Computed tomography of bones and joints

The monograph sums up the problem of CT diagnosis of bones and joints making use of predominantly the authors' own experience based on CT tests of more than 45,000 patients examined at the Department of Radiology, Charles University Medical Faculty of Hygiene teaching hospital in Prague in the years 1980-1988. Specific scans of the skeleton were made in 4,500 patients, mostly for suspicion or closer assessment of neoplasms (43.5%), the radicular lumbosacral syndrome (34.5%), and injuries (12%). The opening chapters sum up basic facts about the principle of computed tomography, the apparatus in use, the evaluation of CT images, CT radiation doses, and the patients' preparation for CT scanning. The use of contrast media is discussed with regard to the possible hazards involved and to the need to hear allergological opinion first. For spinal canal visualization non-ionogenic contrast media are used exclusively. The management of side reactions to contrast medium application is also reviewed. Indications for bone and joint computed tomography now comprise a whole series of traumatological, orthopaedic, oncological, rheumatological, neurological and rehabilitation conditions, each of which is discussed in detail in a separate chapter. CT anatomical studies offer the advantage of being applicable even in patients examined for other than bone or articular diseases. The option of simultaneous soft tissue assessment represents another advantage. The authors describe different anatomical structures in terms of CT images, some of them complete with dimensional and density values. The chapter on anomalies and developmental variants stresses the relevance of computed tomography for precise characteristics of clefts of the spinal column and facial bones and for the diagnosis of anomalies and dysplasias of the spinal column and the chest. A rare case of cephalothoracopagus is demonstrated. As for traumatology, computed tomography is found useful in diagnosing fractures of the orbit and facial bones in general, the atlas, axis and pelvis and in tracing vertebral fragments displaced into the spinal canal. Computed tomography occupies a monopoly position in the diagnosis of post-injury haematomas of intracranial but also thoracic, pelvic and abdominal localization. There is a wealth of illustrations to document a wide range of traumatic conditions. The chapter on degenerative diseases is focused mainly on computed tomography in the lumbosacral radicular syndrome, one of the most frequent and also most effective indications for CT. Protrusion and herniation of the intervertebral disk and sequestra in the spinal canal are all absolute indications for CT scanning where surgical treatment is contemplated.(ABSTRACT TRUNCATED AT 400 WORDS)