Ulas Sevtap Tugce, Diekhoff Torsten
Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Charitéplatz 1, Berlin 10117, Germany.
Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany.
Ther Adv Musculoskelet Dis. 2024 Oct 8;16:1759720X241287373. doi: 10.1177/1759720X241287373. eCollection 2024.
Applications of computed tomography (CT) in arthritis imaging have rapidly expanded in recent years due to ongoing technical developments. Dual-energy CT (DECT) has become indispensable in clinical practice, particularly for diagnosing gouty arthritis and assessing bony structural changes. Technological innovations such as low-dose CT and state-of-the-art reconstruction algorithms reduce radiation exposure while maintaining image quality and short acquisition times. This review explores the growing role of CT in arthritis imaging. Recent innovations have extended DECT's utility beyond gout diagnosis to the detection of inflammatory changes in various arthritic conditions. Postprocessing techniques such as the generation of subtraction images and iodine maps provide valuable insights into tissue perfusion and inflammatory activity, crucial for arthritis management. DECT can distinguish calcium from uric acid crystals, facilitating the differential diagnosis of various crystal arthropathies in a variety of clinical settings. This ability is particularly valuable in distinguishing between different clinical conditions in patients with inflammatory joint changes within a single imaging examination. Moreover, the advent of four-dimensional CT promises a better assessment of dynamic joint instabilities and ligament injuries, especially in the wrist. Overall, DECT offers a comprehensive approach to arthritis imaging, from the detection of structural changes to the assessment of active inflammation in joints and tendons. Continuous advances in CT technology, including photon-counting CT, hold promise for further improving diagnostic accuracy and expanding the role of CT in arthritis imaging and therapy monitoring.
近年来，由于技术的不断发展，计算机断层扫描（CT）在关节炎成像中的应用迅速扩展。双能CT（DECT）在临床实践中已变得不可或缺，特别是在诊断痛风性关节炎和评估骨质结构变化方面。低剂量CT和先进的重建算法等技术创新在保持图像质量和缩短采集时间的同时减少了辐射暴露。本综述探讨了CT在关节炎成像中日益重要的作用。最近的创新已将DECT的效用从痛风诊断扩展到检测各种关节炎病症中的炎症变化。诸如生成减影图像和碘图等后处理技术为组织灌注和炎症活动提供了有价值的见解，这对关节炎的管理至关重要。DECT可以区分钙和尿酸晶体，有助于在各种临床环境中对各种晶体性关节病进行鉴别诊断。这种能力在单次成像检查中区分炎症性关节变化患者的不同临床病症时特别有价值。此外，四维CT的出现有望更好地评估动态关节不稳定和韧带损伤，尤其是在腕关节。总体而言，DECT为关节炎成像提供了一种全面的方法，从检测结构变化到评估关节和肌腱中的活动性炎症。CT技术的不断进步，包括光子计数CT，有望进一步提高诊断准确性，并扩大CT在关节炎成像和治疗监测中的作用。
