Wilkes Banks Petrey MD, Presenter: Nothing to Disclose

Michael Gregory Fox MD, Abstract Co-Author: Nothing to Disclose

To prospectively determine what effect intra-articular anesthetic has on patient comfort, image quality and scan times in shoulder MR arthrography.

140 adult patients were enrolled between September 2009 and March 2010. Patients were randomized and blinded into Group A (12 cc of a 1:200 gadolinium/saline mixture) or Group B (12 cc of a 1:100:100 gadolinium/saline/0.5% Ropivacaine mixture). All injections were performed by the investigators.  Utilizing a conventional 0-10 scale, pain was assessed pre-injection, post-injection, and immediately following MRI. MR image motion artifact was independently assessed by the two investigators utilizing a grading scale of 0-3 (0 = no motion; 1 = minimal motion not affecting diagnostic quality; 2 = moderate motion diminishing diagnostic quality; 3 = severe motion rendering study barely diagnostic). Total MRI scan time and exams with repeated sequences were recorded. In exams with repeated sequences, the repeated sequence with the least motion was used for quality assessment.

Group A (n=70) mean/median pain scores: pre-injection 3.6/3.5, post-injection 2.3/2.0, post-MRI 2.6/2.0. Group B (n=70) mean/median pain scores: pre-injection 3.8/3.5, post-injection 3.3/3.0, post-MRI 3.4/3.0. There was a significant reduction in median pain scores pre v. post-injection (p=0.04) but not pre-injection v. post-MRI (p=0.12). Investigator 1 noted significant motion (Grades 2 or 3) on 14/70 Group A exams and on 26/70 Group B exams. Investigator 2 noted significant motion on 7/70 Group A exams and on 16/70 Group B exams. There were 21/70 Group A and 28/70 Group B exams requiring repeated MR sequences.  Total MR imaging time was 27 and 28 minutes for Groups A and B, respectively. Age/gender data and fluoroscopic time between Groups A and B were not significantly different.

Intra-articular anesthetic significantly reduces arthrography-associated pain and severity of MR image motion artifact in shoulder MR arthrography. Intra-articular anesthetic does not significantly reduce MR imaging time, or number of exams requiring repeated sequences.

Intra-articular anesthetic reduces MR arthrography associated-pain and improves image quality, without reduction in number of exams requiring repeated sequences or total scan time.

Petrey, W, Fox, M, MR Shoulder Arthrography: Does Intraarticular Anesthetic Improve Patient Comfort, Image Quality, and Scan Times?.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9010658.html