Chapter 12 Contrast Arthrography 10 /3/ 10 online ed.

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Chapter 12Contrast Arthrography
10 /3/ 10 online ed.
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• What is contrast arthrography?
• Radiographic examination of soft tissue
  structures of joints after injection of contrast
  media
• MRI has largely replaced contrast arthrography
• Noninvasive
• fewer risks are associated

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Contrast Media

• Air
• Negative contrast
• Iodinated contrast
• Positive contrast

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• What are the most common joints investigated via
  contrast arthrography?
• Knee
• Wrist
• Hip
• Shoulder
• TMJ

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Knee Arthrography

• Most common use
• assess soft tissue areas of knee joint
• Cruciate ligament
• Medial and lateral menisci

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What are the menisci?

• Two pads of cartilaginous tissue
• serve to disperse weight of body and reduce
  friction during movement of joint

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Procedure Indications

• Cartilage, capsular injuries
• Ligament or menisci injuries
• Loose bodies
• Joint rupture
• Bakers cyst
• Synovial disease
• Prosthesis check

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Contraindications?

• Skin infections
• Bleeding tendency
• Anti-coagulent therapy
• Allergy to contrast

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Equipment

• Fluoroscopic unit w/spot film capabilities
• Radiolucent sponges
• Contrast
• Sterile tray
• Lidocaine, forceps, tubing, spinal needles,
  syringes, sterile towels, drapes, gauze pads,
  antiseptic solution, sterile gloves

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Pt Preparation

• Thorough explaination of exam
• Consent form signed by pt
• Obtain scout films
• Area prepped and draped
• Set up and protect sterile instrument tray
• Set up fluoroscopic equipment

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Procedure

• Skin is first cleaned with betadine, then local
  anesthetic is introduced
• Joint is punctured, and synovial fluid may be
  aspirated and sent for analysis

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What is synovial fluid?

• Thick, stringy fluid found in cavities of
  synovial joints
• Reduces friction between articular cartilage and
  other tissues in joints
• Lubricates and cushions during movement

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Procedure contd

• Contrast introduced under fluoroscopic guidance
• Needle is removed- why is pt is asked to exercise
  knee?
• to distribute contrast
• Pt is then turned prone if vertical method is
  used
• Spot radiographs are obtained

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Knee Arthrography

• Vertical ray method
• stress device to widen side of jt space under
  investigation
• Limb placed in stress device after contrast
  administration
• Images acquired
• AP
• AP oblique projections, rotated 20 degrees to
  right and left

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Spot films taken under fluoro by Radiologist

• Prone
• Posterior portion of medial meniscus
• 30º lateral anterior oblique
• 45º oblique
• Middle portion of medial oblique
• 60º lateral posterior oblique
• 90º lateral
• Anterior portion of medial meniscus
• Views are then reversed, beginning with pt supine
  to demonstrate lateral meniscus
• Stress is applied to open the joint space during
  exposure

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Knee Arthrography

• Horizontal ray method
• To demonstrate lateral meniscus, position pt
  semiprone with lateral meniscus up
• same procedure used to demonstrate medial
  meniscus

Tear in medial meniscus
Normal
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Post-Procedure

• Overhead radiographs may be requested
• AP, lateral, tunnel, lateral stress view
• Pt may experience some discomfort for a couple of
  days
• Discourage heavy exercise
• Make sure puncture area is properly bandaged

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Hip Arthrography

• Acetabular region of pelvis
• Upper 1/3 of femur
• What kind of joint is hip?
• Diarthrotic- ball and socket joint
• Allows flexion, extension, abduction, adduction,
  rotation

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Hip Arthrography contd

• Most often performed to visualize
• Congential dislocation
• Loose bodies
• Prosthesis check for loosening or infection
• Rheumatoid or osteoarthritis
• Common puncture site
• ¾?? distal to inguinal crease
• and ¾?? lateral to palpated femoral pulse

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Contraindications

• Infections
• Allergy to contrast
• Bleeding problems

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Hip Procedure

• After preparation, aspiration, and injection, pt
  is supine
• Joint is gently manipulated after injection
• Radiographs must be obtained immediately as
  contrast is rapidly absorbed

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Radiographs

• AP
• Internal and external rotations
• Frog lateral

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Bilateral Hip Arthrogram
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Hip Arthrogram w/Prosthesis
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Hip Arthrogram w/Subtraction
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Pediatric Hip Arthrogram
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TMJ Arthrography

• TMJ -Hinge and gliding jt
• CT and MRI have largely replaced
• Useful in diagnosing abnormalities of articular
  disk
• Small, oval fibrocartilage located between
  mandibular condyle and mandibular fossa

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Indications for Arthrogram of TMJ

• Subluxation -Which is?
• (Incomplete or partial dislocation of bone in
  joint)

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Indications Contd

• Aplasia- which is?
• (defective development)
• Fx
• Ankylosis- (stiffness of jt)
• Arthritis
• DJD

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TMJ

• Procedure
• Preliminary tomograms of TMJ in open and closed
  positions
• contrast injected ½?? anterior to tragus of ear
• Fluoroscopy used to observe and image mandibular
  motion
• Radiographs made with pts mouth closed,
  partially open, and fully open

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Shoulder Arthrography

• Indications
• Rotator cuff or long head of biceps tears
• Foreign bodies
• Persistent pain or weakness
• Frozen shoulder

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Shoulder arthrography

• Common projections
• AP in internal and external rotation
• AP oblique, 30-degree oblique position
• Axillary
• Tangential- (like Y view, with 10 Deg. Angle
  caudad)
• CT often used in conjunction with shoulder
  arthrograms

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Shoulder Arthrograpy
Rotator Cuff Tear
Normal
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Wrist Arthrography

• Indications
• Trauma
• Persistent pain
• Limitation of motion
• Procedure
• Contrast injected into dorsal wrist
• Wrist manipulated to?
• disperse contrast

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Wrist Arthrography

• Common projections
• PA
• Lateral
• Both obliques
• Fluoroscopy recommended during rotation to detect
  leaks