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Direct MR arthrography without image guidance: a practical guide, joint-by-joint
Roque Oca Pernas1,2, Guillermo Fernández Cantón3
1Osakidetza - Basque Health Service, MRI Department, OSATEK, Osatek Deusto, Luis Power, 18, 48014, Bilbao, Spain. roca@osatek.eus.
Abstract:
Direct MR arthrography (dMRA) is a fundamental technique in diagnosing pathology in major peripheral joints, allowing for precise evaluation of intra-articular structures. Although injection guidance is typically performed using imaging techniques such as ultrasound or fluoroscopy, puncture via anatomical landmarks may be useful in certain circumstances where it has been proven to be a safe and effective procedure. This paper describes the indications and injection technique of dMRA, joint by joint, focusing on the different technical details, from the most common locations, like the shoulder or hip, to those with more restricted clinical indications, such as the wrist, knee, elbow, or ankle. The most relevant anatomical landmarks are detailed for each joint, aiding in the intra-articular introduction of diluted contrast, highlighting the most accessible trajectories and structures to avoid when inserting the needle. Additionally, tips are provided to facilitate proper joint distension. With all this information, this paper aims to serve as a suitable reference guide for performing dMRA without image guidance if needed.
Insights
Direct MR arthrography (dMRA) can be safely performed without imaging guidance using anatomical landmarks for various joints. This technique provides precise evaluation of intra-articular structures, serving as a valuable reference for clinicians.
Area of Science:
- Radiology and Imaging
- Musculoskeletal System
- Medical Procedures
Background:
- Direct MR arthrography (dMRA) is essential for diagnosing peripheral joint pathologies.
- Current dMRA relies on imaging guidance (ultrasound, fluoroscopy) for injections.
- Anatomical landmark-guided puncture offers a potential alternative in specific scenarios.
Purpose of the Study:
- To detail the indications and techniques for performing dMRA without image guidance.
- To provide a joint-by-joint anatomical guide for landmark-based injections.
- To serve as a reference for safe and effective dMRA needle placement.
Main Methods:
- Detailed description of anatomical landmarks for dMRA in shoulder, hip, wrist, knee, elbow, and ankle.
- Guidance on optimal needle trajectories and structures to avoid for each joint.
- Techniques to achieve adequate joint distension with diluted contrast.
Main Results:
- Identification of key anatomical landmarks for successful intra-articular contrast injection.
- Demonstration of safe and effective dMRA needle insertion techniques without imaging.
- Practical tips for optimizing joint distension in various peripheral joints.
Conclusions:
- Direct MR arthrography can be performed safely and effectively using anatomical landmarks.
- This landmark-based approach provides a valuable alternative when imaging guidance is unavailable.
- The study serves as a comprehensive guide for clinicians performing image-free dMRA.
