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Direct coronal CTA has been used to assess the integrity of osteochondral lesions of the ankle since the early days of CT. Both single- [40] and double-

Arthrography Osteochondral

Fig. 9. (A) Coronal reformation from ankle CTarthrogram. Tendon anchor (arrow) from prior lateral ligament reconstruction does not interfere with visualization of joint surfaces. Talar dome is normal. (B) Sagittal reformation, same patient, anterior to image left. Tiny cyst of posterior distal tibial articular surface (arrowhead) noted on radiograph (not shown) is not associated with significant cartilage defect. Anterior capsule rupture occurred during arthrogram secondary to capsular scarring confirmed at subsequent surgery.

Fig. 9. (A) Coronal reformation from ankle CTarthrogram. Tendon anchor (arrow) from prior lateral ligament reconstruction does not interfere with visualization of joint surfaces. Talar dome is normal. (B) Sagittal reformation, same patient, anterior to image left. Tiny cyst of posterior distal tibial articular surface (arrowhead) noted on radiograph (not shown) is not associated with significant cartilage defect. Anterior capsule rupture occurred during arthrogram secondary to capsular scarring confirmed at subsequent surgery.

contrast techniques [41] are effective in demonstrating cartilage thickness of the lesions, communication with subjacent cysts, and instability of osteochondral fragments.

A more recent experimental cadaver study compared the effectiveness of double-contrast CTA with three-dimensional (3D) fat suppressed gradient echo MRI (noncontrast), documenting the superiority of CTA in assessing cartilage thickness [42]. CTA was found to be highly accurate in detecting cartilage defects of known thickness. In a clinical study of 36 patients [43], cartilage lesions of the ankle joint were assessed both with single-contrast MR and CT arthrog-raphy. CT arthrography was comparable to MR arthrography in terms of sensitivity and specificity, but interobserver agreement was significantly better with CTA. The authors of the study concluded that hyaline cartilage lesions are best assessed with CTA (Fig. 9), but that soft-tissue abnormalities such as ligament or tendon tears about the ankle are best assessed with MRI or MRA [43].

Ankle Cartilage Defect

Fig. 10. (A) Twenty-one-year-old male sustained prior posterior hip dislocation and posterior wall fracture, now complains of intermittent clicking. Frontal radiograph shows large osseous fragment adjacent to hip joint (arrow). (B) Coronal reformation from single-contrast CTarthro-gram documents intra-articular nature of osteochondral fragment (arrow). (C) Sagittal reformation, same patient, anterior to image left. Osteochondral fragment (arrow) lies in posterior joint capsule. (D) Sagittal reformation, same patient and orientation. Donor site of osteochondral fragment (arrowhead) is outlined by contrast media.

Fig. 11. (A) Thirty-one-year-old man complained of decreased range of motion and pain; faintly calcified periarticular masses noted on radiographs (not shown). Coronal reformation, single-contrast CT arthrogram of the hip shows large partially calcified intra-articular mass (arrows). (B) Sagittal reformation, same patient, anterior to image left. Intra-articular mass (arrows) is in close apposition to anterior femoral neck. Mass found to be synovial osteochondromatosis at surgery. Incidental contrast extravasation (asterisk) into distal iliopsoas bursa and muscle from joint injection is not uncommon during hip arthrography.

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