C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

Guggenberger, Roman; Ulbrich, Erika J.; Dietrich, Tobias Johannes; Scholz, Rosemarie; Kaelin, Pascal; Köhler, Christoph; Elsässer, Thilo; Corroller, Thomas Le; Pfammatter, Thomas; Alkadhi, Hatem; Andreisek, Gustav

doi:10.1007/s00330-016-4382-7

Cited by 7 publications

(6 citation statements)

References 33 publications

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“…Of note, MR image allows detection of cartilage defect but does not permit fine assessment of the flap Some limitations inherent to the materials and methods used in our study should now be considered. First, FPCT arthrography is an innovative technique that has mostly been studied on phantoms, animals, or using cadaveric specimens, with very limited in vivo evaluation [7,13,14,[17][18][19]. Second, we acknowledge that the use of different FPCT acquisition protocols, with different scan duration, tube voltage, and current, may lead to lower contrast-to-noise ratio, or to increased radiation dose, than that observed in our study [7].…”

Section: Discussionmentioning

confidence: 83%

“…In addition, at the ankle, the radiation dose in FPCT is usually similar to or even lower than that associated with MDCT if optimized collimation and scan parameters are used [7]. However, FPCT arthrography is a relatively new imaging modality that remains poorly investigated in vivo [18,19].…”

Section: Discussionmentioning

confidence: 99%

“…FPCT arthrography has recently been shown to be as feasible as MDCT arthrography with similar image quality in vitro and ex vivo [7,13,14,17]. In clinical practice, FPCT arthrography can now be performed immediately after arthrography, without relocating the patient, which avoids resorption of contrast material and improves workflow [18,19]. However, FPCT arthrography is a relatively new imaging modality that has mostly been studied on phantoms and cadaveric specimens, with very limited in vivo evaluation [7,13,14,[17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo

et al. 2020

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Objectives The purpose of this study was to compare the diagnostic performance of flat-panel computed tomography (FPCT) arthrography for cartilage defect detection in the ankle joint to direct magnetic resonance (MR) arthrography using multidetector computed tomography (MDCT) arthrography as the reference standard. Methods Twenty-seven patients with specific suspicion of articular cartilage lesion underwent ankle arthrography with injection of a mixture of diluted gadolinium and iobitridol and were examined consecutively with the use of FPCT, MDCT, and 1.5 T MR imaging. FPCT, MDCT, and MR arthrography examinations were blinded and randomly evaluated by two musculoskeletal radiologists in consensus. In each ankle, eight articular cartilage areas were assessed separately: medial talar surface, medial talar trochlea, lateral talar trochlea, lateral talar surface, tibial malleolus, medial tibial plafond, lateral tibial plafond, and fibular malleolus. Findings at FPCT and MR were compared with MDCT assessments in 216 cartilage areas. Results For the detection of cartilage defects, FPCT demonstrated a sensitivity of 97%, specificity of 95%, and accuracy of 96%; and MR arthrography showed a sensitivity of 69%, specificity of 94%, and accuracy of 87%. FPCT and MR arthrography presented almost perfect agreement (κ = 0.87) and moderate agreement (κ = 0.60), respectively, with MDCT arthrography. Mean diagnostic confidence was higher for FPCT (2.9/3) than for MR (2.3/3) and MDCT (2.7/3) arthrography. Conclusions FPCT demonstrated better accuracy than did 1.5 T MR arthrography for cartilage defect detection in the ankle joint. Therefore, FPCT should be considered in patients scheduled for dedicated imaging of ankle articular cartilage.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo

et al. 2020

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“…In shoulder arthrography, different CBCT acquisition protocols have shown a trade-off between radiation dose and sensitivity for rotator cuff and cartilage pathologies compared with traditional MDCT. 85 In addition, CBCT-arthrography protocols have shown better contrast-to-noise ratios and small structure spatial resolutions, showing potential for tailored protocols for cartilage evaluation. 86 In comparison with 1.5 T MRI, CBCT-arthrography has shown superior diagnostic performance in ankle cartilage defect detection in 1 study.…”

Section: Trauma and Fracture Imagingmentioning

confidence: 99%

Computed Tomography

et al. 2022

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Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the diagnosis and characterization of disease processes. Emerging CBCT technologies improved spatial resolution for osseous microstructures in the quantitative analysis of osteoarthritis-related subchondral bone changes, trauma, and fracture healing. Dual-energy CT–based material decomposition visualizes and quantifies monosodium urate crystals in gout, bone marrow edema in traumatic and nontraumatic fractures, and neoplastic disease. Recently, DE techniques have been applied to CBCT, contributing to increased image quality in contrast-enhanced arthrography, bone densitometry, and bone marrow imaging. This review describes 4-dimensional CT, CBCT, and DECT advances, current logistical limitations, and prospects for each technique.

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“…Therefore, similar to the workflow of most other CT-guided interventions, [9,10] CT image guidance without fluoroscopy remains the predominant workflow for joint injections in clinical practice. In order to decrease patients' radiation dose when undergoing CT-arthrography, various approaches have been taken recently, such as decreasing the tube potential of the X-ray tube [11], utilization of tinfiltration [12] or C-arm flat-panel CT-arthrography [13]. However, to our knowledge until now nobody investigated how to substantially decrease radiation dose for patients and medical staff when performing CT-guided joint injection as preparation for MR-arthrography.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of CT-Guided Ultra-Low-Dose Protocol for Injection Guidance in Preparation of MR-Arthrography of the Shoulder and Hip Joints in Comparison to Conventional and Low-Dose Protocols

et al. 2021

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To evaluate patients’ radiation exposure undergoing CT-guided joint injection in preparation of MR-arthrography. We developed a novel ultra-low-dose protocol utilizing tin-filtration, performed it in 60 patients and compared the radiation exposure (DLP) and success rate to conventional protocol (26 cases) and low-dose protocol (37 cases). We evaluated 123 patients’ radiation exposure undergoing CT-guided joint injection from 16 January–21 March. A total of 55 patients received CT-guided joint injections with various other examination protocols and were excluded from further investigation. In total, 56 patients received shoulder injection and 67 received hip injection with consecutive MR arthrography. The ultra-low-dose protocol was performed in 60 patients, the low-dose protocol in 37 patients and the conventional protocol in 26 patients. We compared the dose of the interventional scans for each protocol (DLP) and then evaluated success rate with MR-arthrography images as gold standard of intraarticular or extracapsular contrast injection. There were significant differences when comparing the DLP of the ultra-low-dose protocol (DLP 1.1 ± 0.39; p < 0.01) to the low dose protocol (DLP 5.3 ± 3.24; p < 0.01) as well as against the conventional protocol (DLP 22.9 ± 8.66; p < 0.01). The ultra-low-dose protocol exposed the patients to an average effective dose of 0.016 millisievert and resulted in a successful joint injection in all 60 patients. The low dose protocol as well as the conventional protocol were also successful in all patients. The presented ultra-low-dose CT-guided joint injection protocol for the preparation of MR-arthrography demonstrated to reduce patients’ radiation dose in a way that it was less than the equivalent of the natural radiation exposure in Germany over 3 days—and thereby, negligible to the patient.

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C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance

Abstract: • FPCT shoulder arthrography is feasible with fluoroscopy and CT in one workflow. • A 5-s FPCT protocol applies a lower radiation dose than MDCT. • A 20-s FPCT protocol is moderately sensitive for cartilage and tendon pathology.

Cited by 7 publications

References 33 publications

Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo

Flat-panel CT arthrography for cartilage defect detection in the ankle joint: first results in vivo

Computed Tomography

Evaluation of CT-Guided Ultra-Low-Dose Protocol for Injection Guidance in Preparation of MR-Arthrography of the Shoulder and Hip Joints in Comparison to Conventional and Low-Dose Protocols

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