CT Arthrography

Dear Colleagues,

By distending the articular cavity with the injection of diluted contrast material, arthrography allows for the identification and fine evaluation of small anatomic structures located inside the articular cavity. Magnetic resonance arthrography (MRA) has been widely used in the past because of its intrinsic high contrast resolution.

However, MRI is a relatively long and expensive procedure that is not always suitable because of absolute or relative contraindications. In addition, MRA image quality could be altered by metal artifacts, often affecting previously operated articulations.

In comparison, computed tomography arthrography (CTA) is a cheaper and faster exam that is virtually free from motion artifacts. CT allows us to obtain high-resolution images for the evaluation of bony structures. Moreover, with the advent of modern scanners, radiation burden does not represent a problem in the adult population.

Computed tomography arthrography (CTA) has been successfully used for diagnosing glenohumeral joint cartilages, labral lesions, and rotator cuff tears. In particular, CTA of the shoulder can be considered comparable with regards to the identification of superior labrum lesions and full-thickness rotator cuff tears and represents a more reliable imaging tool for the evaluation of glenoid rim fractures and inferior glenohumeral ligament injuries. Moreover, CTA is a powerful tool for the evaluation of operated shoulders. Additionally, in the case of shoulder dislocation, CT allows the assessment of glenoid bone loss.

In the hip, CTA has been proposed for the diagnosis of labrum and cartilage lesions. Thanks to isotropic images and high spatial resolution, CTA can be used to identify subtle cartilage defects in the femoral head or the acetabular roof. Finally, CTA is accurate in depicting intra-articular loose bodies and for the measurement of femoral and acetabular angles.

In the knee, CTA can be used to diagnose subtle menisci rupture and dissection OCLs.

In the wrist, ankle, and elbow, CTA can be proposed because of its high spatial resolution.

Moreover, dual-energy CT (DECT) has recently been proposed in musculoskeletal imaging to increase tissue contrast and reduce metal artifacts; potential advantages in CTA are the use of virtual non-calcium images for the detection of bone marrow edema, or the use of monoenergetic images for image contrast optimization and metal artifact reduction. Additionally, virtual non-contrast images can be used to remove contrast material to focus on the assessment of bony structures.

For these reasons, dual-energy CTA could increase the overall diagnostic accuracy with respect to standard CTA.

Dr. Giovanni Foti
Guest Editor

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