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

Abstract

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.

Medial Soft tissue and medial malleolus loss-the posterior tibial artery perforator technique combined with iliac crest autograft to Stabilize the ankle and cover Soft tissue defect: A case Series

“…Clinically, there are four types of medial malleolus loss, 7,8,[12][13][14][15][16] including medial malleolus soft tissue and partial cortical bone loss (type I), medial malleolus soft tissue and non-weight bearing articular surface loss (type II), medial soft tissue and medial malleolus loss (type III) and distal tibia soft tissue and weight bearing articular surface loss (type IV). Among them, the medial soft tissue and medial malleolus loss (type III) is more complicated with a large number of tissue structure defects, which make surgical repair more difficult.…”

Arthroscopic defect size measurement in osteochondral lesions of the talus underestimates the exact defect size and size measurement with arthro-MRI (MR-A) and high-resolution flat-panel CT-arthro imaging (FPCT-A)

“…For high‐resolution imaging of intrinsic wrist structures, FPCT‐A was superior to MR‐A with regard to image quality and time‐efficiency [32]. In a more recent study, Pagliano et al demonstrated FPCT‐A to have better accuracy than 1.5‐T MR‐A in the detection of cartilage defects in the ankle joint [22]. Similarly, Pirimoglu et al reported higher sensitivity, specificity, and accuracy rates for multi detector CT‐A compared with MR‐A with 3D VIBE sequences in the detection and grading of osteochondral lesions [23].…”

“…Currently, MRI is the most commonly used imaging modality to evaluate OLT [11, 15]. However, improvements in CT technology have renewed interest in CT arthrography [5, 20], and recent studies suggested that flat‐panel computed tomography (FPCT) allows precise evaluation of cartilage thickness and defects [10, 22].…”

Computed Tomography

“…86 In comparison with 1.5 T MRI, CBCT-arthrography has shown superior diagnostic performance in ankle cartilage defect detection in 1 study. 87 Cone-beam CT studies comparing its ability to detect fractures compared with plain radiographs, including those of the wrist, hand, finger, ankle, foot, and toe, demonstrated a remarkable improvement in sensitivity for detecting subtle fractures. 88 There is also an increase in the agreement of the advised orthopedic therapy owing to CBCT interpretation from moderate to near perfect.…”

“…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 87 …”