title: 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.
abstract: OBJECTIVE
  The purpose of this study is to compare the diagnostic performance and radiation exposure of flat-panel CT arthrography for cartilage defect detection in the ankle joint to standard MDCT arthrography, using gross anatomy and thermoluminescent dosimetry as reference standards.
  
  
  METHODS
  Ten cadaveric ankle specimens were obtained from individuals who had willed their bodies to science. Five milliliters of a mixture of diluted ioxaglate and saline were injected. Specimens were examined consecutively with the use of flat-panel CT and MDCT. Radiation doses of flat-panel CT and MDCT were recorded using thermoluminescent dosimeters. Flat-panel CT and MDCT arthrography examinations were blinded and randomly evaluated by two musculoskeletal radiologists in consensus. In each ankle specimen, eight cartilage areas were assessed separately: medial talar surface, medial talar trochlea, lateral talar trochlea, lateral talar surface, tibial malleolus, medial tibial pla-fond, lateral tibial plafond, and fibular malleolus. Findings at flat-panel CT and MDCT arthrography were compared with macroscopic assessments in 80 cartilage areas.
  
  
  RESULTS
  For the detection of cartilage lesions, flat-panel CT showed a sensitivity of 80%, specificity of 98%, and accuracy of 94%, and MDCT arthrography showed a sensitivity of 55%, specificity of 98%, and accuracy of 88%. Flat-panel CT and MDCT arthrography showed almost perfect (κ = 0.83) and substantial (κ = 0.65) agreement, respectively, with anatomic examination. Radiation dose was significantly lower for flat-panel CT (mean, 2.1 mGy; range, 1.1-3.0 mGy) than for MDCT (mean, 47.2 mGy; range, 39.3-53.8 mGy) (p < 0.01).
  
  
  CONCLUSIONS
  Flat-panel CT arthrography is accurate for detecting cartilage defects in the ankle joint and is an alternative to MDCT arthrography that may have better diagnostic performance and may permit the use of a lower radiation dose.
authors.affiliation: 1 Radiology Department, APHM, Hôpital Sainte Marguerite, 270 Blvd de Sainte Marguerite, 13009 Marseille, France.
authors.forename: David
authors.initials: D
authors.lastname: Chemouni
authors.forename: Pierre
authors.initials: P
authors.lastname: Champsaur
authors.forename: Daphné
authors.initials: D
authors.lastname: Guenoun
authors.forename: Julie
authors.initials: J
authors.lastname: Desrousseaux
authors.forename: Vanessa
authors.initials: V
authors.lastname: Pauly
authors.forename: Thomas
authors.initials: T
authors.lastname: Le Corroller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000000981:diagnostic imaging*; D001175:Arthrography / Q000295:instrumentation*; D002102:Cadaver; D002357:Cartilage Diseases / Q000000981:diagnostic imaging*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000295:instrumentation*; D011829:Radiation Dosage; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014963:X-Ray Intensifying Screens
keywords: CT; MRI; anatomy; ankle; arthrography; flat-panel