Arthrography: past, present, and future.

Abstract

Technological advances in arthroscopy and the imaging techniques of sonography, CT, and surface-coil MR have had a substantial impact on conventional arthrographic procedures in the past decade. An individual’s perception of the usefulness of arthrography is influenced by personal interests and those of orthopedic colleagues, referral patterns, access to newer imaging techniques, and recently published data. A survey was done to assess the current and future status of arthrography in relationship to its past use. A questionnaire was sent to 1 46 radiologists who were interested in arthrography. Replies were received from 67% (98/146). The respondents, almost two-thirds of whom were members of the International Skeletal Society, were from 13 countries; 77% (75/98) practiced in the United States or Canada. Seventy-eight percent (76/98) considered their practice to be primarily academic, 1 6% (1 6/98) were hospitalbased nonacademic radiologists, and 6% (6/98) had primarily an office practice. The 98 respondents, representing 92 departments, performed or supervised a total of more than 33,000 arthrograms each year (i.e., for each respondent, 337 per year or six to seven per week). The number of arthrograms performed during the past 5-1 0 years decreased approximately 20% overall; 30% of departments experienced a decrease, and 15% experienced an increase. The decline in examinations was greater in academic centers, perhaps reflecting the fact that arthrography was a relatively new technique 1 0 years ago and was used by fewer private practitioners. Knee examinations accounted for 55% of all arthrograms currently performed. The number of knee studies done during the past 5-1 0 years decreased 50% overall; 85% of respondents experienced a decrease, 1 0% had no change, and only 5% showed an increase. All respondents mentioned arthroscopy as the major factor resulting in this decline. Those practicing in prepaid systems, such as a health maintenance organization or the British Health Service, generally experienced less reduction, and this was attributed to different economic considerations in orthopedic practice. Some arthrographers thought that their only orthopedic referrals were patients with relative contraindications to arthroscopy, such as those who were debilitated, elderly, or overweight; or those who had medicolegal problems or refused arthroscopy. A majority of respondents thought that knee arthrography would continue to decline. A minority thought that continued emphasis on cost containment and the growth of health maintenance organizations would result in a modest increase. A general concern was that arthrography, particularly of the knee, would suffer because of a lack of adequate experience among recent trainees and current radiology residents. Few respondents thought that CT or CT-arthrography would play a significant role in assessment of knee problems in the foreseeable future. On the other hand, noninvasive MR imaging was thought by many to be an excellent technique for assessing the menisci and probably the cruciate ligaments. Those respondents with personal experience in MR imaging of the knee had a throughput of two to three patients per hour and an accuracy that was thought to be almost equivalent to that for arthrography. Some thought that MR imaging, despite its present cost, eventually would replace both arthroscopy and arthrography as the technique of choice for assessment of suspected internal knee injuries. Shoulder arthrograms accounted for 20% of the total ar-