Morbidity of direct MR arthrography.

摘要

The article by Giaconi et al. [1] in the April 2011 issue of the A JR documents the substantial delayed morbidity associated with MR ar-thrography. Three decades ago, I was among those calling attention to the underappreciated 4- to 6-hour delayed onset of pain after shoulder arthrography was performed using iodinated contrast media [2]. At that time, we speculated, as do Giaconi et al., whether this was caused by direct irritation of the syno-vium or by delayed distention of the joint secondary to the hyperosmolarity of the injected iodinated contrast agent. The subsequent introduction of low-osmolarity contrast agents allowed us to support the latter hypothesis [3]. In that study, shoulder arthrography using traditional single-contrast high-osmolarity meglumine diatrizoate (Renografm-M-60, Squibb) resulted in a 50-70% incidence of moderate or severe delayed shoulder pain, whereas the recently introduced low-osmolarity metrizamide (Amipaque, Winthrop) resulted in only a 14% incidence of similar pain. Double-contrast arthrography, using a small amount of positive contrast agent, resulted in an intermediate 45% incidence of pain.