MR arthrography of the shoulder: tolerance evaluation of four different injection techniques.
OBJECTIVE
We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography.


METHODS
A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n(1) = 37), with CT guidance using an anterior (n(2) = 29) or a posterior approach (n(3) = 32) and with ultrasound guidance (n(4) = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = "no pain", 10 = "intolerable pain"), technical success of the method used, and reason for referral were recorded.


RESULTS
The technical success rate was 100% for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 ± 1.24, CT anterior guidance demonstrated a mean pain of 3.87 ± 0.95, CT posterior guidance showed a mean pain of 1.59 ± 0.81, and ultrasound guidance a mean pain of 3.63 ± 1.12. A significant difference (p < .05) was observed for the posterior route under CT guidance. The mean pain level was significantly higher for older (> 51 year) female patients.


CONCLUSIONS
No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient.
Department of Medical Imaging, University Hospital, Heraklion, 71110, Crete, Greece.
Evangelos
E
Perdikakis
Eleni
E
Drakonaki
Thomas
T
Maris
Apostolos
A
Karantanas
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D003287:Contrast Media; D005260:Female; D005471:Fluoroscopy; D019786:Gadolinium DTPA; D006801:Humans; D007592:Joint Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D015641:Radiography, Interventional; D012785:Shoulder Joint; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional
D003287:Contrast Media; D019786:Gadolinium DTPA