Purpose: To develop an MR-guided technique for joint puncture in MR arthrography of the shoulder and to confirm the intracapsular position of the needle tip by visualization of the flow of contrast media into the joint.
Materials and methods: Three unfixed human shoulder joint specimens were examined on a LOT unit. The optimal point of entrance and depth for joint puncture were estimated by means of MR-compatible markers on the skin. Needle orientation and localization of the needle tip (MR-compatible 22-gauge needle) in the shoulder joint were monitored by rapid localizer gradient-echo sequences in two or thogonal planes. To confirm the intracapsular position of the needle tip, diluted gadolinium-DTPA was administered via a long connecting tube and the flow of contrast media into the joint was viewed directly on an LCD screen using real-time MR imaging (local look technique).
Results: The MR-compatible markers on the skin allowed determination of the optimal point of entrance and estimation of the depth for joint puncture. Passive visualization of the MR-compatible needle due to spin dephasing and signal loss provided adequate localization of the intra-articular needle tip position in all specimens, although significant artefacts were present on rapid localizer gradient-echo sequences with an increase in width of the apparent needle shaft. Real-time MR imaging of the flow of contrast media was possible using the local look technique and the LCD screen of the MR unit and allowed confirmation of the intracapsular position.
Conclusion: MR-guided joint puncture and real-time MR-assisted contrast media application results in improved MR-arthrography and may replace conventional fluoroscopic guidance.