Problems in the knees, shoulders, hips and other joints where two bones meet can be tricky to diagnose from physical exams or more simple imaging scans. At Yale Medicine, our radiologists are skilled at using direct MRI arthrography, a form of magnetic resonance imaging (MRI) for this purpose.

With MRI arthrography, a contrast agent is injected directly into the affected joint, guided by fluoroscopy (a low-dose form of X-ray) to ensure the accuracy of the injection, followed by MRI imaging. The contrast material allows for clearer images of the tendons, ligaments and cartilage in the affected area.

At Yale Medicine, we have decades of experience with MRI, a seasoned and dedicated team and state-of-the-art equipment, including components specifically dedicated to the imaging of the knees, shoulders, elbows, wrists and hips.

Patients experiencing joint pain, who have had a traditional MRI that didn't use contrast and turned out negative might be candidates for MRI arthography.

In those situations, he says, the radiologists may see a tear, free-floating fragments of cartilage or bone or articular cartilage abnormalities. MRI arthrography is also used in patients who have already had surgery, especially after knee or shoulder surgical procedures.

The use of contrast allows for the clearest possible images of all components of the joint, even the very small ones.

“For instance, in the shoulder, if we see the contrast extend into the labrum (a rim of cartilage millimeters in diameter that reinforces the ball and socket of the shoulder), we can be sure there is a labral tear," says Andrew Haims, MD, a Yale Medicine radiologist. "In patients who have had knee surgery and then present with pain, we can tell the difference between a re-tear, scar, or another unsuspected diagnosis."

The use of contrast helps to reveal differentiation of smaller structures and improve diagnosis.

“We want to avoid injections when we can—they’re an additional expense and invasive,” Dr. Haims says. “With MRI arthrography, it adds diagnostic value to have contrast in the joint." 

The procedure is performed in a radiology suite using fluoroscopy to visualize the joint. The area of skin and muscle is anesthetized with lidocaine down to the joint. Once the position is confirmed, contrast is injected. The procedure takes about 10 minutes.

Next, the patient is taken to the MRI scanner for cross-sectional imaging by a technologist, who remains in constant contact with the radiologist interpreting the completed arthrogram.

As the images are produced, they’re sent to an image archive. After the procedure is complete, the radiologist closely studies the images to make a diagnosis. The report is uploaded into the patient’s electronic medical record and available for the patient’s physician to review or for discussion at the patient’s next scheduled appointment.

Yale Medicine’s decades-long experience with MRI, seasoned and dedicated team and state-of-the-art equipment help to ensure the highest quality images.

“Our team includes five world-class bone radiologists who concentrate solely on orthopedic imaging,” Dr. Haims says, adding, “something that at other institutions might be performed by a general radiologist.

Every week we hold a conference so that our radiologists and Yale Medicine's Orthopedics & Rehabilitation physicians can review recent studies to ensure that our patients are receiving the best possible care.