Skip to main content
SpringerLink
Log in

CT Arthrography of the Ankle: Technique, Indications, Advantages, and Disadvantages

  • Chapter
  • First Online:
Imaging of the Foot and Ankle

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 233 Accesses

Abstract

CT is a crucial imaging modality in evaluation of pathologies of foot and ankle. CT provides three-dimensional imaging of the foot and ankle with increased spatial resolution. This is extremely helpful in evaluation of fractures and assessment of arthrodesis. CT arthrography (CTA) is a well-established method in evaluating the articular cartilage of the ankle joint. The application of CTA requires knowledge of indications and limitations as well as the safe injection techniques by the supervising radiologist. CTA is indicated mostly in patients with MR imaging contraindications and in the postoperative painful syndrome where metallic artifacts may downgrade the quality of the images. In addition, CTA is better in showing small cartilage defects due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is constantly increasing.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Anderson AE, Ellis BJ, Peters CL, Weiss JA (2008) Cartilage thickness: factors influencing multidetector CT measurements in a phantom study. Radiology 246(1):133–141

    Article  PubMed  Google Scholar 

  • Barg A, Bailey T, Richter M, de Cesar NC, Lintz F, Burssens A et al (2018) Weight bearing computed tomography of the foot and ankle: emerging technology topical review. Foot Ankle Int 39:376–386

    Article  PubMed  Google Scholar 

  • Bernasconi A, De Cesar NC, Siegler S, Jepsen M, Lintz F (2021) Weightbearing CT assessment of foot and ankle joints in Pes Planovalgus using distance mapping. Foot Ankle Surg. https://doi.org/10.1016/j.fas.2021.10.004

  • Buckwalter KA (2006) CT arthrography. Clin Sports Med 25(4):899–915

    Article  PubMed  Google Scholar 

  • Cerezal L, Abascal F, García-Valtuille R, Canga A (2005) Ankle MR arthrography: how, why, when. Radiol Clin North Am 43(4):693–707

    Article  PubMed  Google Scholar 

  • Cerezal L, Llopis E, Canga A, Rolón A (2008) MR arthrography of the ankle: indications and technique. Radiol Clin North Am 46(6):973–994

    Article  PubMed  Google Scholar 

  • Chang EY, Tadros AS, Amini B et al (2018) ACR Appropriateness Criteria® chronic ankle pain. J Am Coll Radiol 15(5):S26–S38

    Article  PubMed  Google Scholar 

  • Chemouni D, Champsaur P, Guenoun D, Desrousseaux J, Pauly V, Le Corroller T (2014) Diagnostic performance of flat-panel CT arthrography for cartilage defect detection in the ankle joint: comparison with MDCT arthrography with gross anatomy as the reference standard. AJR Am J Roentgenol 203(5):1069–1074

    Article  PubMed  Google Scholar 

  • Choi JY, Heung SK, Sung HH et al (2008) Optimization of the contrast mixture ratio for simultaneous direct MR and CT arthrography: an in vitro study. Korean J Radiol 9(6):520–525

    Article  PubMed  PubMed Central  Google Scholar 

  • Chou H, Chin TY, Peh WC (2017) Dual-energy CT in gout – a review of current concepts and applications. J Med Radiat Sci 64:41–51

    Article  PubMed  PubMed Central  Google Scholar 

  • Cochet H, Pelé E, Amoretti N, Brunot S, Lafenêtre O, Hauger O (2010) Anterolateral ankle impingement: diagnostic performance of MDCT arthrography and sonography. AJR Am J Roentgenol 194(6):1575–1580

    Article  PubMed  Google Scholar 

  • Conti MS, Ellis SJ (2020) Weight-bearing CT scans in foot and ankle surgery. J Am Acad Orthop Surg 28:e595–e603

    Article  PubMed  Google Scholar 

  • De Smet AA, Ilahi OA, Graf BK (1996) Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 25(2):159–163

    Article  PubMed  Google Scholar 

  • Draeger RW, Singh B, Parekh SG (2009) Quantifying normal ankle joint volume: an anatomic study. Indian J Orthop 43(1):72–75

