Chapter 12Chapter 12

Contrast ArthrographyContrast Arthrography

9 25 2014 online ed.

What is contrast arthrography?What is contrast arthrography?

Radiographic examination of soft tissue Radiographic examination of soft tissue structures of joints after injection of contrast structures of joints after injection of contrast mediamedia

MRI has largely replaced contrast MRI has largely replaced contrast arthrographyarthrography

Noninvasive Noninvasive fewer risks are associatedfewer risks are associated

Contrast MediaContrast Media

AirAirNegative contrastNegative contrast

Iodinated contrastIodinated contrastPositive contrastPositive contrast

KneeKnee

WristWrist

HipHip

ShoulderShoulder

TMJTMJ

What are most common joints investigated using contrast arthrography?

Knee ArthrographyKnee Arthrography

To assesse soft To assesse soft tissue areas of tissue areas of knee jointknee joint

Cruciate ligamentCruciate ligament

Medial and lateral Medial and lateral meniscimenisci

What are menisci?What are menisci?

Two pads of Two pads of cartilaginous tissuecartilaginous tissue

Serve to Serve to disperse weight of body and reduce friction during movement of joint of joint

Procedure IndicationsProcedure Indications

Cartilage, capsular injuriesCartilage, capsular injuries

Ligament or menisci injuriesLigament or menisci injuries

Loose bodiesLoose bodies

Joint ruptureJoint rupture

Baker’s cystBaker’s cyst

Synovial diseaseSynovial disease

Prosthesis checkProsthesis check

ProcedureProcedure

Skin is first cleaned with betadineSkin is first cleaned with betadine

Local anesthetic is introducedLocal anesthetic is introduced

Joint is puncturedJoint is punctured

(synovial fluid may be aspirated and sent for (synovial fluid may be aspirated and sent for analysis)analysis)

Thick, stringy fluid found Thick, stringy fluid found in cavities ofin cavities of synovial synovial jointsjoints

Reduces friction between Reduces friction between articular cartilage and articular cartilage and other tissues in joints other tissues in joints

Lubricates and cushions Lubricates and cushions during movementduring movement

What is synovial fluidWhat is synovial fluid??

ProcedureProcedure cont’dcont’d

Contrast introduced under fluoroscopic guidanceContrast introduced under fluoroscopic guidance

Needle is removed Needle is removed

Pt exercises kneePt exercises knee to distribute contrast to distribute contrast

Pt is then turned prone if Pt is then turned prone if vertical methodvertical method is used is used

Spot radiographs are obtainedSpot radiographs are obtained

Vertical ray methodVertical ray method

Beam shoots Beam shoots down down (or up if using (or up if using fluoroscopy)fluoroscopy)

Limb placed in Limb placed in stress device to stress device to widen side of jt widen side of jt space under space under investigationinvestigation

TypicalTypical Spot films taken under fluoro by Spot films taken under fluoro by RadiologistRadiologist

(Don’t need to learn for midterm)(Don’t need to learn for midterm)

ProneProne3030º lateral anterior obliqueº lateral anterior oblique45º oblique45º oblique60º lateral posterior oblique60º lateral posterior oblique90º lateral90º lateral

Views are then reversed, Views are then reversed, beginning with pt supine to beginning with pt supine to demonstrate lateral meniscusdemonstrate lateral meniscus

Stress is applied to open the Stress is applied to open the joint space during exposurejoint space during exposure

Horizontal ray methodHorizontal ray method

To demonstrate To demonstrate lateral and medial lateral and medial meniscusmeniscus

Same procedure as Same procedure as with with Vertical method Vertical method but with crosstable but with crosstable CR CR (fluoroscopy not possible)(fluoroscopy not possible)

Tear in medial meniscus

Normal

Post-ProcedurePost-Procedure

Overhead radiographs by tech Overhead radiographs by tech may be requested:may be requested:– AP, lateral, tunnel, lateral viewsAP, lateral, tunnel, lateral views

Make sure puncture area is properly bandagedMake sure puncture area is properly bandaged

Pt may experience some discomfort for a couple of Pt may experience some discomfort for a couple of daysdays

Discourage heavy exerciseDiscourage heavy exercise

Hip ArthrographyHip Arthrography

Acetabular region of Acetabular region of pelvis pelvis

What kind of joint is hip?What kind of joint is hip?Diarthrotic- ball and Diarthrotic- ball and socket jointsocket joint

Allows flexion, extension, Allows flexion, extension, abduction, adduction, abduction, adduction, rotationrotation

Hip Arthrography Hip Arthrography cont’dcont’d

Most often performed on children to evaluate hip Most often performed on children to evaluate hip dislocation before treatmentdislocation before treatment

In adults, primarily to check prosthesis dislocation In adults, primarily to check prosthesis dislocation or presence of infectionor presence of infection

Common puncture siteCommon puncture site–¾¾ distal to inguinal crease distal to inguinal crease

and ¾and ¾ lateral to palpated femoral pulse lateral to palpated femoral pulse

ContraindicationsContraindications

InfectionsInfections

Allergy to contrastAllergy to contrast

Bleeding problemsBleeding problems

Hip ProcedureHip Procedure

After preparation, aspiration, and injection, After preparation, aspiration, and injection, pt is supinatedpt is supinated

Joint is gently manipulated after injectionJoint is gently manipulated after injection

Radiographs must be obtained immediately as Radiographs must be obtained immediately as contrast is rapidly absorbedcontrast is rapidly absorbed

RadiographsRadiographs

APAP

Internal and external rotationsInternal and external rotations

Frog lateralFrog lateral

Hip Arthrogram w/ProsthesisHip Arthrogram w/Prosthesis

Hip ArthrogramHip Arthrogram

With “subtraction”

Radiopaque cement can be hard to distinquish from contrast

Pediatric Hip ArthrogramPediatric Hip Arthrogram

TMJ ArthrographyTMJ Arthrography

CT and MRI have largely replacedCT and MRI have largely replaced

TMJ –What kind of joint?TMJ –What kind of joint?Hinge and gliding jtHinge and gliding jt

Useful in diagnosing abnormalities Useful in diagnosing abnormalities of articular diskof articular disk

(Small, oval fibrocartilage located between (Small, oval fibrocartilage located between mandibular condyle and mandibular fossa)mandibular condyle and mandibular fossa)

Indications for Arthrogram of TMJIndications for Arthrogram of TMJ

Subluxation Subluxation ((Incomplete or partial dislocation of Incomplete or partial dislocation of bone in joint)bone in joint)

More indications for performing More indications for performing examexam

Aplasia- (defective development)

Fx

Ankylosis- (stiffness of jt)

Arthritis

TMJTMJ

Shoulder ArthrographyShoulder Arthrography

Indications: Indications:

Rotator cuff or long head Rotator cuff or long head of biceps tearsof biceps tears

Foreign bodiesForeign bodies

Persistent pain or Persistent pain or weaknessweakness

Frozen shoulderFrozen shoulder

Shoulder ArthrograpyShoulder Arthrograpy

Rotator Cuff TearNormal

Wrist ArthrographyWrist Arthrography

IndicationsIndicationsTraumaTraumaPersistent painPersistent painLimitation of motionLimitation of motion

ProcedureProcedureContrast injected into Contrast injected into dorsal wristdorsal wristWrist manipulated to Wrist manipulated to disperse contrast disperse contrast

The EndThe End