W516 AJR:194, June 2010
Zubler et al.
o conventional radiography and CT or ex-plaining the osseous causes o elbow stiness.
Material and Methods
Two hundred seven consecutive patients re-erred or CT or CT arthrography o the elbow be-tween September 2004 and September 2008 wereidentied in our PACS system. Patients older than18 years were included in the study when conven-tional radiography was perormed within 100 daysbeore or ater CT without any elbow surgery inbetween. Patients were excluded when image qual-ity was nondiagnostic (motion artiact, absence o secondary reormation,
= 3), in the presence o a tumor (
= 12), ater a recent racture or dislo-cation (within 6 months beore CT) (
= 13), pres-ence o an elbow prosthesis (
= 6), hemophiliacarthropathy (
= 2), posttraumatic pseudoarticula-tion o the humerus (
= 2), severe posttraumaticdeormity o the joint (
= 4), extensive osteosyn-thesis material (
= 2), ankylosis o the joint (
=2), and spasm o the triceps muscle caused by abirth deect (brachial plexus damage) (
= 1).The nal study group consisted o 94 patients(71 men and 23 women [mean age, 41 years; range,18–68 years]). Thirty-seven patients (37/94, 39%)underwent standard CT, and 57 patients (57/94,61%) underwent CT arthrography. Fity-eight o the 94 patients (62%) underwent surgery within190 days (mean, 43.4 days; range 0–190 days) a-ter CT. Twenty-eight o these 58 (48%) underwentopen surgery; 27 o 58 (47%), arthroscopy; andthree o 58 (5%), implantation o a prosthesis. Sur-gery and arthroscopy included débridement, re-section o osteophytes, removal o loose bodies,releasing o brosis, resection o plicae, neurolysiso the ulnar nerve, and the Outerbridge-Kashiwa-gi procedure. In each patient, only one elbow wasevaluated (34 let elbows, 60 right elbows). Themean interval between conventional radiographyo the elbow and CT or CT arthrography was 32days (range, 0–98 days). Our institutional reviewboard does not require approval or inormed con-sent or the retrospective review o patient recordsor images. However, patients’ rights are protectedby a law that requires that they must be inormedthat their charts and images might be reviewed orscientic purposes and that grants patients the op-portunity to orbid such use o their data. All pa-tients agreed to the use o their data.
Conventional Radiography, CT, and CT Arthrography
Conventional radiographic assessment includ-ed anteroposterior views (sitting patient, arm 90°elevated, elbow extended (i possible), wrist supi-nated, beam orientation anteroposterior) and lateralviews o the elbow (sitting patient, arm 90° elevat-ed, elbow fexion 90° [i possible], beam orientationrom radial to ulnar). Intraarticular contrast medi-um was injected in a standardized ashion. CT wasperormed on a Somatom Plus 4 scanner (SiemensHealthcare) (57 o 94, 61%) and on a Brilliance CT40 scanner (Philips Healthcare) (37 o 94, 39%)The imaging parameters were ultra high resolu-tion; 120 kV; 150 mAs; collimation, 20 × 0.625;matrix, 150; thickness, 0.67; increment, 0.33; win-dow center, 450; and window width, 2,000. Trans-versal, coronal, and sagittal reormations were per-ormed (thickness, 2.0; increment, 2.0). Patientswere examined in the prone position with the armextend i possible over the head and the orearm asextended as ar as possible. Thirty-seven patients(37/94, 39%) underwent standard CT and 57 pa-tients (57/94, 60%) underwent CT arthrography.
26-year-old man with clinically 20° restriction o extension and 25° restriction o fexion.
Lateral conventional radiograph obtained anteriorly in ossa coronoidea shows apparent small osteophyte(
). Not clearly visible are osteophytes in ossa olecrani and loose body.
Transverse CT image shows large osteophytes (
) in ossa coronoidea and ossa olecrani.
Sagittal CT reormation image (
) shows osteophytes in ossa coronoidea and ossa olecrani andloose body in anterior aspect o joint. Diagram (
) shows angles ormed with rays connecting maximal extento loose bodies (a
) or osteophytes (b
[posterior]) to center o capitulum humeri. By adding thesemeasured angles, degree o compromise was estimated separately or fexion and extension.
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