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Low-Dose Computed Tomography Arthrography Using Tin-Filter Technology: Advancing High-Resolution Cartilage Evaluation
Nikolai Schmid1, Simone Schüle2, Markus Rienecker3
1Bundeswehr Institute of Radiobiology, Neuherbergstraße 11, 80937 Munich, Germany (N.S.); Federal Armed Forces Hospital Ulm, Department of Radiology and Neuroradiology, Oberer Eselsberg 40, 89081 Ulm, Germany (N.S., S.S., M.R., C.H.).
Rationale And Objectives:
Arthrographic imaging is essential for diagnosing and managing joint pathologies. Computed tomography arthrography (CTA) offers high spatial resolution and can complement or replace magnetic resonance imaging (MRI) when needed. Dose-reduction methods are crucial due to the significant radiation exposure from radiological procedures. This study explores the use of tin-filter technology in musculoskeletal radiology to reduce radiation dose without compromising image quality.
Materials And Methods:
39 sonographically guided joint fillings were conducted with no reported complications. Tin-filter CTA with tube voltage of 100 kVp was conducted for all patients, with radiation exposure metrics (DLP, CTDIVol) recorded and imaging results compared to MRI and if available arthroscopy for diagnostic accuracy. Four independent readers rated the images subjective quality by a range of different items like diagnostic suitability for assessing cartilage damage. For the objective image assessment, the contrast-to-noise ratio (CNR) and Signal-to noise ratio (SNR) were used.
Results:
Tin-filter CTA achieved a mean DLP of 19.37 mGy-cm (± 4.3). High subjective image quality was maintained (diagnostic grade: 1.71; intraclass correlation coefficient: 0.966). The mean CNR was 97.92 (± 34.65) for bone and 135.24 (± 68.56) for the contrast agent. Similarly, the mean SNR was 91.85 (± 32.74) for bone and 129.18 (± 67.44). Cartilage damage was identified in 69.2% of cases, with 78.9% confirmation in arthroscopy. CTA aligned with MRI findings in 74.1% of cases.
Conclusion:
Tin-filter CTA, combined with sonographically guided joint filling, is a low-radiation, high-resolution method for assessing ankle joint cartilage. Its ability to detect subtle damage makes it invaluable for surgical planning, especially for patients with metal implants or inconclusive MRI results.
