arthrography

Arthrography is a radiologic examination in which contrast material is injected into a joint space to outline intra-articular structures on imaging. It enhances visualization of the joint capsule, labrum, ligaments, cartilage, and menisci, aiding in the diagnosis of joint pathology. Traditional arthrography uses fluoroscopy with radiographs; newer forms include MR arthrography and CT arthrography.

The procedure is performed under sterile conditions. A needle is inserted into the joint under imaging guidance, and a water-soluble contrast agent is injected to distend the joint. For MR or CT arthrography, MRI or CT is performed after injection to obtain the detailed images of the enhanced structures. Injection may be performed with local anesthesia, and imaging often includes dynamic positioning to distribute the contrast.

Common indications vary by joint but include suspected labral tears of the shoulder or acetabular labrum, instability, and intra-articular pathology when conventional imaging is inconclusive. In the knee, wrist, elbow, and hip, arthrography can improve detection of soft-tissue injuries and cartilage defects when combined with CT or MRI. MR arthrography is particularly used for labral and cuff-related pathology, while CT arthrography can better delineate osseous and subtle soft-tissue details in selected cases.

Advantages include increased sensitivity for certain soft-tissue lesions and improved delineation of joint structures. Limitations are invasiveness and risks of infection, bleeding, and contrast reactions; conventional radiographic arthrography involves radiation exposure. MR arthrography and CT arthrography reduce or modify these risks but require access to MRI or CT and contrast agents, such as gadolinium or iodinated contrast.

Contraindications include active joint infection, septic arthritis, known allergy to iodinated or gadolinium-based contrast, pregnancy, and uncorrected coagulopathy. After the procedure, patients may experience temporary joint pain and are advised to rest the joint briefly and follow local guidelines.