Arthrography is an invasive radiology imaging technique that images the soft tissue structures of joints by means of double contrast agent administration. The diagnostic and differential diagnostic method is therefore particularly relevant with regard to inflammatory and degenerative joint diseases. In the meantime, MRI and CT have largely replaced arthrography, but arthrography is still used for examination of the shoulder joint despite these two newer and even more precise imaging methods.
What is arthrography?
Arthrography is an invasive radiology imaging technique that images the soft tissue structures of joints using dual contrast agents. Arthrography is a radiology imaging examination procedure. It is of particular diagnostic and differential diagnostic importance. In this invasive procedure, the radiologist examines the joints and images their bony structures, including all soft tissue structures, using X-ray imaging. The soft tissue structures include, above all, the cartilaginous joint coatings on the joint surfaces, the interarticular discs and the synovial fluid. The joint chambers, tendon sheaths, and bursae are also imaged. These structures are visualized by intravenous contrast administration, which makes all the fine structures stand out in the imaging. The soft tissue structures depicted in this way would not be visible on a conventional X-ray, but they would be on MRI or CT images. For this reason, arthrography has now nearly outlived its usefulness with the increasing popularity of MRI and CT.
Function, effect, and goals
Arthrography involves imaging various joint interiors with their individual structures. This makes the procedure particularly relevant with regard to inflammatory joint diseases such as arthritis or degenerative joint diseases such as osteoarthritis. However, the procedure can also be used to visualize deformities such as hip joint dysplasia. Even traumatic and tumorous joint diseases can be depicted using arthrography. Ultimately, all joints of the body can be imaged using this procedure. However, this type of imaging is currently most frequently performed on the shoulder joint. In this context, imaging can show a dislocated shoulder, for example. The procedure is also indicated in impingement syndrome, which is when the shoulder is overloaded due to athletic activity. In impingement syndrome, arthrography shows, for example, a thickened and pinched supraspinatus tendon that is impairing the function of the shoulder joint. Arthrography can also be used to diagnose a rupture of the shoulder joint muscles. In addition to the shoulder joint, joints such as the elbow joint, wrist joint and hip joint as well as the knee joint, ankle joint or finger joints can ultimately also be imaged. In most cases, however, the examination is not necessary for these joints, as MRI or CT can serve the same purpose. To have an arthrography performed, the patient turns to an appropriately equipped radiology department. The radiology staff pays strict attention to sterile conditions during the examination. For example, the patient’s skin is carefully disinfected beforehand. The attending physician then punctures the joint space. Usually under fluoroscopy, he injects the contrast medium into it. In addition to positive X-ray contrast medium, negative air is also usually used as a contrast medium in an arthrography, as is the case in pneumarthrography, for example. This double-contrast method depicts the joint most precisely. Following the administration of the contrast medium, images are taken in two planes and medically evaluated.
Risks, side effects, and hazards
Before the advent of MRI, CT, and sonographic imaging, arthography was the only option for soft tissue structural imaging. That has since changed, and arthrography is therefore losing its justification as a method. Today, MRI or sonography imaging is more commonly used for the same purpose. MRI in particular depicts soft tissues in joints even more precisely. On the other hand, arthrography is still a standard procedure for complaints in the carpal and shoulder joints, which is conventionally combined with magnetic resonance imaging or CT.In addition, both X-ray and MRI and CT procedures are in a way arthographies, which are nowadays implemented via contrast medium administration. In X-ray imaging, air is used as a contrast medium to visualize the soft tissues. MRI uses a water-soluble contrast agent, and CT uses air and water-soluble contrast agent in combination. The now rare use of actual arthrography is not least due to the risks of the inversive procedure. As a rule, the patient tolerates the procedure well; nevertheless, side effects may occur under certain circumstances. A professional staff is a top prerequisite for an arthrography, because under non-sterile conditions, for example, severe inflammations and infections can occur. In addition, because the joint is punctured during the procedure with the administration of a contrast medium, this partial step can cause pain. With expert, experienced personnel, this risk of pain is reduced. In the past, the administration of contrast media itself was also associated with considerable risks, as carcinogenic agents were sometimes used. Today, water-soluble contrast media are usually either iodine– or gadolinium-based, which limits the harmful effects. Nevertheless, allergic reactions to iodine or gadolinium may occur as a contraindication in rare cases. Apart from that, contrast administration may cause nausea or headache. Sports activities should not be undertaken on the same day. Before the examination, the patient takes part in an extensive informative talk, which informs him about all risks and side effects. He signs a consent form at the end of the discussion. In the case of acute inflammation, allergies to contrast media and infections, the procedure is generally not advised.
Typical and common joint diseases
- Osteoarthritis
- Joint inflammation
- Joint pain
- Joint swelling
- Rheumatoid arthritis
