Imaging Pearls ❯ Musculoskeletal ❯ Techniques
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- “Computed tomography (CT) is a common modality employed for musculoskeletal imaging. Conventional CT techniques are useful for the assessment of trauma in detection, characterization and surgical planning of complex fractures. CT arthrography can depict internal derangement lesions and impact medical decision making of orthopedic providers. In oncology, CT can have a role in the characterization of bone tumors and may elucidate soft tissue mineralization patterns. Several advances in CT technology have led to a variety of acquisition techniques with distinct clinical applications. These include four-dimensional CT, which allows examination of joints during motion; cone-beam CT, which allows examination during physiological weight-bearing conditions; dual-energy CT, which allows material decomposition useful in musculoskeletal deposition disorders (e.g., gout) and bone marrow edema detection; and photon-counting CT, which provides increased spatial resolution, decreased radiation, and material decomposition compared to standard multi-detector CT systems due to its ability to directly translate X-ray photon energies into electrical signals. Advanced acquisition techniques provide higher spatial resolution scans capable of enhanced bony microarchitecture and bone mineral density assessment. Together, these CT acquisition techniques will continue to play a substantial role in the practices of orthopedics, rheumatology, metabolic bone, oncology, and interventional radiology.”
CT in musculoskeletal imaging: still helpful and for what?
Carrino JA, Ibad H, Lin Y et al.
Skeletal Radiol. 2024 Jul 6. doi: 10.1007/s00256-024-04737-w. Epub ahead of print. PMID: 38969781. - • MDCT (multi-detector computed tomography) is commonly used for appendicular and axial skeleton imaging for detecting and characterizing fractures as well as surgical planning.
• DECT (dual-energy computed tomography) and PCCT (photon counting computed tomography) improve contrast resolution and allow for tissue decomposition, playing a role in the diagnosis of gout and bone marrow edema.
• Bone health determinants may be considered by mineral content, architecture, and strength; CT imaging can have a role in each of these.
• CT guidance allows for safe and effective percutaneous MSK biopsies and spine injection
CT in musculoskeletal imaging: still helpful and for what?
Carrino JA, Ibad H, Lin Y et al.
Skeletal Radiol. 2024 Jul 6. doi: 10.1007/s00256-024-04737-w. Epub ahead of print. PMID: 38969781. - “Several additional advances in CT acquisition technology have allowed the gradually increased adoption of the modality for MSK indications: (1) the introduction of 320- slice large-bore MDCT in 2008 has additionally enabled kinematic CT imaging of peripheral joints (four-dimensional CT; 4DCT), (2) dual-energy CT acquisitions (DECT) has enabled material-specific and spectral analysis in the past decade, (3) cone-beam CT (CBCT) has provided avenues for high-resolution acquisitions of the lower extremity joints under physiological weight-bearing conditions, and the most recently developed photon-counting CT (PCCT) allows for even greater spatial resolution by minimizing electrical noise associated with traditional MDCT’s energy-integrating detectors as well as improved capability for spectral resolution.”
CT in musculoskeletal imaging: still helpful and for what?
Carrino JA, Ibad H, Lin Y et al.
Skeletal Radiol. 2024 Jul 6. doi: 10.1007/s00256-024-04737-w. Epub ahead of print. PMID: 38969781. - 4DCT is a technique that allows volumetric acquisitions of a peripheral joint during motion with high resolution, enabled by the introduction of wide-detector (up to 320 slices) MDCT. Sequential, non-continuous scans through pre-defined motions (such as dart-throwing motions of the wrist) can be suboptimal for comprehensive capture of biomechanical derangements. Instead, 4DCT allows a detailed analysis of dynamic biomechanical derangements of otherwise occult pathologies through an entire range of motion such as for the assessment of dissociative and non-dissociative carpal instability patterns and for providing insights into the kinematics of anterior cruciate ligament deficient knees. The uses of 4DCT in clinical practice can be categorized by anatomy. There has been substantial work performed over the last decade on 4DCT’s role in the evaluation of peripheral joint biomechanics more commonly on knee, wrist, and ankle, andless commonly on elbow, hip, and shoulder joints.
