Musculoskeletal Computed Tomography Imaging: A 30-Year Perspective

Computed tomography remains essential in musculoskeletal imaging, offering superior spatial resolution and contrast for detailed assessment of bone anatomy and fractures, as well as for evaluation in the pre-and postoperative settings. Decades of technological progress-from helical to advanced high-resolution, dose-efficient systems-have reinforced the central role of computed tomography in bone imaging.Expanding beyond static skeletal assessment, spectral computed tomography enables characterization of crystal deposits, marrow edema, and metal artifact reduction; weight-bearing cone-beam computed tomography assesses joint alignment; computed tomography arthrography offers a radiation-based alternative to magnetic resonance imaging to assess internal joint disorders; and dynamic computed tomography provides insight into joint motion.Emerging technologies such as photon-counting computed tomography promise unprecedented spatial and spectral performance with reduced dose. Synthetic computed tomography derived from magnetic resonance imaging data integrates osseous detail without radiation exposure.This 30-year perspective reviews major technological advances, highlights current clinical applications, and explores future directions shaping the role of computed tomography in musculoskeletal imaging.