Although MR arthrography is considered to be the gold standard in joint imaging, CTA performed on modern multidetector CT scanners can be a very useful clinical tool. When the joint surfaces and intra-articular structures are in question, CTA is indicated for patients who have MR-incompatible implants or metal in or near joints, bulky or morbidly obese patients, and patients who have severe claustrophobia. CT arthrography also is useful in the event of a failed MR arthrogram; the arthrogram procedure can be salvaged if iodinated contrast media is routinely injected with the gadolinium contrast agent.
In the knee, CTA is similar in accuracy to MRI for the detection of meniscal tears, cartilage defects, and complete ACL tears. In the shoulder, CTA is similar in accuracy to MRI for the detection of complete and articular surface rotator cuff tears as well as labral tears. The efficacy of CTA in detecting SLAP lesions is less clear. The role of CTA in other joints is variable. Most of the research done to date suggests that CTA can provide useful information about the joint surfaces and may be helpful in locating intra-articular loose bodies. For these reasons, it is important to recognize that CTA is a viable option for the nonoperative diagnosis of joint disease in many patients.
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