MR and CT arthrography in cartilage imaging Indications and implementation

Background The imaging of chondral pathologies is an essential part in the work-up of acute and chronic joint diseases. Besides conventional MR imaging, CT and MR arthrography are well-established methods in evaluating articular cartilage. The application of these techniques requires knowledge of indications and safe injection procedures by the performing radiologist. Purpose Our goal is to describe the techniques of cross-sectional arthrographies of different joints, give an overview of general and joint-specific considerations for practical application as well as provide typical indications for cartilage imaging. Materials and methods A selective PubMed literature search concerning arthrography, CT arthrography, MR arthrography, arthrography cartilage, arthrography wrist, arthrography elbow, arthrography shoulder, arthrography hip, arthrography knee, arthrography ankle, arthrography complications, arthrography imaging guidance osteochondral lesion, cartilage imaging and cartilage lesion was performed. Results and conclusion CT and MR arthrography are valuable and safe tools in cartilage imaging. They are useful to verify and specify chondral pathologies, usually after conventional MR imaging, and have an important role in evaluating the stability and therefore in therapeutic decision making of osteochondral lesions. CT arthrography is not only a substitute technique in case of MR contraindications, it can be advantageous in small joints (wrist, elbow, ankle) compared to MR arthrography due to its higher image resolution. Fluoroscopic guided joint puncture is still the most commonly used image guidance method, but the role of ultrasound is steadily increasing. Joint traction in MR arthrography is a promising technique to improve cartilage visualization, though it is not yet used in clinical routine imaging.