Elbow

For many years, complex motion tomography with or without arthrography was the gold standard nonoperative method to assess elbow joint surfaces and loose bodies. One of the first reports of elbow joint CTA was in 1986 [33], describing the effectiveness of the double-contrast technique in the investigation of joint pain, stiffness, locking, or snapping. A more recent report [34] found no difference between conventional MRI and CTA in the detection of elbow loose bodies, and, furthermore found that neither technique did any better than conventional plain film radiography.

A rigorous study comparing modern multislice CTA and MRA in cadaver elbow specimens used a single-contrast technique to assess for cartilage lesions in the joint [35]. CT and MR arthrography showed an overall sensitivity/specificity of 80%/93% (CT) and 78%/95% (MR) in detecting cartilage lesions. A more detailed analysis revealed that CT was less sensitive than MRI in detecting cartilage fissuring and blistering, but was comparable to MRI in detecting partial- and full- thickness defects (sensitivity/specificity of 87°/o/94°/o and 85%/95% for CT and MR arthrography respectively). The authors of the study suggested that CTA might perform better in vivo when assessing for cartilage defects, because motion artifacts are more prevalent on MR examinations. These results are encouraging and illustrate the potential effectiveness of CTA in evaluating the elbow joint surfaces (Fig. 7).

CT arthrography also is useful in the evaluation of ulnar collateral ligament tears [36]. Both conventional MRI and CTA were found to be 100% specific in

Fig. 7. Double-contrast CTarthrogram of elbow in patient complaining of painful motion. (A) Sagittal reformation. (B) Coronal reformation. Small osteochondral lesion of distal humerus results in irregularity of articular surface (A, B, arroW) secondary to accessory ossicles or adherent loose bodies which were visible on radiographs (not shown). Cysts (A, B, arrowheads) underlie surface defect. Trapped air adjacent to olecranon articulation (A, curved arroW) illustrates a challenge in interpretation of double-contrast examinations.

the diagnosis of full-thickness tears, but CTA was more sensitive than MRI (86% versus 57%). CT arthrography was more helpful when a partial tear was present. Today, MR arthrography is considered the gold standard examination in the assessment of elbow ligament tears, but CTA still can be a helpful examination if an MR cannot be performed.

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