Gadolinium Mixture for Arthrography

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High iodine concentration in the contrast mix or too high of a concentration of Gd can cause dephasing artifact on both T1 and T2 weighted sequences - black joint in this case.

Here is the dilution mixture I'd like to propose: (1:200 dilution of Gd)

20 mL syringe

  1. 5 ml of 1% lidocaine (for patient comfort)
  2. 10 ml of normal saline
  3. 5 ml of Omnipaque 300 or Isovue 300 (seems to be the ubiquitous contrast available in all hospitals)
  4. 0.1 ml of diluted Gd (Omniscan, Magnivist, or Multihance all ok)

Mix the solution well before purging the bubbles. Inadequate mixing can cause layering of the iodine contrast at the dependent portion of the joint after injection causing dephasing artifact due to high iodine concentration.

For wrist arthrograms, take fluoro images after the injection, profiling the scapholunate, lunotriquetral and distal radio-ulnar joints.

Larry Tang