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

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To investigate radiation dose and diagnostic performance of C-arm flat-panel CT (FPCT) versus standard multi-detector CT (MDCT) shoulder arthrography using MRI-arthrography as reference standard.

Methods

Radiation dose of two different FPCT acquisitions (5 and 20 s) and standard MDCT of the shoulder were assessed using phantoms and thermoluminescence dosimetry. FPCT arthrographies were performed in 34 patients (mean age 44 ± 15 years). Different joint structures were quantitatively and qualitatively assessed by two independent radiologists. Inter-reader agreement and diagnostic performance were calculated.

Results

Effective radiation dose was markedly lower in FPCT 5 s (0.6 mSv) compared to MDCT (1.7 mSv) and FPCT 20 s (3.4 mSv). Contrast-to-noise ratios (CNRs) were significantly (p < 0.05) higher in FPCT 20-s versus 5-s protocols. Inter-reader agreements of qualitative ratings ranged between к = 0.47–1.0. Sensitivities for cartilage and rotator cuff pathologies were low for FPCT 5-s (40 % and 20 %) and moderate for FPCT 20-s protocols (75 % and 73 %). FPCT showed high sensitivity (81–86 % and 89–99 %) for bone and acromioclavicular-joint pathologies.

Conclusion

Using a 5-s protocol FPCT shoulder arthrography provides lower radiation dose compared to MDCT but poor sensitivity for cartilage and rotator cuff pathologies. FPCT 20-s protocol is moderately sensitive for cartilage and rotator cuff tendon pathology with markedly higher radiation dose compared to MDCT.

Key Points

• 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.

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Acknowledgments

The scientific guarantor of this publication is Prof. Juerg Hodler. The authors of this manuscript declare relationships with the following companies: Rosemarie Scholz, Christoph Koehler and Thilo Elsässer are employees of Siemens Healthcare GmbH, Business Area Advanced Therapies. They were involved in in vitro phantom measurements and data acquisitions but not in in vivo FPCT and MR arthrographies and consecutive data acquisitions. They had no influence on the statistic work-up of the acquired in vivo data.

All the other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by Siemens Healthcare GmbH, Business Area Advanced Therapies and was conducted as part of a collaboration contract with the Institute of Diagnostic and Interventional Radiology of the University Hospital Zurich. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, 8091, Zürich, Switzerland

    Roman Guggenberger, Erika J. Ulbrich, Pascal Kaelin, Thomas Pfammatter, Hatem Alkadhi & Gustav Andreisek

  2. Department of Radiology, Balgrist University Hospital, Zurich, Switzerland

    Tobias J. Dietrich

  3. Siemens Healthcare GmbH, Business Area Advanced Therapies, Forchheim, Germany

    Rosemarie Scholz, Christoph Köhler & Thilo Elsässer

  4. Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France

    Thomas Le Corroller

  5. Radiology Department, APHM, Marseille, France

    Thomas Le Corroller

Authors
  1. Roman Guggenberger
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  2. Erika J. Ulbrich
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  3. Tobias J. Dietrich
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  4. Rosemarie Scholz
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  8. Thomas Le Corroller
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  9. Thomas Pfammatter
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  11. Gustav Andreisek
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Corresponding author

Correspondence to Roman Guggenberger.

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Guggenberger, R., Ulbrich, E.J., Dietrich, T.J. et al. C-arm flat-panel CT arthrography of the shoulder: Radiation dose considerations and preliminary data on diagnostic performance. Eur Radiol 27, 454–463 (2017). https://doi.org/10.1007/s00330-016-4382-7

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  • DOI: https://doi.org/10.1007/s00330-016-4382-7

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