This April 2009 needs additional citations for verification .(May 2009) |
Arthrogram | |
---|---|
ICD-9-CM | 88.32 |
OPS-301 code | 3-13k |
An arthrogram is a series of images of a joint after injection of a contrast medium, usually done by fluoroscopy or MRI. The injection is normally done under a local anesthetic such as Novocain or lidocaine. The radiologist or radiographer performs the study using fluoroscopy or x-ray to guide the placement of the needle into the joint and then injects around 10 ml of contrast based on age. There is some burning pain from the anesthetic and a painful bubbling feeling in the joint after the contrast is injected. This only lasts 20 – 30 hours until the Contrast is absorbed. During this time, while it is allowed, it is painful to use the limb for around 10 hours. After that the radiologist can more clearly see what is going on under your skin and can get results out within 24 to 48 hours.
It is used primarily in the evaluation of menisci, cruciate ligaments, articular cartilage, and loose body within a joint. Fluoroscopic allows general view of the medial, lateral, and patellofemoral ligaments of the joint, overall cartilage thickness, focal defects, imbibition (absorption} of contrast material into the articular cartilage (a sign of cartilage fibrillation - splaying and fraying of the cartilage). [1]
CT arthrography is used to examine the patellofemoral joint. [1]
MR sequences such as spin echo with T1 and T2-weighted sequences, inversion recovery, chemical shift selective techniques, and gradient echo techniques are used to examine the articular cartilage. [1]
Shoulder arthrography can be used to study tears of the rotator cuff, glenoid labrum and biceps. [2] The type of contrast injected into the joint depends on the subsequent imaging that is planned. For pneumoarthrography, gas is used, for CT or radiographs, a water-soluble radiopaque contrast, and for MRI, gadolinium. Double-contrast arthrography can be used for more anatomically complex cases, though its use is relatively infrequent. The needle is radiographically guided into the glenohumeral joint space, after which the patient is evaluated by fluoroscopy, CT or MRI. The gadolinium in the contrast fluid yields a bright signal on T1 weighted images allowing for better evaluation of the joint capsule, the articular surface of the bones and, in particular, the labral cartilage. MR arthrography is most often used in evaluation of the hip and acetabular labrum, of the shoulder rotator cuff and glenoid labrum, and less often in the wrist. [2] Arthrograms can be diagnostic and therapeutic. Therapeutic arthrograms often distend the joint with cortisone and lidocaine, with a common site being the shoulder. Diagnostic arthrograms can be direct, as described above with penetration of the joint, or indirect, by a venous injection of contrast material and delayed imaging with CT or MRI. [2]
Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, or latex should not have this procedure. Potential risks are infections at the puncture site where the radiopaque substance and/or air are injected. Bleeding is also a small risk. Rarely, gadolinium, found in MRI contrast agents, can cause nephrogenic systemic fibrosis (NSF), a debilitating and potentially fatal disease affecting skin, muscle, and internal organs, in patients with impaired renal function. [3]
Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography and industrial radiography. Similar techniques are used in airport security. To create an image in conventional radiography, a beam of X-rays is produced by an X-ray generator and is projected toward the object. A certain amount of the X-rays or other radiation is absorbed by the object, dependent on the object's density and structural composition. The X-rays that pass through the object are captured behind the object by a detector. The generation of flat two dimensional images by this technique is called projectional radiography. In computed tomography an X-ray source and its associated detectors rotate around the subject which itself moves through the conical X-ray beam produced. Any given point within the subject is crossed from many directions by many different beams at different times. Information regarding attenuation of these beams is collated and subjected to computation to generate two dimensional images in three planes which can be further processed to produce a three dimensional image.
Radiology is the medical discipline that uses medical imaging to diagnose diseases and guide their treatment, within the bodies of humans and other animals. It began with radiography, but today it includes all imaging modalities, including those that use no electromagnetic radiation, as well as others that do, such as computed tomography (CT), fluoroscopy, and nuclear medicine including positron emission tomography (PET). Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.
In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.
Shoulder problems including pain, are one of the more common reasons for physician visits for musculoskeletal symptoms. The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. This instability increases the likelihood of joint injury, often leading to a degenerative process in which tissues break down and no longer function well.
The human shoulder is made up of three bones: the clavicle (collarbone), the scapula, and the humerus as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder make up the shoulder joints. The shoulder joint, also known as the glenohumeral joint, is the major joint of the shoulder, but can more broadly include the acromioclavicular joint. In human anatomy, the shoulder joint comprises the part of the body where the humerus attaches to the scapula, and the head sits in the glenoid cavity. The shoulder is the group of structures in the region of the joint.
Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both diagnostic and therapeutic procedures through very small incisions or body orifices. Diagnostic IR procedures are those intended to help make a diagnosis or guide further medical treatment, and include image-guided biopsy of a tumor or injection of an imaging contrast agent into a hollow structure, such as a blood vessel or a duct. By contrast, therapeutic IR procedures provide direct treatment—they include catheter-based medicine delivery, medical device placement, and angioplasty of narrowed structures.
Synovial osteochondromatosis (SOC) is a rare disease that creates a benign change or proliferation in the synovium or joint-lining tissue, which changes to form bone-forming cartilage. In most occurrences, there is only one joint affected, either the knee, the hip, or the elbow. Rarely involves the TMJ.
The shoulder joint is structurally classified as a synovial ball-and-socket joint and functionally as a diarthrosis and multiaxial joint. It involves an articulation between the glenoid fossa of the scapula and the head of the humerus. Due to the very loose joint capsule that gives a limited interface of the humerus and scapula, it is the most mobile joint of the human body.
Gadopentetic acid, sold under the brand name Magnevist, is a gadolinium-based MRI contrast agent.
Sialography is the radiographic examination of the salivary glands. It usually involves the injection of a small amount of contrast medium into the salivary duct of a single gland, followed by routine X-ray projections.
The glenoid labrum is a fibrocartilaginous structure rim attached around the margin of the glenoid cavity in the shoulder blade. The shoulder joint is considered a ball and socket joint. However, in bony terms the 'socket' is quite shallow and small, covering at most only a third of the 'ball'. The socket is deepened by the glenoid labrum, stabilizing the shoulder joint.
A Bankart lesion is an injury of the anterior (inferior) glenoid labrum of the shoulder. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. It is an indication for surgery and often accompanied by a Hill-Sachs lesion, damage to the posterior humeral head.
A Hill–Sachs lesion, or Hill–Sachs fracture, is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
Projectional radiography, also known as conventional radiography, is a form of radiography and medical imaging that produces two-dimensional images by x-ray radiation. The image acquisition is generally performed by radiographers, and the images are often examined by radiologists. Both the procedure and any resultant images are often simply called "X-ray". Plain radiography or roentgenography generally refers to projectional radiography. Plain radiography can also refer to radiography without a radiocontrast agent or radiography that generates single static images, as contrasted to fluoroscopy, which are technically also projectional.
Lameness is an abnormal gait or stance of an animal that is the result of dysfunction of the locomotor system. In the horse, it is most commonly caused by pain, but can be due to neurologic or mechanical dysfunction. Lameness is a common veterinary problem in racehorses, sport horses, and pleasure horses. It is one of the most costly health problems for the equine industry, both monetarily for the cost of diagnosis and treatment, and for the cost of time off resulting in loss-of-use.
Hydrodilatation or hydraulic arthrographic capsular distension or distension arthrography is a medical treatment for adhesive capsulitis of shoulder. The treatment is applied by a radiologist assisted by a radiographer. Contrast medium, a local anaesthetic and cortisone are injected into the joint. Then up to 40ml of sterile saline solution are injected, using X-ray as guidance, to stretch the joint capsule. Risk of complications is low. Whether the treatment is successful is known after a couple of weeks.
Gadoteric acid, sold under the brand name Dotarem among others, is a macrocycle-structured gadolinium-based MRI contrast agent (GBCA). It consists of the organic acid DOTA as a chelating agent, and gadolinium (Gd3+), and is used in form of the meglumine salt (gadoterate meglumine). The paramagnetic property of gadoteric acid reduces the T1 relaxation time (and to some extent the T2 and T2* relaxation times) in MRI, which is the source of its clinical utility. Because it has magnetic properties, gadoteric acid develops a magnetic moment when put under a magnetic field, which increases the signal intensity (brightness) of tissues during MRI imaging.
Pain in the hip is the experience of pain in the muscles or joints in the hip/ pelvic region, a condition commonly arising from any of a number of factors. Sometimes it is closely associated with lower back pain.
An occult fracture is a fracture that is not readily visible, generally in regard to projectional radiography ("X-ray"). Radiographically, occult and subtle fractures are a diagnostic challenge. They may be divided into 1) high energy trauma fracture, 2) fatigue fracture from cyclical and sustained mechanical stress, and 3) insufficiency fracture occurring in weakened bone. Independently of the cause, the initial radiographic examination can be negative either because the findings seem normal or are too subtle. Advanced imaging tools such as computed tomography, magnetic resonance imaging (MRI), and scintigraphy are highly valuable in the early detection of these fractures.
Magnetic resonance myelography is a noninvasive medical imaging technique that can provide anatomic information about the subarachnoid space. It a is type of MRI examination that uses a contrast medium and magnetic resonance imaging scanner to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, tumors and other abnormalities. The procedure involved the injection of a gadolinium based contrast media into the cervical or lumbar spine, followed by the MRI scan.