MR Arthrography
Arthrography is MR imaging of the joints after an intra-articular injection of a suitable solution of paramagnetic contrast and saline.
Magnetic resonance arthrography is a great tool and the preferred imaging technique of unstable joints. It is especially useful in the diagnosis of the most complex joints: the shoulder, wrist, hip, the knee joints and the ankle. Magnetic resonance arthrography reliably shows the subtle changes in the joints. It provides valuable information on the scale of damage to the joint elements, thanks to which surgeons get to know what the necessary repairs will be in arthroscopic surgery. Arthrography MRI visualizes structures invisible in other studies – parts of the cartilage of the joints. It is an ideal alternative to invasive diagnostic methods, namely the endoscopic method of imaging (arthroscopy).
Arthrography is particularly useful in evaluating the labrum of the joint, muscle attachments, articular cavity, ligaments, tendons, cartilage and other soft tissues not visible during a standard test.
The test is performed in planes
• transverse
• top
• sagittal
There are two methods of arthrography: direct, where the contrast material is injected into the joint, and indirect, where the contrast is administered intravenously.
In Medical Centers Medici we perform the direct method.
It is a safe, minimally invasive procedure that causes distention of the joint cavity – for better MR imaging.
Course of Examination:
Option A: The patient has only MR arthrography
The initial phase of the Examination: the patient has an MRI of the shoulder joint limited to a few sequences needed to carry out a full assessment of the joint, after the injection of contrast. (15 minutes)
Intermediate phase: the patient goes into the treatment room, where the doctor – a specialist in orthopedics and traumatology – provides a contrast to the joint with a syringe and a long needle. To avoid accidental injection of contrast to the soft tissue thus causing difficulties in the interpretation procedure, it should be performed under the control of X-ray or ultrasound. The procedure is done under local anesthetic – lidocaine. (15 minutes)
For an effective arthrography, MRI with a clear image, the MRI should be performed immediately after the injection of the contrast.
Final phase: after about 30 minutes - the time needed to correct the "wash" of the joint structures with the contrast – the patient returns to the MR to scan after the injection of contrast. Thanks to the contrast all the joint components are shown, especially the broken ones. (about 25 minutes)
Option B: A full scan of the joint and MR arthrography are carried out
The initial phase of the study: the patient has a full MRI with full sequence required. (40 minutes)
Intermediate phase: the patient goes into the treatment room, where the doctor – a specialist in orthopedics and traumatology – provides a contrast to the joint with a syringe and a long needle. To avoid accidental injection of the contrast to the soft tissue thus causing difficulties in the interpretation procedure, it should be performed under the control of X-ray or ultrasound. The procedure is done under local anesthetic – lidocaine. (15 minutes)
For an effective arthrography MRI with a clear image, the MRI should be performed immediately after the injection of the contrast.
Final phase: after about 30 minutes - the time needed to correct the "wash" of the joint structures with the contrast – the patient returns to the MR to scan after the injection of contrast. Thanks to the contrast all the joint components are shown, especially the broken ones. (about 25 minutes)
After the test, the contrast mix is absorbed from the joint cavity without leaving a trace.
During the MRI, the patient is asked to leave outside the laboratory metal objects such as jewelry, glasses, sunglasses, watches, pins, safety pins and bras with metal frame. Before the test, the patient must fill out a questionnaire. There are questions about metal implants or medical electronic devices, e.g. Pacemakers, which are an absolute contraindication to carry out an MRI.
Indications for MR arthrography of the joint:
• damage
• cartilage
• ligaments
The study is particularly recommended in patients with a history of ankle sprain.
The indication for a magnetic resonance arthrography study are damaged cartilage and ligaments. They arise mainly because of injuries in which the shoulder joint is often exposed (in tennis, basketball, gym), knee (skiers) and hip (footballers). This study is particularly recommended in the monitoring of treatment of the meniscus of the knee.
Indications for shoulder arthrography:
evaluation of the integrity of the joint,
instability of the shoulder (evaluation of complex hem-ligament-capsular)
for the diagnosis of hip labrum, acetabular bone damage
evaluation of the adhesion of basic elements to each other
arthritis, pain syndrome, overloaded or stretched tendons, joint degeneration,
damage of the tendon of the long head biceps (SLAP)
damage of the tendons of the rotator cuff
Arthrography of the knee:
Arthrography of the knee is currently the best method to assess the recurrent damage to the meniscus as well as the assessment of treatment after partial removal or repair of the meniscus. MR arthrography may also be useful for the examination of hyaline cartilage in the knees. MR arthrography has been demonstrated to be superior over conventional MRI in assessing the stability of the cartilage and bone fragments of the knee. The presence of intra-articular contrast better shows the size and depth of the defects of articular cartilage and can help with the classification of the damage.
Therefore, MR arthrography of the knee is invaluable in cases of:
- Knee injuries
- Joint damage because of the natural aging process
- Assessment of ligaments and cartilage
- Synovial fluid and joint space
Indications for magnetic resonance arthrography of the knees:
• damage to the meniscus
• Baker's cyst
• changes in the area of the ligaments
• pathological changes of articular cartilage
• osteochondritis
• intra-articular loose bodies
• evaluation of the meniscus after surgery
Indications for MR arthrography of the elbow:
• inflammatory changes
• tumors
• cartilage damage – MR arthrography is the most accurate method
Indications for MR arthrography of the hand:
• a thorough evaluation of the triangular fibrocartilage
• accurate assessment of the ligaments of the wrist
Indications for MR arthrography of the hip:
• evaluation of tumors
• evaluation of inflammatory changes
• assessment of articular labrum
Contraindications for arthrography
Allergy to iodine
Allergy to topical anesthetic
In Medical Centers the Medici we do arthrography of:
- shoulder
- hip
- knee
- elbow
- hand
- joints of the foot
In Medical Centers the Medici, advanced diagnostic imaging of the joints can be performed. During a Magnetic Resonance Study, all research in the field of orthopedics can be performed.