Morbidity of Direct MR Arthrography

OBJECTIVE. The purpose of this study was to determine the incidence and severity of arthrographic pain after intraarticular injection of a gadolinium mixture diluted in normal saline for direct MR arthrography. SUBJECTS AND METHODS. From March 2009 until January 2010, 155 consecutive patients underwent direct MR arthrography; 20 patients were lost to follow-up. Patients were contacted by telephone between 3 and 7 days after joint injection. Using an 11-point numeric pain rating scale, patients were asked to report if they had experienced joint pain that was different or more intense than their preinjection baseline, the severity of pain, the duration of pain, time to onset of pain, and eventual resolution of pain. RESULTS. The incidence of postarthrographic pain was 66% (89/135), with an average intensity of pain of 4.8 +/- 2.4 (range, 1-10). Postarthrographic pain lasted an average of 44.4 +/- 30.5 hours (range, 6-168 hours). The time to onset of pain after joint injection was on average 16.6 +/- 13.1 hours (range, 4-72 hours). There was no significant difference regarding the severity or incidence of postarthrographic pain between groups on the basis of patient age (p = 0.20 and 0.26), patient sex (p = 0.20 and 0.86), contrast mixture contents (p = 0.83 and 0.49), or joint injected (p = 0.51 and 0.47). No patients experienced any other serious side effects. CONCLUSION. Sixty-six percent of patients who undergo direct MR arthrography will experience a fairly severe delayed onset of pain that completely resolves over the course of several days.