Flat-Panel CT Arthrography Feasibility Study and Comparison to Multidetector CT Arthrography

Objectives: To show the feasibility of flat-panel computed tomography (FPCT) arthrography and quantitatively and qualitatively compare different FPCT protocols with standard multidetector computed tomography (MDCT). Materials and Methods: First, a phantom simulating joint space with increasing iodine concentrations was scanned using a standard MDCT and 3 different FPCT protocols. Quantitative analyses were performed by measuring CT numbers of iodine dilutions, radiation dose, and image noise as well as signal-to-noise ratio and contrast-to-noise ratio. Second, FPCT arthrographies of 4 animal joint specimens were performed and analyzed qualitatively by 2 independent readers who evaluated image artifacts, image noise, overall image quality and anatomic depiction of bone, cartilage, and soft tissue. Kappa values were calculated for inter-reader agreement. Pearson's correlation coefficient (r) and Wilcoxon signed-ranks test with Bonferroni corrections for multiple comparisons were used to compare MDCT and FPCT. Results: In phantoms, all CT scans showed a linear correlation between increasing iodine concentrations and mean HU values of contrast media and radiation dose, respectively (r = 0.98-0.99, P < 0.01). Dose-length product remained constant for MDCT scans. Signal-to-noise ratio for phantom water linearly decreased in all FPCT scans with increasing iodine concentrations. Contrast-to-noise ratio curves showed reduced slope at iodine concentrations higher than 75 mg/mL. FPCT arthrography after intra-articular administration of 5 to 6 mL of a 25% dilution of iopromide (Ultravist 300 mg/mL, Bayer HealthCare, Berlin, Germany) was successfully performed in all 4 animal joint specimens. Kappa values for inter-reader agreement of qualitative image analyses were 0.62 to 0.91. Image and depiction quality of 20-s FPCT scans were similar or superior compared with standard MDCT (P < 0.005). Conclusion: FPCT arthrography is feasible and may allow similar image quality compared with standard MDCT arthrography.