Miscellaneous Contrast Studies

Arthrography, myelography, and HSG are all classified as what type of procedures?

Fluoroscopy procedures

Medication used to vasoconstrict capillaries and keep contrast in the area of interest longer

Epinephrine

Purpose of epinephrine during fluoroscopic procedures

Keep contrast in the area of interest longer

Condition that must be present when performing contrast injections

Sterile technique

Fluid that is aspirated before contrast injection if present in a joint

Joint effusion

When is local anesthetic administered during arthrography?

Before contrast administration

How is contrast administered during arthrography?

Under fluoroscopy

What does the radiologist do after contrast injection into a joint?

Manipulates the joint to distribute contrast

Radiographic examination of joint soft tissues after contrast injection

Arthrography

Soft tissue structures evaluated with arthrography

Ligaments, menisci, bursae, articular cartilage

Types of contrast that may be used in arthrography

Positive, negative, or both

Most common joint evaluated with arthrography

Shoulder

Other commonly evaluated joints with arthrography

Knee, hip, wrist

Soft tissue structures demonstrated in knee arthrography

ACL, PCL, menisci, fibular collateral ligament, tibial collateral ligament

Projections obtained for knee arthrography using the vertical ray method

AP and AP obliques

Degree of rotation used for AP oblique knee arthrogram projections

20 degrees

Important marker requirement for knee arthrography

Mark medial and lateral side

Patient position to demonstrate the medial meniscus during horizontal ray knee arthrography

Semiprone with medial meniscus up

Number of exposures used to evaluate a meniscus during horizontal ray knee arthrography

Six exposures

Amount the limb is rotated between exposures during horizontal ray knee arthrography

30 degrees

Patient position to demonstrate the lateral meniscus during horizontal ray knee arthrography

Semiprone with lateral meniscus up

Evaluation criteria for arthrography images

Entire capsule outlined, proper positioning, optimal exposure, markers visible

Conditions commonly evaluated with shoulder arthrography

Rotator cuff tears, labral tears, frozen shoulder

Volume of positive contrast used in single-contrast shoulder arthrography

0–12 mL

Volume of positive contrast used in double-contrast shoulder arthrography

2–4 mL

Volume of air used in double-contrast shoulder arthrography

10–12 mL

Common injection site for shoulder arthrography

0.5 inch inferior and lateral to the coracoid process

Common projections for shoulder arthrography

1. AP internal and external

2. AP oblique

3. Axillary

4. Tangential

Imaging modality often performed with shoulder arthrography

CT

Contrast agent commonly injected for MR arthrography

Gadolinium

Most common indications for hip arthrography

Congenital hip displacement, loose prosthesis, infection

Common puncture site for hip arthrography

¾ inch distal to inguinal crease and ¾ inch lateral to femoral pulse

Needle commonly used to reach the hip joint capsule

Spinal needle

Any joint can be evaluated with what fluoroscopic procedure?

Arthrography

Radiologic examination of CNS structures within the vertebral canal

Myelography

Space where contrast is injected during myelography

Subarachnoid space

Typical lumbar puncture levels for myelography

L2-L3 or L3-L4

Alternative cervical puncture site for myelography

C1-C2

Term describing injection into the subarachnoid space

Intrathecal injection

Typical patient status for myelography

Outpatient

Recovery time after myelography

4–8 hours

Type of contrast used for myelography

Nonionic water soluble iodinated contrast

Why nonionic contrast is preferred for myelography

Fewer side effects

Property of myelographic contrast that allows mixing with CSF

Miscible in spinal fluid

What type of contrast must always be used for myelography?

Intrathecal contrast

Structure extending from the brain to the L1-L2 level

Spinal cord

Pointed terminal end of the spinal cord

Conus medullaris

Fibrous structure connecting the conus medullaris to the coccyx

Filum terminale

Collection of spinal nerve roots below the conus medullaris

Cauda equina

Three meningeal layers

Pia mater, arachnoid, dura mater

Innermost meningeal layer

Pia mater

Middle meningeal layer

Arachnoid

Outermost meningeal layer

Dura mater

Space between pia mater and arachnoid

Subarachnoid space

Space between arachnoid and dura mater

Subdural space

Space between dura mater and vertebral periosteum

Epidural space

Structure that cushions adjacent vertebrae

Intervertebral disk

Outer fibrous portion of an intervertebral disk

Annulus fibrosus

Soft central portion of an intervertebral disk

Nucleus pulposus

Condition where the nucleus pulposus protrudes through the annulus fibrosus

Herniated nucleus pulposus (HNP)

Most common levels for herniated nucleus pulposus

L4-L5 and L5-S1

Equipment that should be attached before a myelography procedure

Footboard and shoulder supports

Food restriction before myelography

No solid food for 4–8 hours

Patient hydration recommendation before myelography

Well hydrated

Why hydration is encouraged before myelography

CSF is replaced faster

Position most commonly used for spinal puncture during myelography

Prone

Alternative position for spinal puncture during myelography

Lateral with spine flexed

What is often withdrawn and sent to the laboratory during myelography?

CSF

How is contrast moved through the spinal canal during myelography?

Gravity and table angulation

Head position used to prevent contrast from entering the ventricles

Acute extension

Structure compressed by acute head extension during myelography

Cisterna magna

Common projections obtained during myelography

Cross-table lateral, PA, obliques

Postprocedural head elevation after myelography

30–45 degrees

Postprocedural activity restriction after myelography

Bed rest

Postprocedural recommendation after myelography

Encourage fluids

Procedure similar to myelography but without contrast

Lumbar puncture

Diagnostic uses of lumbar puncture

Infection, demyelinating disease, bleeding, pressure measurement

Therapeutic uses of lumbar puncture

Medication administration, anesthesia, pressure relief, blood patch

Procedure used to determine whether a disk is the source of chronic back pain

Diskography

Contrast used during diskography

Nonionic water soluble iodinated contrast

Structure injected during diskography

Nucleus pulposus

Purpose of diskography

Evaluate internal disk lesions and chronic back pain

Procedure used to evaluate the uterus and fallopian tubes

Hysterosalpingography (HSG)

Primary purposes of HSG

Evaluate uterus, tubes, lesions, infertility

Type of contrast used during HSG

Water soluble radiopaque contrast

Device used to introduce contrast into the uterus during HSG

Uterine cannula

When should HSG be scheduled relative to menstruation?

Approximately 10 days after onset

Why HSG is scheduled shortly after menstruation

Least risk of irradiating a fertilized ovum

Patient preparation before HSG

Empty bladder and cleanse perineal region

Initial image obtained before HSG contrast injection

Scout image

Patient position used during HSG

Lithotomy position

Instrument inserted into the vagina during HSG

Speculum

Where contrast is injected during HSG

Uterus through a cannula

What indicates patent fallopian tubes during HSG?

Contrast spills into the peritoneal cavity

Common projection obtained during HSG

AP

Additional projections that may be obtained during HSG

Oblique, axial, lateral

Radiologic exam of soft tissue structures of synovial/diarthrodial joints

Arthrogram

Additional joints commonly evaluated with arthrography

TMJ

Possible radiographs obtained before and after joint manipulation during arthrography

Pre-exercise and post-exercise films

Purpose of knee arthrography

Visualize articular cartilage, menisci, and ligaments after traumatic injury