Morbidity of direct MR arthrography
Joseph C Giaconi1, Thomas M Link, Thomas P Vail
1Department of Radiology, University of California, San Francisco, San Francisco, CA, USA. joseph.giaconi@cshs.org
Objective:
The purpose of this study was to determine the incidence and severity of arthrographic pain after intraarticular injection of a gadolinium mixture diluted in normal saline for direct MR arthrography.
Subjects And Methods:
From March 2009 until January 2010, 155 consecutive patients underwent direct MR arthrography; 20 patients were lost to follow-up. Patients were contacted by telephone between 3 and 7 days after joint injection. Using an 11-point numeric pain rating scale, patients were asked to report if they had experienced joint pain that was different or more intense than their preinjection baseline, the severity of pain, the duration of pain, time to onset of pain, and eventual resolution of pain.
Results:
The incidence of postarthrographic pain was 66% (89/135), with an average intensity of pain of 4.8 ± 2.4 (range, 1-10). Postarthrographic pain lasted an average of 44.4 ± 30.5 hours (range, 6-168 hours). The time to onset of pain after joint injection was on average 16.6 ± 13.1 hours (range, 4-72 hours). There was no significant difference regarding the severity or incidence of postarthrographic pain between groups on the basis of patient age (p = 0.20 and 0.26), patient sex (p = 0.20 and 0.86), contrast mixture contents (p = 0.83 and 0.49), or joint injected (p = 0.51 and 0.47). No patients experienced any other serious side effects.
Conclusion:
Sixty-six percent of patients who undergo direct MR arthrography will experience a fairly severe delayed onset of pain that completely resolves over the course of several days.
Insights
Most patients (66%) experience moderate pain after MR arthrography, typically starting 16 hours post-procedure and lasting about 44 hours. This postarthrographic pain resolves completely within several days.
Area of Science:
- Radiology
- Musculoskeletal Imaging
- Pain Management
Background:
- Direct MR arthrography is a common diagnostic procedure.
- Understanding post-procedural pain is crucial for patient management.
Purpose of the Study:
- To determine the incidence and severity of arthrographic pain.
- To evaluate pain characteristics following intraarticular gadolinium injection for MR arthrography.
Main Methods:
- 155 patients underwent direct MR arthrography.
- Pain was assessed 3-7 days post-injection using an 11-point numeric rating scale.
- Data collected included pain incidence, severity, duration, onset, and resolution.
Main Results:
- 66% of patients reported postarthrographic pain.
- Average pain intensity was 4.8/10, lasting 44.4 hours.
- Pain onset averaged 16.6 hours post-injection; no serious side effects were reported.
Conclusions:
- A majority of patients experience delayed-onset pain after MR arthrography.
- This pain is generally moderate and self-limiting, resolving within days.
- Findings aid in patient counseling and managing expectations.