An arthrogram is a series of images of a

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw ...

after injection of a

contrast medium A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, which is different from radi ...

, usually done by

fluoroscopy Fluoroscopy () is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a physician to see the internal structure and functi ...

or MRI. The injection is normally done under a

local anesthetic A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general an ...

such as

Novocain Procaine is a local anesthetic drug of the amino ester group. It is most commonly used in dental procedures to numb the area around a tooth and is also used to reduce the pain of intramuscular injection of penicillin. Owing to the ubiquity of ...

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, li ...

. The

radiologist Radiology ( ) is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiati ...

radiographer Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialise in the imaging of human anatomy for the diagnosis and treatment of pathology. Radio ...

performs the study using

x-ray X-rays (or rarely, ''X-radiation'') are a form of high-energy electromagnetic radiation. In many languages, it is referred to as Röntgen radiation, after the German scientist Wilhelm Conrad Röntgen, who discovered it in 1895 and named it ' ...

to guide the placement of the needle into the joint and then injects around 10 ml of contrast based on age. There is some burning pain from the anesthetic and a painful bubbling feeling in the joint after the contrast is injected. This only lasts 20 – 30 hours until the Contrast is absorbed. During this time, while it is allowed, it is painful to use the limb for around 10 hours. After that the radiologist can more clearly see what is going on under your skin and can get results out within 24 to 48 hours.

Types

Conventional arthrography

It is used primarily in the evaluation of menisci, cruciate ligaments, articular cartilage, and loose body within a joint. Fluoroscopic allows general view of the medial, lateral, and patellofemoral ligaments of the joint, overall cartilage thickness, focal defects, imbibition (absorption} of contrast material into the articular cartilage (a sign of cartilage fibrillation - splaying and fraying of the cartilage).

CT arthrography

CT arthrography is used to examine the patellofemoral joint.

MR arthrography

MR sequences such as

spin echo In magnetic resonance, a spin echo or Hahn echo is the refocusing of spin magnetisation by a pulse of resonant electromagnetic radiation. Modern nuclear magnetic resonance (NMR) and magnetic resonance imaging (MRI) make use of this effect. The N ...

with T1 and T2-weighted sequences,

inversion recovery Inversion recovery is an MRI sequence that provides high contrast between tissue and lesion. It can be used to provide high T1 weighted image, high T2 weighted image, and to suppress the signals from fat, blood, or cerebrospinal fluid (CSF). Fluid- ...

, chemical shift selective techniques, and gradient echo techniques are used to examine the articular cartilage.

Use

Shoulder arthrography can be used to study tears of the rotator cuff, glenoid labrum and

biceps The biceps or biceps brachii ( la, musculus biceps brachii, "two-headed muscle of the arm") is a large muscle that lies on the front of the upper arm between the shoulder and the elbow. Both heads of the muscle arise on the scapula and join ...

. 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, and for MRI,

gadolinium Gadolinium is a chemical element with the symbol Gd and atomic number 64. Gadolinium is a silvery-white metal when oxidation is removed. It is only slightly malleable and is a ductile rare-earth element. Gadolinium reacts with atmospheric oxygen o ...

. Double-contrast arthrography can be used for more anatomically complex cases, though its use is relatively infrequent. 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 In anatomy, a joint capsule or articular capsule is an envelope surrounding a synovial joint.articular The articular bone is part of the lower jaw of most vertebrates, including most jawed fish, amphibians, birds and various kinds of reptiles, as well as ancestral mammals. Anatomy In most vertebrates, the articular bone is connected to two oth ...

surface of the bones and, in particular, the labral cartilage. MR arthrography is most often used in evaluation of the hip and

acetabular labrum The acetabular labrum (glenoidal labrum of the hip joint or cotyloid ligament in older texts) is a ring of cartilage that surrounds the acetabulum of the hip. The anterior portion is most vulnerable when the labrum tears. It provides an articula ...

, of the shoulder

rotator cuff The rotator cuff is a group of muscles and their tendons that act to stabilize the human shoulder and allow for its extensive range of motion. Of the seven scapulohumeral muscles, four make up the rotator cuff. The four muscles are the supraspi ...

and

glenoid labrum The glenoid labrum (glenoid ligament) is a fibrocartilaginous structure (not a fibrocartilage as previously thought) rim attached around the margin of the glenoid cavity in the shoulder blade. The shoulder joint is considered a ball and socket ...

, and less often in the wrist. 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.

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. Rarely, gadolinium, found in MRI contrast agents, can cause

nephrogenic systemic fibrosis Nephrogenic systemic fibrosis is a rare syndrome that involves fibrosis of skin, joints, eyes, and internal organs. NSF is caused by exposure to gadolinium in gadolinium-based MRI contrast agents (GBCAs) in patients with impaired kidney function. ...

(NSF), a debilitating and potentially fatal disease affecting skin, muscle, and internal organs, in patients with impaired renal function.

References

External links

FDA website on gadolinium-containing contrast agents

Video tutorial for performing an arthrogram
{{Medical imaging Projectional radiography Bone, cartilage, and joint procedures