4/24/2023 0 Comments Mr contrast injection![]() (2019) PM & R : the journal of injury, function, and rehabilitation. Chondrotoxic Effects of Local Anesthetics on Human Knee Articular Cartilage: A Systematic Review. using a 20 mL for the clear MR arthrogram solution will identify it from other clear solution syringes such as local anesthetic for the skin and iodinated contrast medium, often in 5 mL and 10 mL syringes.wrist, so as not to fill the joint then leaving no room for the MR solution if intra-articular injection is confirmed first with only iodinated contrast medium, care must be taken in small joints i.e.confirming an intra-articular needle position first with only iodinated contrast medium will reduce the chance of extra-articular gadolinium, which can interfere with interpretation although more experienced practitioners may opt to only inject the MR arthrogram solution.joint volumes differ and the injected volume of the MR arthrogram solution should reflect the size of the joint, i.e.3T MRI techniques have much improved labral and meniscal (TFCC) imaging and many institutions will first perform non-arthrographic imaging before considering MR arthrography, particular for hip joints.MR arthrogram solutions differ in different institutions, and it is time well spent familiarising with local ‘recipes’ before undertaking.the amount and concentrations of solutions used to make the MR arthrogram solution.the total injected volume of the MR arthrogram solution.The arthrogram injection report should include: Iatrogenic gas bubbles will have similar appearances to intra-articular loose bodies, therefore needles and tubes should be primed before injection. Insufficiently-diluted gadolinium can result in the ‘black contrast effect’ resulting in low signal (black) fluid on all sequences 4. MRI sequences performed will be predominantly fat-saturated T1 sequences, thus leaving the T1 high signal gadolinium to outline or extend into a labral or meniscal tear. Their addition in a small quantity, offer a diagnostic benefit with the patient keeping a pain diary after their injection. Of all routinely available anesthetics, ropivacaine at concentrations of 0.5% appears safest 3. Local anesthetic use is more controversial, with many shown to be chondrotoxic at typical therapeutic doses, particularly lidocaine 2,3. It is not required for ultrasound-guided procedures. Iodinated contrast medium can be substituted for 0.9% saline however its inclusion will enable the practitioner to assess joint distention and for extra-articular injection. Suggested MR arthrogram solution mixture for ultrasound-guided injections ref: 5 mL longer-acting local anesthetic / 5 mL 0.9% saline.Suggested MR arthrogram solution mixtures for x-ray guided injections ref: ![]() Commonly used is a 1 in 200 dilution of gadolinium i.e. MR arthrogram solutions differ in different institutions, but will broadly contain a mixture of gadolinium, diluted with saline and iodinated contrast medium and/or local anesthetic. Fluoroscopy, ultrasound or CT guidance can be used to cannulate a joint, which is then injected with the MR arthrogram solution.
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