Meet Tim, Tucson team member
An arthrogram is a series of images obtained after injection of a contrast medium into a joint. The radiologist injects the contrast material, and Tim, a seasoned radiology tech, performs the scan. At Radiology Ltd. in Tucson, we perform hundreds of arthrograms a year, most frequently on shoulders, knees, and wrists.
An arthrogram is an imaging examination performed after contrast material has been injected into a joint to outline the internal soft tissue structures within the joint on X-ray, CT, and/or MRI images. This procedure is used to evaluate persistent or unexplained joint pain or discomfort, swelling, or abnormal movement of a joint. The images obtained from an arthrogram can help your doctor decide between different treatment options, including arthroscopy, open surgery, and joint replacement.
Conventional arthrography utilizes a special form of X-ray called fluoroscopy and an iodine-containing contrast material that is injected directly into the joint. Fluoroscopy makes it possible to see the bones and joints on “real-time” X-ray images. When contrast material is injected into a joint, it is clearly visible on the fluoroscopic images and allows the radiologist to better assess the anatomy and function of the joint. While the injection is monitored with fluoroscopy, regular X-ray images are also obtained for documentation.
CT arthrography uses the same type of contrast material as conventional arthrography and may be supplemented by air to produce a double-contrast CT arthrogram. CT uses X-ray pictures taken from multiple different angles to create cross-sectional images that appear as “slices” of the bones and joints.
MR arthrography also involves the injection of contrast material into a joint. However, the contrast material used for MRI evaluation is different from that used for conventional and CT arthrography. As in conventional and CT arthrography, the contrast material outlines the structures within the joint, allowing them to be evaluated by the radiologist on the MRI images. MRI uses a powerful magnetic field, radio waves, and a computer to produce detailed pictures of organs, soft tissues, bones, and other internal body structures. Unlike other imaging techniques such as X-rays and CT scans, MRI does not expose patients to the potentially harmful effects of radiation.
You will not be able to have an MRI examination if you have any of the following:
- Most pacemakers
- Certain brain aneurysm clips
- Cochlear implants
- Metallic fragments in an eye
- Implanted spinal cord stimulator
- Certain other metal-containing implants
MRI contrast is an organically bound gadolinium-based material that is extremely safe and typically has no side effects, though there is always the potential for allergic reaction. Please let us know if:
- You are pregnant or think you might be
- You are breast feeding
- You have anemia or any diseases that affect red blood cells
- You have asthma or other allergic respiratory disorders
- You have kidney (renal) disease
- You have a history of injury during military service
- You have a history of working with metal
You will be asked not to eat for 4 hours prior to the procedure. You may have clear liquids up to 2 hours before the procedure but should eat nothing after that.
If you are taking prescribed anticoagulants (blood thinners) such as Coumadin or Plavix, you should ask your physician for instructions prior to the procedure. Patients should not take over-the-counter aspirin or aspirin-containing medications for at least 5 days prior to their procedure. Please consult with your doctor or healthcare provider before stopping ANY medications.
Please arrive for your arthrogram with a responsible adult who can drive you home.
After you arrive for your appointment, you will be escorted to a procedure room, where you will be asked to change into a patient gown. You will be positioned on an exam table, and fluoroscopy will be used to evaluate the joint and determine the most appropriate needle entry site. The radiologist will cleanse the overlying skin, and a small amount of local anesthetic (lidocaine) will be injected with a small needle. You will feel a tiny pinch similar to a pinprick while the anesthetic is injected.
After the area becomes numb, the radiologist will insert a needle into the joint while observing under fluoroscopy to ensure proper placement. The contrast material will then be injected through the needle into your joint. Depending on the type of arthrogram, your joint may be injected with an iodine-containing or gadolinium-based contrast agent, with air, or with both (double-contrast arthrogram). The needle will then be removed. You may be asked to walk a few steps or move your joint around to help evenly distribute the contrast material throughout the joint. X-ray images will be obtained and reviewed to ensure that the contrast material has filled the entire joint.
During the exam you will lie on a table that moves into the doughnut-shaped scanner. Your technologist will watch you through an observation window and will be able to communicate with you at all times. CT scans are non-invasive and painless, though you will hear humming, buzzing, or clicking sounds as the CT machine moves to position you. It is very important to follow all instructions and remain still during scanning in order to obtain clear images.
The CT contrast agent is an iodine-based material. Radiology Ltd. uses only non-ionic contrast agents (the safest kind), but with all contrast agents there is always the potential for allergic reaction. Be sure to tell your technologist if you have experienced a reaction to CT contrast in the past. If you are diabetic and take Glucophage, Glucovance, or any other type of metformin medication to regulate your diabetes, you will need to stop taking it for 48 hours after your exam.
The MRI machine creates a magnetic field around you and directs radio waves at your body to create the MRI images. You won’t feel the magnetic field or radio waves, but you may hear loud tapping and thumping sounds coming from inside the machine. While the images are obtained, you will be instructed to breathe normally but to lie as still as possible. The technologist will monitor you from another room. You will be able to speak to the technologist through a microphone, and the technologist will also be able to talk to you.
For your safety and the protection of others, we do not allow anybody except patients in our exam rooms.
Significant complications related to an arthrogram are very uncommon. The primary risks associated with this procedure include:
- Allergic reaction to the contrast material
Most arthrograms are very well tolerated, with minimal discomfort afterwards that is usually easily controlled with non-prescription pain medication. You may apply ice to the joint to reduce swelling if necessary. Symptoms usually disappear within 48 hours; contact your physician or healthcare provider if they persist for more than two days.
After your study, the images will be evaluated by one of our board-certified radiologists with expertise in joint imaging. A final report will be sent to your doctor or healthcare provider, who can then discuss the results with you in detail.