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Computed tomography 

Computed tomography
Computed tomography
Oxford Textbook of Rheumatology (4 ed.)

Geoff Hide

and Jennifer Humphries

Previous versions of this chapter are available. To view earlier versions of this chapter view the full site here.

Computed tomography (CT), along with its cross-sectional partner MRI, continues to evolve apace. Although MRI retains the larger role in the musculoskeletal system due to its unparalleled soft tissue contrast and, not least, its lack of ionizing radiation, CT offers significant advantages in many areas. Imaging acute trauma is more rapid with CT, allowing ‘whole body’ assessment of patients following polytrauma, and CT is more useful than MRI in demonstrating the configuration of fractures, aiding surgical planning. CT can clearly identify cortical bone and areas of calcification, making the diagnosis of tarsal coalitions straightforward and facilitating the diagnosis and characterization of bone tumours such as osteoid osteoma and chondroid lesions. CT arthrography supplements standard imaging with intra-articular contrast to allow the detection of subtle joint abnormalities, and CT can demonstrate needles precisely within bone and soft tissue to enable the performance of complex image-guided procedures. Developments in CT have been especially rapid in the past decade and although this has particularly impacted on cardiac imaging, other areas of medicine, including rheumatology, have benefited. High multislice scanners can obtain data for a volume of tissue allowing reconstruction of slices with exceptional detail in any plane, and can rapidly image large areas of the body such as the spine. CT is responsible for a large proportion of the population’s medical radiation exposure. Although techniques allowing reduction in dose continue to advance, radiologists and referrers retain responsibility to ensure that requests for CT examinations are necessary and justifiable.

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