The Dark Side of Gadolinium: A Study of Arthrographic Contrast at Extreme Concentrations

Kurra, Chandana; Harmon, Taylor S; Taylor, Kristin; Utz, Joseph A.; Hernandez, Mauricio; Matteo, Jerry; Wasserman, Paul

doi:10.7759/cureus.6006

Cited by 6 publications

(4 citation statements)

References 10 publications

(9 reference statements)

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“…For concentrations that are too low, standard fluid-sensitive sequences from a cMRI protocol could be used to salvage the exam. For concentrations that are too high, a “black” contrast effect can be seen on the MR images as a result of T2 shortening [ 102 – 104 ]. There is no danger to the patient, and for the larger joints, repeat MR imaging after a few hours can potentially salvage the exam in some instances [ 102 ] (Fig.…”

Section: “When the Dmra Goes Wrong”mentioning

confidence: 99%

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

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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Objective Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. Materials and methods The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. Results Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. Conclusion Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

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Section: “When the Dmra Goes Wrong”mentioning

confidence: 99%

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

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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“…Gadolinium intraarticular injection for MR arthrography is an off-label use of the FDA-approved intravascular administration [ 42 ]. Small quantities of dilute gadolinium, prepared by dilution with saline and non-ionic contrast, allow visualization during fluoroscopy and allow for optimal signal and contrast on MR arthrography sequences [ 43 ]. A 1:200 dilution of gadolinium within a mixture composed of 50% iodinated contrast and 50% 0.9% saline is generally accepted [ 1 ].…”

Section: Medicationsmentioning

confidence: 99%

Fluoroscopic-guided procedures of the lower extremity

et al. 2022

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This article reviews the literature and the authors’ experiences regarding the performance of lower extremity fluoroscopically guided procedures from the hip to the toes. An overview of injections and aspirations, their indications, risks, and complications are provided, focusing on anesthetics, corticosteroids, and contrast agents. A variety of approaches to each joint and the associated pearls and pitfalls of each approach will be discussed.

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“…Intra-articular knee injection is a common procedure in treatment and diagnosis of the knee joint. For example, local anesthesia injection to the knee joint is done in the elective knee arthroscopy cases [1,2] and in some knee physical examinations that need to be done under anesthesia [3], gadolinium contrast media injection in knee joint imaging [4] and viscosupplement and corticosteroid injection to alleviate the knee pain. These procedures are done as the knee osteoarthritis is one of the most common degenerative joint disease and impacts functional capacity in elderly (prevalence of 3.8% and 2.7 times more common in women than men) [5].…”

Section: Introductionmentioning

confidence: 99%

A Vibration Sensor Approach to Detect Intra-Articular Needle Tip Placement in the Knee Joint

Apinyankul¹,

Siriwattanasit²,

Srungboonmee³

et al. 2021

Preprint

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Background: Intra-articular injection in the dry knee joint is technically challenging particularly for the beginners. The aim of this study was to investigate the possible use of the vibration sensor to detect if the needle tip was at the knee intra-articular position by characterizing the frequency component of the vibration signal during empty syringe air injection.Methods: Two milliliters of air were injected supero-laterally at extra- and intra-articular positions of a cadaveric knee joint, using needles of size 18, 21 and 24 gauge. Ultrasonography was used to confirm the positions of needle tip. A piezoelectric accelerometer was mounted medially on the knee joint to collect the vibration signals which were analyzed to characterize the frequency components of the signals during injections. Results: The vibration frequency band power in the range of 500-1,500 Hertz was visually observed to potentially localize the needle tip placement during air injection whether they were at the knee extra-articular or intra-articular positions, as demonstrated by the higher band power (over -40 decibel or dB) for all the needle sizes. The differences of frequency band power between extra- and intra-articular positions were 18.1 dB, 26.4 dB and 39.2 dB for the needle size 18, 21 and 24 gauge respectively. The most obvious difference was found in the smallest needle diameter.Conclusions: A vibration sensor approach was preliminarily proved to distinguish the intra-articular from extra-articular needle placement in the knee joint. This study demonstrated a possible alternative electronic device implementation of this technique to detect the intra-articular knee injection.

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The Dark Side of Gadolinium: A Study of Arthrographic Contrast at Extreme Concentrations

Cited by 6 publications

References 10 publications

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

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

Fluoroscopic-guided procedures of the lower extremity

A Vibration Sensor Approach to Detect Intra-Articular Needle Tip Placement in the Knee Joint

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