Computed Tomography of the Musculoskeletal System

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Computed Tomography of the Musculoskeletal System

• March Hochman, MD
• Beth Israel Deaconess Medical Center

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Shoulder CT - Parameters

• Plane axial
• Section thickness 3mm
• Pitch 1 1.5
• Reconstruction interval 1 1.5
• Kernal bone, standard
• Reformat - optional

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Shoulder CT - Indications

• Trauma
• Joint evaluation
• CT arthrography
• Scapula
• Is the fracture intraarticular?

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Elbow CT - Parameters

• Plane axial extended and axial flexed
• Section thickness 2 3mm
• Reconstruction interval 1 1.5mm
• Pitch 1 1.5
• Kernal bone
• Reformat optional sagittal

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Elbow CT - Indications

• Loose bodies/DJD
• Osteochondritis dissecans
• Fracture anatomy
• Radial head fracture depression

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Wrist CT - Parameters

• Plane direct coronal and direct axial
• Section thickness 1mm
• Reconstruction interval 1mm
• Pitch 1
• Kernal bone
• Reformat optional sagittal

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Wrist CT Indications

• Clinically suspected fractures not seen on
  radiograph
• Complex fractures that require further evaluation
• Carpal fractures e.g. hamate, scaphoid, etc.

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Scaphoid CT - Parameters

• Plane oblique sagittal
• Sections thickness 1mm
• Conventional
• Kernal bone
• Optional direct axial or coronal
• Assess for other carpal fractures

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Scaphoid CT - Indications

• Clinically suspected fracture of scaphoid
• Fracture displacement/angulation
• Evaluate for healing/AVN
• Malunion ot non-union
• S/P ORIF ?osseous union?

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Sternoclavicular Joint CT

• Stop fooling around (Rogers, L)
• Radiographic evaluation of sternoclavicular
  joints is unreliable. Therefore use CT.

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Sternoclavicular Joint CT

• Trauma Fracture/Dislocation?
• Pain or mass? Osteoarthritis?
• Section thickness 1 3mm
• Coronal reformat

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Pelvic/Hip CT - Indications

• Pelvic trauma
• Evaluate complex pelvic fracture/dislocation
• Loose bodies

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Imaging Parameters in Musculoskeletal Multislice
CT Protocols
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Pelvic/Hip CT - Parameters

• Plane axial
• Section thickness 3 - 5mm
• Pitch 1 1.5
• Kernal bone, standard
• Reformat optional coronal and sagittal
• Optional SSD and volume-rendered

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Sacral CT

• Evaluation of sacral trauma and arthropathy
• Direct oblique coronal scan along the long axis
  of the sacrum

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Knee CT Indication

• Tibial plateau fracture
• Patellar fracture
• Loose bodies

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Knee CT - Parameters

• Plane axial
• Section thickness 2 3mm
• Pitch 1 1.5
• Reconstruction interval 1 1.5
• Kernal bone, standard
• Reformat sagittal and coronal