This is an education resource only. Ordering of all procedure codes on this website are subject to the Canberra Health Services guidelines for imaging orders.
CT ANKLE CONTRAST
FOR ALL EXTREMITIES, PLEASE REFERENCE SIDE AND REGION OF INTEREST TO BE SCANNED IN CT REQUEST
INDICATIONS (1-4)
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Post-operative evaluation
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Ankle Soft tissue mass (X-ray and US non-diagnostic & MRI Contraindicated), particularly if concern for mass adjacent to bone or vascular malformation suspected.
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Osteomyelitis/Septic arthritis of the ankle:
- Arthroplasty or implanted intra-articular surgical hardware -
- X-ray suggests a joint effusion or soft tissue swelling
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Soft tissue infection of the ankle:
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- Puncture wound, possible foreign body, joint effusion and/or soft tissue swelling.
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- X-ray normal, necrotizing fasciitis highly suspected
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- Soft tissue gas on radiography, no puncture wound
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- X-ray findings suggest joint effusion or soft tissue swelling
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* please note: there may be other imaging modalities that are more suitable for these indications
PATIENT PREPARATION
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Patient able to lie still for ten minutes
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Not claustrophobic (sedation may be given)
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Cognitively capable of following basic instructions
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Metal artefacts removed from the region of interest, including bra’s
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No respiratory distress when lying supine
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Not allergic to Iodine based Contrast
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No known kidney disease (eGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function
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No hyperthyroidism, may induce thyroid storm
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Patient to have 20G cannula in anterior cubital fossa.
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Preferably patient fasted for 4 hours
ANATOMY INCLUDED
SCAN RANGE: Distal third of tibia/fibula to mid metatarsals (or to include area of interest i.e fracture)
CT Ankle Contrast- Soft tissue window (axial)
CT Ankle Contrast- Bone window (axial)
CT Ankle Contrast- Soft tissue window (coronal)
CT Ankle Contrast- Bone window (coronal)
CT Ankle Contrast- Soft tissue window (sagittal)
CT Ankle Contrast- Bone window (sagittal)
CT ANKLE NON CONTRAST
FOR ALL EXTREMITIES, PLEASE REFERENCE SIDE AND REGION OF INTEREST TO BE SCANNED IN CT REQUEST
INDICATIONS (1-4)
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Ankle trauma:
- Continued pain >1wk and <3wks, x-ray negative
- Fracture on x-ray, particularly if complex fracture.
- Osteochondral injury suspected on x-ray, next imaging
- Alignment abnormality on x-ray or physical exam, dislocation or syndesmotic injury suspected, next imaging -
Chronic ankle pain, gout or pseudogout suspected, (x-ray inconclusive), consider dual energy CT.
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Primary tumour suspected of ankle- osteoid osteoma suspected on x-ray or clinical exam
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Soft tissue infection of the ankle (iodinated contrast contraindicated)
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Osteonecrosis of ankle, articular collapse on x-ray, preoperative planning
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Fracture union and healing
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Post-operative follow-up
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Pre-operative planning
PATIENT PREPARATION
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Patient able to lie still for five minutes
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Not claustrophobic (sedation may be given)
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Cognitively capable of following basic instructions
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Metal artefacts removed from the region of interest
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No respiratory distress when lying supine
ANATOMY INCLUDED
SCAN RANGE: Distal third of tibia/fibula to mid metatarsals (or to include area of interest i.e fracture)
CT Ankle Non Contrast- Bone window (axial)
CT Ankle Non Contrast- Bone window (coronal)
CT Ankle Non Contrast- Bone window (sagittal)
CT Ankle Non Contrast- Soft tissue window (axial)
REFERENCES
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Radiopaedia. CT ankle (protocol). [Internet]. 2010 [updated 23 March 2023, cited 04 Feb 2024]. Available from https://radiopaedia.org/articles/ct-ankle-protocol-1?lang=gb
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Melenevsky Y, Mackey R, Abrahams R, Thomson N. Talar Fractures and Dislocations: A Radiologist’s Guide to Timely Diagnosis and Classification. Radiographics. 2015;35(3):765-79. doi:10.1148/rg.2015140156 – Pubmed
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Johnson, P. T., Fayad, L. M., & Fishman, E. K. (2007). CT of the foot. Journal of Computer Assisted Tomography, 31(6), 961–969. https://doi.org/10.1097/rct.0b013e318043a1d8
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American College of Radiology (ACR). Appropriateness Criteria. [ Internet]. 2022 [Updated 2023, Cited 20 Jan 2024]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria