper spot. Fluoroscopy uses a low dose of radiation because it uses X-ray technology, but the benefit of an accurate diagnosis far outweighs the risk. Learn more about Fluoroscopy.
- MR arthrography may be able to visualize some structures better than other joint imaging methods.
Risks
- Any medical devices implanted into your body may be at risk of malfunction due to the strong magnetic environment.
- In very rare cases, in patients with poor kidney function, nephrogenic systemic fibrosis is a possible complication when contrast is used.
- Gadolinium-based contrast has a very slight risk of causing an allergic reaction which can usually be easily treated.
- Pregnant women should consult with their physician prior to an MRI exam. However, there have been no documented negative effects of MRI in the many years of medical usage of MRI, and MRI is often the method of imaging chosen for pregnant women and fetuses. It should be noted that MRI contrast agents are not recommended to be used during pregnancy unless the benefits far outweigh the risks.
- The ACR states that current information suggests breastfeeding is safe after the use of intravenous contrast. Please discuss your breastfeeding options with your medical provider.
What can I expect during this procedure?
- You will be asked to change into a gown and be be required to remove all metal objects from your body.
- X-rays may be taken before the MRI to have a baseline exam to refer to later.
- The radiologist or technologist will use fluoroscopy imaging to help guide the needle to the appropriate placement within your joint. The contrast agent will expand the joint and enhance the detail on the MRI image.
- The area to be injected is cleansed with antiseptic and a sterile drape placed around the injection site. Using a small needle, the technologist will inject local anesthetic. Once the area is numb, a larger needle will be used to inject the contrast material.
- You will be moved to the MRI to complete the next portion of your exam.
What should I expect after this procedure?
Patients may resume non-strenuous activities immediately after the procedure. Avoid strenuous activity for 24 hours following the procedure. There may be mild discomfort of the joint following the exam. You may apply ice to the joint and take a mild pain relief medicine such as Tylenol. Avoid aspirin. The discomfort will disappear within 1 – 2 days after the exam. Some soreness may also be present at the injection site for up to 24 hours.
