Arthrography

An arthrogram is a series of images, often X-rays, of a joint after injection of a contrast medium. The injection is normally done under a local anesthetic. The radiologist performs the study utilizing fluoroscopy or ultrasound to guide the placement of the needle into the joint and then injects an appropriate quantity of contrast. The physician or technologist then obtains a series of X-rays, or alternatively computerized tomography (CT) scans or Magnetic resonance imaging (MRI) scans. The joint can be imaged from many angles in fluoroscopy, or on a slice by slice basis in CT and MRI scans. The physician assesses the images produced.

Shoulder arthrography can be used to study tears of the rotator cuff. The procedure can also define abnormalities of the glenoid labrum and bicipital tendon and sheath.

For pneumoarthrography, a gaseous medium has been used, for opaque arthrography a water-soluble iodinated medium is used, and a combination of both has been used in double-contrast arthrography. Current practice is single contrast arthrography usually coupled with CT or MR imaging.

The exam is usually done under the fluoroscope, or less commonly ultrasound, to guide the needle into the correct place in the joint.

Increasingly utilized in the last ten years, Magnetic Resonance Arthrography and Computed tomography arthrography (CT) combines a standard arthrogram with Magnetic Resonance Imaging or CT scanning. While preparing the iodine contrast for injection into the joint, the physician adds a small quantity (usually less than 1 ml) of gadolinium contrast. Once the joint has been injected, the traditional radiographic images may or may not be obtained, and the patient then undergoes an MR or CT of the joint. The gadolinium in the contrast fluid yields a bright hyperintense signal on T1 weighted images and allows evaluation of quite small defects of the joint capsule, the articular surface of the bones and of the labral cartilage. MR arthrography is most often used in evaluation of the hip and acetabular labrum, of the shoulder rotator cuff and glenoid labrum, and less often in the wrist.

Arthrograms, in practice, can be diagnostic or therapeutic. Therapeutic arthrograms are often joint distention and cortisone injection procedures. A frequent site for such a procedure is the shoulder. Diagnostic arthrograms can be direct, as described above with penetration of the joint, or indirect, by a venous injection of contrast material and later imaging with CT or MRI.

Risks

Patients who are allergic to or sensitive to medications, contrast dyes, local anesthesia, iodine, or latex should not have this procedure. Potential risks are infections at the puncture site where the radiopaque substance and/or air are injected. Bleeding is also a small risk.

Reports have arisen of gadolinium contrast agents causing nephrogenic systemic fibrosis (NSF), a debilitating and potentially fatal disease affecting skin, muscle, and internal organs.These cases have only occurred in people with moderate-to-end-stage kidney disease; there have been zero reports of gadolinium leading to health problems in individuals with healthy kidneys. The mechanism linking gadolinium, kidney dysfunction, and NSF is currently unknown. The U.S. Food and Drug Administration (FDA) has recommended that physicians refrain from using gadolinium contrast agents on patients with kidney disease “unless the diagnostic information is essential and can not be obtained with non-contrast-enhanced MRI or other diagnostic procedures.”

Aside from the risk of NSF in people with kidney disease, arthrograms carry the same risks as ordinary X-rays or MRI scans.

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Myelography

Myelography is a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. The procedure often involves injection of contrast medium into the cervical or lumbar spine, followed by several X-ray projections. A myelogram may help to find the cause of pain not found by an MRI or CT. Myelography has been largely replaced by the use of CT and MRI scans. A CT is typically performed after myelographic material has been placed with fluoroscopic guidance. The material is typically water-based, which has largely replaced oil based fluids. A CT myelogram is most useful for patients who cannot undergo MRI (eg those with pacemakers or cochlear implants) or for those in whom MRI provides limited information (eg those with extensive metal in the spine). The process usually involves lying face down on a table, with the lower extremities secured tightly with straps to the table. The radiologist (or neurosurgeon) will perform the spinal tap, introducing the contrast medium. The table is then slowly rotated in a circular motion, first down at the head end for approximately 4-6 minutes, then rotated up at the head end for the same duration. Several more minutes lying flat and the process is complete. This movement insures the contrast has sufficiently worked its way through the spinal cord. If the fluid introduced in the spinal tap was oil based, the physician conducting the procedure will remove the fluid after the procedures is complete. When water-based fluid is used, it is typically not removed, as the fluid will eventually be absorbed into the body. Post-procedure case centers on ensuring that infection does not set in and that the “plug” at the site of the spinal tap does not become dislodged. Patients are usually instructed to avoid strenuous activity and heavy lifting, for example. Some patients are given instructions to keep their heads elevated at least 30 degrees for a specified number of hours. Complications from the surgery can cause a loss of cerebrospinal fluid (CSF), which could cause severe headaches. This can be corrected by returning to the medical facility and having them perform a blood patch. In this procedure a small amount of blood is taken from the arm and injected into the exact spinal tap location to stop the leaking of CSF.

