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Muskoskeletal radiology

Interventional radiology

Sinography and fistulography

Musculoskeletal infections with development of sinus tracts or fistulas are not uncommon. It is essential for the surgeon to know the relationship of the sinus tract or fistula to vital structures, such as nerves and vessels but also to joints, bones, and, in some cases, endoprostheses. Contrast medium is injected through a thin catheter or cone-shaped needle introduced into the sinus tract or fistula, and contrast opacification is observed

a	Figure 101. Sinography in a patient with chronic osteomyelitis. a) It is not possible with conventional technique to determine the relationship of the sinus tract system to bone, vessels, or nerves. b) This relationship is clearly shown with CT, however.
b

under fluoroscopy. Precise assessment of the exact anatomic location of the sinus tracts or fistulas may require CT (Fig. 101).

Diagnostic biopsy

Biopsy of pathologic lesions in bone or soft tissue is an important diagnostic procedure. Biopsy may be done as a fine needle aspiration or with larger (trephine) needles (1 to 5 mm in diameter) during fluoroscopic, ultrasonographic, or CT guidance. CT -guided biopsy is important in certain regions of the skeleton, especially in the upper part of the thoracic spine, where it is difficult to assess the region with fluoroscopy. Even small lesions may be biopsied in this way (Fig. 102).

Angiography

A major indication for angiography is localization of sites of vascular damage and embolization of sites of bleeding, especially in the pelvis and with certain vascular malformations in the soft tissue.

Arthrography

This interventional method was described previously in this chapter.

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Figure 102.
CT-guided biopsy of infective spondylitis.
The patient is examined in the prone position. The most informative CT section through the area of destruction is chosen. Guided by the CT image, the needle is directed towards the area of destruction and the correct position is verified with additional CT scans.

Niels Egund, Kjell Jonsson, Holger Pettersson and Donald Resnick