    Article  PubMed  PubMed Central  Google Scholar 

  • Fox MG, Petrey WB, Alford B, Huynh BH, Patrie JT, Anderson MW (2012) Shoulder MR arthrography: intraarticular anesthetic reduces periprocedural pain and major motion artifacts but does not decrease imaging time. Radiology 262(2):576–583

    Article  PubMed  Google Scholar 

  • Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A (2013) CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging 94(4):371–388

    Article  PubMed  Google Scholar 

  • Gorbachova T, Melenevsky YV, Latt LD, Weaver JS, Taljanovic MS (2021) Imaging and treatment of posttraumatic ankle and hindfoot osteoarthritis. J Clin Med 10(24):5848

    Article  PubMed  PubMed Central  Google Scholar 

  • Hauger O, Moinard M, Lasalarie JC, Chauveaux D, Diard F (1999) Anterolateral compartment of the ankle in the lateral impingement syndrome: appearance on CT arthrography. AJR Am J Roentgenol 173:685–690

    Article  PubMed  Google Scholar 

  • Jung HG, Kim NR, Jeon JY et al (2018) CT arthrography visualizes tissue growth of osteochondral defects of the talus after microfracture. Knee Surg Sports Traumatol Arthrosc 26(7):2123–2130

    Article  PubMed  Google Scholar 

  • Kampen WU, Westphal F, Van den Wyngaert T et al (2018) SPECT/CT in postoperative foot and ankle pain. Semin Nucl Med 48:454–468

    Article  PubMed  Google Scholar 

  • Kirschke JS, Braun S, Baum T et al (2016) Diagnostic value of CT arthrography for evaluation of osteochondral lesions at the ankle. Biomed Res Int 2016:12–16

    Article  Google Scholar 

  • Kraniotis P, Maragkos S, Tyllianakis M, Petsas T, Karantanas AH (2012) Ankle post-traumatic osteoarthritis: a CT arthrography study in patients with bi- and trimalleolar fractures. Skeletal Radiol 41(7):803–809

    Article  PubMed  Google Scholar 

  • Kreuz PC, Steinwachs M, Angele P (2018) Single-dose local anesthetics exhibit a type-, dose-, and time-dependent chondrotoxic effect on chondrocytes and cartilage: a systematic review of the current literature. Knee Surg Sports Traumatol Arthrosc 26(3):819–830

    Article  PubMed  Google Scholar 

  • Lecouvet FE, Simoni P, Koutaïssoff S, Vande Berg BC, Malghem J, Dubuc JE (2008) Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations. Eur J Radiol 68(1):120–136

    Article  PubMed  Google Scholar 

  • Lintz F, Beaudet P, Richardi G, Brilhault J (2021) Weight-bearing CT in foot and ankle pathology. Orthop Traumatol Surg Res 107(1S):102772. https://doi.org/10.1016/j.otsr.2020.102772

    Article  PubMed  Google Scholar 

  • Lungu E, Moser TP (2015) A practical guide for performing arthrography under fluoroscopic or ultrasound guidance. Insights Imaging 6(6):601–610

    Article  PubMed  PubMed Central  Google Scholar 

  • Messina C, Banfi G, Aliprandi A et al (2016) Ultrasound guidance to perform intra-articular injection of gadolinium-based contrast material for magnetic resonance arthrography as an alternative to fluoroscopy: the time is now. Eur Radiol 26(5):1221–1225

    Article  PubMed  Google Scholar 

  • Mosimann PJ, Richarme D, Becce F et al (2012) Usefulness of intra-articular bupivacain and lidocain adjunction in MR or CT arthrography: a prospective study in 148 patients. Eur J Radiol 81(9):e957–e961

    Article  PubMed  Google Scholar 

  • Obermann WR, Bioem JL, Hermans J (1989) Knee arthrography: comparison of iotrolan and ioxaglate sodium meglumine. Radiology 173(1):197–201

    Article  PubMed  Google Scholar 

  • Obradov M, Gielen JLMA (2018) Image-guided intra- and extra-articular musculoskeletal interventions. Springer International, Cham, Switzerland

    Book  Google Scholar 

  • Ogul H, Cankaya B, Kantarci M (2021) The distribution in joint recesses and adjacent synovial compartments of loose bodies determined on MR and CT arthrographies of ankle joint. Br J Radiol 94:20201239

