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Radio-carpal wrist MR arthrography: comparison of ultrasound with fluoroscopy and palpation-guided injections

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Abstract

Objective

To compare ultrasound- (US), fluoroscopy- (FL), and palpation-guided contrast injection techniques used for dorsal radio-carpal wrist MRA.

Materials and methods

Patients with chronic wrist pain were randomized as to which injection technique they underwent into three groups of 50 participants. Dorsal radio-carpal contrast injection was performed under US, FL guidance (one radiologist for each), or palpation guidance by an orthopedic surgeon. The three techniques were compared by procedure time, success rate, number of attempts needed, frequency and grade of extravasation, joint distension, and MRA image quality. Additionally, any change from baseline wrist pain was recorded using the visual analog scale (VAS) at five time points (immediately, 8 h, 24 h, 48 h, and 1 week) after injection.

Results

One hundred and fifty patients (83 males and 67 females; mean age 29 ± 6.5 years) were included. Success rates for US- and FL-guided injections were 100%, while palpation-guided approach was significantly less successful (72%) (P = 0.02) with significantly more frequent extravasation (56%)(P < 0.001). US guidance was the least time-consuming (6.5 ± 1.6 min) compared to FL guidance (12.5 ± 1.9 min) and palpation guidance (8 ± 1.2 min) (all P < 0.001). The mean number of joint puncture attempts was significantly lower with imaging-guided techniques (1.1 ± 0.24 and 1.2 ± 0.4 for US and FL, P = 0.23) compared to palpation-guided one (1.6 ± 0.8) (P = 0.007). The largest increases in baseline-pain were 8-h post-injection, and US guidance was the least painful at all-time points (all P < 0.05). Joint distension and image quality were significantly better with imaging-guided techniques (P < 0.001 and P = 0.003).

Conclusions

US-guided radio-carpal injection is a less time-consuming, more tolerable, and successful radiation-free method when compared to FL guidance. Palpation-guided injections require multiple attempts to enter the joint with high failure rates and frequent extravasation.

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Authors and Affiliations

  1. The Department of Diagnostic Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt

    Abeer Houssein Ali, Omran Khodary Qenawy & Nagham Nabil Omar

  2. The Department of Orthopedic Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt

    Waleed Riad Saleh

  3. The Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Assiut, Egypt

    Abdelaziz Monsef Ali

  4. The Department of Diagnostic Radiology, Egyptian Ministry of Health, Aleman General Hospital, Assiut, Egypt

    Eman Sayed Abdul Monem

Authors
  1. Abeer Houssein Ali
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Correspondence to Abeer Houssein Ali.

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Ethics approval

This study had approval from Faculty of Medicine Research Ethics Committee, Assiut University, Egypt. All patients who participated in this study signed informed written consent for participation and publication of the data contained in this research. The procedures included in this study were performed following the ethical standards of our institutional committee and with the 1964 Helsinki declaration and its later modifications. The research was done by scientifically qualified and trained personnel. Benefit assessments for all patients were indicated for the examination during this study. All patients’ data were confidentially kept.

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The authors declare no competing interests.

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Ali, A.H., Qenawy, O.K., Saleh, W.R. et al. Radio-carpal wrist MR arthrography: comparison of ultrasound with fluoroscopy and palpation-guided injections. Skeletal Radiol 51, 765–775 (2022). https://doi.org/10.1007/s00256-021-03845-1

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  • DOI: https://doi.org/10.1007/s00256-021-03845-1

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