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Upper G.I.

Upper GI series, also upper gastrointestinal (GI) tract radiography, is a radiological examination of the upper gastrointestinal tract. It consists of a series of X-ray images of the esophagus, stomach and duodenum. The most common use for this medical testing is to look for signs of ulcers, acid reflux disease, uncontrollable vomiting, or unexplained blood in the stools (hematochezia or positive fecal occult blood).

This is a non-invasive test, consisting of an X-Ray. In the X-ray room, the patient is given two medications to drink that help improve the quality of the resulting X-rays. The patient may also be administered glucagon, a pancreatic hormone that is injected intravenously. The first drink is very carbonated, made from baking-soda crystals which expand the stomach by causing gas to build in the stomach. The second drink is a contrast agent, typically a thick, chalky liquid containing a barium salt. (This test is sometimes called a barium swallow.) The barium outlines the stomach on the X-rays, helping the doctor find tumors or other abnormal areas.

The patient then has X-rays taken. The doctors usually take a series of pictures with the patient in a number of different positions to capture different poses and views of the digestive system. Normally the patient needs to hold their breath to avoid the pictures from blurring and causing unneeded challenges in diagnosing the illness.

During the test, the doctor may pump air into the stomach to make features such as small tumors easier to see.

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Barium Enema (BE or lower GI)

A barium enema, or lower gastrointestinal (GI) examination, is an X-ray examination of the large intestine (colon and rectum). The test is used to help diagnose diseases and other problems that affect the large intestine. To make the intestine visible on an X-ray picture, the colon is filled with a contrast material containing barium. This is done by pouring the contrast material through a tube inserted into the anus. The barium blocks X-rays, causing the barium-filled colon to show up clearly on the X-ray picture.

Why a barium enema is done:

Identify inflammation of the intestinal wall that occurs in inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease. A barium enema also may be used to monitor the progress of these diseases.

Detect problems with the structure of the large intestine, such as narrowed areas (strictures) or pockets or sacs (diverticula) in the intestinal wall.

Help correct a condition called ileocolic intussusception , in which the end of a child’s small intestine protrudes into the large intestine.

Evaluate abdominal symptoms such as altered bowel habits, anemia, or unexplained weight loss.

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Obstetric ultrasonography

Obstetric sonography (ultrasonography) is the application of medical ultrasonography to obstetrics, in which sonography is used to visualize the embryo or foetus in its mother’s uterus (womb). The procedure is often a standard part of prenatal care, as it yields a variety of information regarding the health of the mother and of the fetus, as well as regarding the progress of the pregnancy.



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Reports and Films

Gulf Coast MRI and Diagnostic offer a multitude of ways for physicians to receive diagnostic reports and film in a timely manner. Reports from our radiologists can be delivered via fax, internet (with a password), or hand delivered by our courier.

Film can be hand delivered by our courier or received over our web based PACS (Picture Archiving and Communications System) system.

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Pain Management

Pain Management procedures can be ordered by your physician for diagnosis and/or therapeutic treatment of pain in all areas of the spine and joints (hip, shoulder, knee, etc.) Some of the various pain management procedures performed at Gulf Coast MRI & Diagnostic include:

  • Discogram – used to detect structural damage to a disc, if it has begun to rupture, and if it has tears. The Discogram is an enhanced x-ray exam of the intervertebral discs. The radiologist will inject dye into the disc to increase pressure and note any structural damage to the disc. Normal discs do not usually cause pain even under pressure. The Discogram is usually performed prior to surgery to pinpoint the location of the problem.
  • Epidural Steroid Injection (ESI) – used to provide pain relief by delivering a local anesthetic and anti-inflammatory steroid medication
  • Lumbar Punctures – also called a spinal tap. This procedure is sometimes performed to remove fluid and to relieve cerebrospinal fluid pressure caused by certain medical problems.
  • Lumbar Blood Patch -Procedure involves a tech drawing some blood from the patient and then injecting the blood into the area where the lumbar puncture was performed. This procedure can be performed to help alleviate a bad spinal headache in the days or weeks after the initial lumbar puncture was performed.
  • Facet Injection – Facet joints are located along the back of the spine on each side of the vertebrae. When a facet joint has been identified as the source of pain, a facet injection can be delivered by a physician to relieve back pain.

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