    Google Scholar 

  • Omoumi P, Mercier GA, Lecouvet F, Simoni P, Vande Berg BC (2009) CT arthrography, MR arthrography, PET, and scintigraphy in osteoarthritis. Radiol Clin North Am 47(4):595–615

    Article  PubMed  Google Scholar 

  • Omoumi P, De Gheldere A, Leemrijse T et al (2010) Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases. Skeletal Radiol 39(4):381–386

    Article  PubMed  Google Scholar 

  • Pohler GH, Sonnow L, Ettinger S et al (2021) High resolution flat-panel CT arthrography vs. MR arthrography of artificially created osteochondral defects in ex vivo upper ankle joints. PloS One 16(8 August):1–14

    Google Scholar 

  • Rastogi AK, Davis KW, Ross A, Rosas HG (2016) Fundamentals of joint injection. AJR Am J Roentgenol 207(3):484–494

    Article  PubMed  Google Scholar 

  • Saifuddin A, Abdus-Samee M, Mann C, Singh D, Angel JC (2005) CT guided diagnostic foot injections. Clin Radiol 60(2):191–195

    Article  PubMed  Google Scholar 

  • Sandhu R, Aslan M, Obuchowski N, Primak A, Karim W, Subhas N (2021) Dual-energy CT arthrography: a feasibility study. Skeletal Radiol 50(4):693–703

    Article  PubMed  Google Scholar 

  • Schmid MR, Pfirrmann CWA, Hodler J, Vienne P, Zanetti M (2003) Cartilage lesions in the ankle joint: comparison of MR arthrography and CT arthrography. Skeletal Radiol 32(5):259–265

    Article  PubMed  Google Scholar 

  • Sverzut J, Campagna R, Guerini H, Feydy A, Drapé J, Pessis E (2015) Reduction of metal artifact with dual-energy CT: virtual monospectral imaging with fast kilovoltage switching and metal artifact reduction software. Semin Musculoskelet Radiol 19:446–455

    Article  PubMed  Google Scholar 

  • Thomas C, Schabel C, Krauss B, Weisel K, Bongers M, Claussen CD (2015) Dual-energy CT: virtual calcium subtraction for assessment of bone marrow involvement of the spine in multiple myeloma. AJR Am J Roentgenol 204:W324–W331

    Article  PubMed  Google Scholar 

  • Tsai LL, Grant AK, Mortele KJ, Kung JW, Smith MP (2015) A practical guide to MR imaging safety: what radiologists need to know. Radiographics 35(6):1722–1737

    Article  PubMed  Google Scholar 

  • Tuominen EKJ, Kankare J, Koskinen SK, Mattila KT (2013) Weight-bearing CT imaging of the lower extremity. AJR Am J Roentgenol 200(1):146–148

    Article  PubMed  Google Scholar 

  • Wang CK, Tsai JM, Chuang MT, Wang MT, Huang KY, Lin RM (2013) Bone marrow edema in vertebral compression fractures: detection with dual-energy CT. Radiology 269:525–533

    Article  PubMed  Google Scholar 

  • Wright PR, Fox MG, Alford B, Patrie JT, Anderson MW (2014) An alternative injection technique for performing MR ankle arthrography: the lateral mortise approach. Skeletal Radiol 43(1):27–33

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece

    George A. Kakkos, Michail E. Klontzas, Evangelia E. Vassalou & Apostolos H. Karantanas

  2. Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece

    Michail E. Klontzas & Apostolos H. Karantanas

Authors
  1. George A. Kakkos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michail E. Klontzas
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Evangelia E. Vassalou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Apostolos H. Karantanas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Apostolos H. Karantanas .

Editor information

Editors and Affiliations

  1. Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK

    Mark Davies

  2. Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK

    Steven James

  3. Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK

    Rajesh Botchu

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kakkos, G.A., Klontzas, M.E., Vassalou, E.E., Karantanas, A.H. (2023). CT Arthrography of the Ankle: Technique, Indications, Advantages, and Disadvantages. In: Davies, M., James, S., Botchu, R. (eds) Imaging of the Foot and Ankle. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2023_386

Download citation

  • DOI: https://doi.org/10.1007/174_2023_386

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-38608-4

  • Online ISBN: 978-3-031-38609-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation