Indirect arthrography

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Indirect arthrography is an MRI technique to produce arthrographic images without the need to perform a direct joint injection.

A standard dose of a gadolinium-containing contrast agent is injected intravenously and imaging of the shoulder performed after a delay of typically between 5 and 15 minutes , during which time exercise of the joint is performed to facilitate the diffusion of contrast into the joint.

Although the advantages of indirect arthrography are obvious (not requiring direct injection into the joint), it is not without substantial drawbacks that have limited widespread adoption. The main concerns are:

lack of predictability of the degree of intra-articular enhancement, dependent on synovial surface area, inflammation, and amount of joint fluid

lack of joint distention (unless a joint effusion is already present)

inability to detect non-anatomical communications between fluid-containing spaces, as they will all enhance simultaneously