CT in musculoskeletal imaging: still helpful and for what?
Carrino JA, Ibad H, Lin Y et al.
Skeletal Radiol. 2024 Jul 6. doi: 10.1007/s00256-024-04737-w. Epub ahead of print.. - “Traditionally, the initial evaluation of traumatic injuries of the musculoskeletal system is performed using radiography. CT is not only used in cases with radiographically occult injuries (such as midfoot Lisfranc injuries , hip fracture, and complex wrist fractures) with remaining clinical suspicion or for assessment of intra-articular extension, distraction, or displacement to aid surgical management. With the added utility that CT provides in the form of multiplanar reformatting, volume-rendering, and metal artifact reduction, the use of both traditional MDCT and novel acquisition techniques is increasing to enable better characterization for surgical planning and facilitate medical decision-making.”
CT in musculoskeletal imaging: still helpful and for what?
Carrino JA, Ibad H, Lin Y et al.
Skeletal Radiol. 2024 Jul 6. doi: 10.1007/s00256-024-04737-w. Epub ahead of print.. - “Therefore, it is not clear to us that any application that CT is used today will be completely replaced in the adult population. Quantitative CT techniques and AI based processing will contribute to bone health and muscle quality assessment in both a dedicated and opportunistic fashion. The use of CT for procedure guidance and monitoring is also expanding beyond radiology and into the operating room as part of safety and quality control. In our estimation, we expect that CT will very much continue to have an important role in musculoskeletal radiology for the foreseeable future!”
CT in musculoskeletal imaging: still helpful and for what?
Carrino JA, Ibad H, Lin Y et al.
Skeletal Radiol. 2024 Jul 6. doi: 10.1007/s00256-024-04737-w. Epub ahead of print..
- Do you need to look at the full field of view on a CT scan and if so when?
- Cardiac CTA of Cardiac Calcium Scoring Study
- Spine CT especially T-spine, L-spine and Sacrum - “ Reviewing the full-FOV from lumbar spine CT examinations will result in the detection of a small number of substantial extraspinal pathologic findings in addition to many benign incidental findings.”
Extraspinal Findings at Lumbar Spine CT Examinations: Prevalence and Clinical Importance
Lee SY et al.
Radiology 2012; 263:502-509 - “ Extraspinal findings were present in 40.5% of adult outpatients undergoing lumbar spine CT examinations for low back pain and/or radiculopathy, most (62.3%) of whom had findings classified as benign and not requiring further work-up.”
Spine CT Examinations: Prevalence and Clinical Importance
Lee SY et al.
Radiology 2012; 263:502-509 - “ The full field of view (FOV) abdominal images were required o best visualize extraspinal abnormalities in 79.4% of cases.”
Spine CT Examinations: Prevalence and Clinical Importance
Lee SY et al.
Radiology 2012; 263:502-509 - “ A small percentage (14.8%) of patients had indeterminate or potentially clinically important findings requiring clinical correlation or further evaluation. Substantial extraspinal pathologic findings, consisting of an early stage renal cell carcinoma and transitional cell carcinoma, chronic lymphocytic leukemia, sarcoidosis, and 13 abdominal aortic aneuysms, were present in 4.3% of our cohort of 400 patients.”
Spine CT Examinations: Prevalence and Clinical Importance
Lee SY et al.
Radiology 2012; 263:502-509 - “ Substantial extraspinal pathologic findings, consisting of an early stage renal cell carcinoma and transitional cell carcinoma, chronic lymphocytic leukemia, sarcoidosis, and 13 abdominal aortic aneuysms, were present in 4.3% of our cohort of 400 patients.”
Spine CT Examinations: Prevalence and Clinical Importance
Lee SY et al.
Radiology 2012; 263:502-509 - “ A small percentage (14.8%) of patients had indeterminate or potentially clinically important findings requiring clinical correlation or further evaluation.”
Spine CT Examinations: Prevalence and Clinical Importance
Lee SY et al.
Radiology 2012; 263:502-509