title: Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now.
abstract: Magnetic resonance (MR) imaging has been definitively established as the reference standard in the evaluation of joints in the body. Similarly, magnetic resonance arthrography has emerged as a technique that has been proven to increase significantly the diagnostic performance if compared with conventional MR imaging, especially when dealing with fibrocartilage and articular cartilage abnormalities. Diluted gadolinium can be injected in the joint space using different approaches: under palpation using anatomic landmarks or using an imaging guidance, such as fluoroscopy, computed tomography, or ultrasound. Fluoroscopy has been traditionally used, but the involvement of ionizing radiation should represent a remarkable limitation of this modality. Conversely, ultrasound has emerged as a feasible, cheap, quick, and radiation-free modality that can be used to inject joints, with comparable accuracy of fluoroscopy. In the present paper, we discuss the advantages and disadvantages of using fluoroscopy or ultrasound in injecting gadolinium-based contrast agents in joints to perform magnetic resonance arthrography, also in view of the new EuroSAFE Imaging initiative promoted by the European Society of Radiology and the recent updates to the European Atomic Energy Community 2013/59 directive on the medical use of ionizing radiation.
  
  
  CONCLUSIONS
  • Intra-articular contrast agent injection can be performed using different imaging modalities • Fluoroscopy is widely used, but uses ionizing radiation • Ultrasound is an accurate, quick, and radiation-free modality for joint injection • X-rays should be avoided when other radiation-free modalities can be used.
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milano, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Messina
authors.affiliation: IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milano, Italy.|Università Vita-Salute San Raffaele, Via Olgettina 58, 20132, Milano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Banfi
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milano, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aliprandi
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milano, Italy.|Unità di Radiologia Interventistica, Istituto Europeo di Oncologia, Via Giuseppe Ripamonti 435, 20141, Milano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mauri
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milano, Italy.|Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato, Milanese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milano, Italy.|Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato, Milanese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Mangiagalli 31, 20100, Milano, Italy. io@lucasconfienza.it.|Servizio di Radiologia, IRCCS Policlinico San Donato, Piazza Malan 1, 20097, San Donato, Milanese, Italy. io@lucasconfienza.it.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
mesh_terms: D001175:Arthrography / Q000379:methods*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D005471:Fluoroscopy / Q000379:methods*; D005682:Gadolinium / Q000008:administration & dosage*; D006801:Humans; D007270:Injections, Intra-Articular; D007592:Joint Diseases / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Fluoroscopy; Ionizing radiation; Magnetic resonance arthrography; Radiation protection; Ultrasound