Direct MR arthrography of the shoulder: current practice in the UK

Abstract

There is wide variation in the technique and type of contrast used for MR arthrography of shoulder. In this article, we discuss the current practice in UK and the reason for the change over the last few years. Keywords Arthrogram • Shoulder • UK Direct MR arthrograms (MRA) utilise distension of the joint capsule to separate intra-capsular structures and hence improve visualisation, when compared to conventional non-arthrographic MRI. Clinical applications of direct MRA were first described in the shoulder, which remains one of the primary joints imaged with this technique. Although MRA of the shoulder is performed in many centres across the UK, there is variation in the way this study is performed, including whether gadolinium-based contrast agents (GdCAs), saline or other agents are used to distend the joint space. An online survey was conducted of musculoskeletal radiologists in the UK to ascertain current practise in MRA of the shoulder, changes in practice in the last 5 years, and reasons for such changes. There have been recent concerns regarding gadolinium deposition in the brain and other tissues following enhanced MRI studies. In this commentary, we discuss the issues surrounding GdCA use in shoulder arthrograms, with reference to the literature and our survey findings.

SSR white paper: guidelines for utilization and performance of direct MR arthrography

“…Anterior instability is one of the most common indications for dMRA [ 174 , 187 ]. One study demonstrated 88% sensitivity, 91% specificity, and 89% accuracy with regard to dMRA and detection of anteroinferior labral tears [ 188 ] (Fig.…”

Imaging update on cartilage

“…Arthrography is an invasive technique of joint evaluation following intra-articular injection of contrast agent or combination of saline &/or local anesthetic 28 to achieve joint distension. Multiplanar fat suppressed T1 weighted image acquisition is performed for MR arthrographic evaluation, if gadolinium based contrast agents are administered.…”