Kenneth A Buckwalter MD

Indiana University School of Medicine, Department of Radiology, Indiana University Hospital, Room 0615E, 550 University Boulevard, Indianapolis, IN 46202, USA

lthough MRI or MR arthrography (MRA) is the gold-standard nonop erative joint-imaging technique, CT arthrography (CTA) can be an ex tremely helpful tool to address many clinical questions. Advances in CT technology, including multichannel detector arrays and the availability of submillimeter-thick slices, make it possible to examine joints in high detail in the sagittal and coronal imaging planes. Specific indications for CTA include a failed MR or MRA, an obese or severely claustrophobic patient, a patient who has an MR-incompatible implanted medical devices, and the postoperative patient who has metal hardware in close proximity to the joint. CTA also is useful to consider if access to MR is limited.

This article discusses relevant technological advances in CT imaging, reviews technique and indications for CTA, and illustrates application of CTA in multiple joints.

Although it is possible to scan some joints directly in a sagittal or coronal plane, CT usually is restricted to axial plane imaging. For some applications, this is sufficient; however, the development of multidetector CT scanners now allows for the detailed depiction of joints in imaging planes that were traditionally the domain of tomography or MRI. Most multidetector CT scanners can acquire submillimeter-thick sections that enable the production of very high-quality multiplanar reformations (MPR) in sagittal and coronal planes. High-quality CTA would not be possible without these advances. For the referring physician, it is only important to ask if the equipment with which the examination is performed has submillimeter slice capability.

CT arthrography is a mature technique, reported first in the late 1970s and early 1980s for evaluation of the cruciate ligaments [1], the glenoid labrum

Indiana University Department of Radiology has a CT teaching arrangement with Philips Medical Systems, Andover, MA. The author of this article receives no direct compensation from Philips.

E-mail address: [email protected]

0278-5919/06/$ - see front matter © 2006 Elsevier Inc. All rights reserved.

doi:10.1016/j.csm.2006.06.002 sportsmed.theclinics.com

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