Pain and other side effects after MR arthrography: prospective evaluation in 1085 patients

Abstract

Purpose: To prospectively evaluate pain and other side effects after magnetic resonance (MR) arthrography.

Materials and methods: Institutional review board approval and patient informed consent were obtained. MR arthrography was performed in 1085 patients. In 1011 patients, 2 mmol/L gadopentetate dimeglumine was injected. In patients whose wrists were examined, 5 mmol/L gadoterate dimeglumine was injected. Pain was measured directly after injection, 4 hours after injection, 1 day [18-30 hours] after injection, and 1 week [6-8 days] after injection and compared with pain at baseline (before contrast material was injected). A visual analogue scale or verbal rating scale (score range, 0-10) was used to measure pain. When increased pain persisted at the end of the observation period, additional assessment was performed to exclude infection. Evaluated factors with a potential effect on pain were time after injection, joint type, contrast agent volume, patient age and sex, and radiologist experience. Repeated measures analysis of variance was used.

Results: Mean pain increase was most pronounced 4 hours after injection (P < .0001). This increase was most pronounced in the hip, followed by the elbow, knee, wrist, ankle, and shoulder. (Differences between joints were not significant [P = .26].) Pain scores returned to baseline levels 1 week after injection. Patients younger than 30 years had more pronounced pain than did patients in other age groups at all time points (P = .044). Joint type, contrast agent volume (P = .44), patient sex (P = .29), and radiologist experience (P = .10) did not significantly affect pain scores. No patient had infection or any other severe side effect. Besides joint pain, minor side effects included pressure, headache, muscle ache, swollen hand, fatigue, vertigo, increased blood glucose level, and pruritus.

Conclusion: MR arthrography temporarily increases joint-related pain. Such pain depends on patient age but not on joint type, contrast material volume, patient sex, or radiologist experience.