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Demehri S, Baffour FI, Klein JG, Ghotbi E, Ibad HA, Moradi K, Taguchi K, Fritz J, Carrino JA, Guermazi A, Fishman EK, Zbijewski WB. Musculoskeletal CT Imaging: State-of-the-Art Advancements and Future Directions. Radiology 2023; 308:e230344. [PMID: 37606571 PMCID: PMC10477515 DOI: 10.1148/radiol.230344] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 08/23/2023]
Abstract
CT is one of the most widely used modalities for musculoskeletal imaging. Recent advancements in the field include the introduction of four-dimensional CT, which captures a CT image during motion; cone-beam CT, which uses flat-panel detectors to capture the lower extremities in weight-bearing mode; and dual-energy CT, which operates at two different x-ray potentials to improve the contrast resolution to facilitate the assessment of tissue material compositions such as tophaceous gout deposits and bone marrow edema. Most recently, photon-counting CT (PCCT) has been introduced. PCCT is a technique that uses photon-counting detectors to produce an image with higher spatial and contrast resolution than conventional multidetector CT systems. In addition, postprocessing techniques such as three-dimensional printing and cinematic rendering have used CT data to improve the generation of both physical and digital anatomic models. Last, advancements in the application of artificial intelligence to CT imaging have enabled the automatic evaluation of musculoskeletal pathologies. In this review, the authors discuss the current state of the above CT technologies, their respective advantages and disadvantages, and their projected future directions for various musculoskeletal applications.
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Affiliation(s)
- Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Francis I. Baffour
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Joshua G. Klein
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Elena Ghotbi
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Hamza Ahmed Ibad
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Kamyar Moradi
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Katsuyuki Taguchi
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Jan Fritz
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - John A. Carrino
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Ali Guermazi
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Elliot K. Fishman
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
| | - Wojciech B. Zbijewski
- From the Russell H. Morgan Department of Radiology and Radiological
Science (S.D., J.G.K., E.G., H.A.I., K.M., K.T., E.K.F.) and Department of
Biomedical Engineering (W.B.Z.), Johns Hopkins University School of Medicine,
601 N Carolina St, Baltimore, MD 21287; Division of Musculoskeletal Imaging,
Department of Radiology, Mayo Clinic, Rochester, Minn (F.I.B.); Department of
Radiology, New York University Grossman School of Medicine, New York, NY (J.F.);
Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY
(J.A.C.); and Department of Radiology, Quantitative Imaging Center, Boston
University School of Medicine, Boston, Mass (A.G.)
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Buzzatti L, Keelson B, Vanlauwe J, Buls N, De Mey J, Vandemeulebroucke J, Cattrysse E, Scheerlinck T. Evaluating lower limb kinematics and pathology with dynamic CT. Bone Joint J 2021; 103-B:822-827. [PMID: 33934642 DOI: 10.1302/0301-620x.103b5.bjj-2020-1064.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Evaluating musculoskeletal conditions of the lower limb and understanding the pathophysiology of complex bone kinematics is challenging. Static images do not take into account the dynamic component of relative bone motion and muscle activation. Fluoroscopy and dynamic MRI have important limitations. Dynamic CT (4D-CT) is an emerging alternative that combines high spatial and temporal resolution, with an increased availability in clinical practice. 4D-CT allows simultaneous visualization of bone morphology and joint kinematics. This unique combination makes it an ideal tool to evaluate functional disorders of the musculoskeletal system. In the lower limb, 4D-CT has been used to diagnose femoroacetabular impingement, patellofemoral, ankle and subtalar joint instability, or reduced range of motion. 4D-CT has also been used to demonstrate the effect of surgery, mainly on patellar instability. 4D-CT will need further research and validation before it can be widely used in clinical practice. We believe, however, it is here to stay, and will become a reference in the diagnosis of lower limb conditions and the evaluation of treatment options. Cite this article: Bone Joint J 2021;103-B(5):822-827.
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Affiliation(s)
- Luca Buzzatti
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Benyameen Keelson
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Johan Vanlauwe
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics, Vrije Universiteit Brussel, Brussels, Belgium.,Interuniversity Microelectronics Centre, Leuven, Belgium
| | - Erik Cattrysse
- Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Mousavian A, Shakoor D, Hafezi-Nejad N, Haj-Mirzaian A, de Cesar Netto C, Orapin J, Schon LC, Demehri S. Tibiofibular syndesmosis in asymptomatic ankles: initial kinematic analysis using four-dimensional CT. Clin Radiol 2019; 74:571.e1-571.e8. [PMID: 31076084 DOI: 10.1016/j.crad.2019.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/19/2019] [Indexed: 12/26/2022]
Abstract
AIM To evaluate the reliability of ankle syndesmotic measurements and their changes during active motion using four-dimensional computed tomography (4DCT) examination in asymptomatic ankles. MATERIALS AND METHODS 4DCT was performed on both ankles of patients with signs and symptoms of unilateral ankle instability. Ankles from the asymptomatic side of 10 consecutive patients were included in this analysis. Five ankle syndesmotic measurements were adopted from the available literature and performed by two fellowship-trained foot and ankle surgeons: (1) syndesmotic anterior distance (SAD); (2) syndesmotic posterior distance (SPD); (3) syndesmotic translation (ST); (4) syndesmotic tibiofibular angle (STFA); and (5) ankle tibiofibular angle (ATFA). A Monte Carlo simulation was also performed to obtain exact p-values with 99% confidence intervals. RESULTS Excellent interobserver reliability was observed among the two readers for four out of five measurements (intra-class correlation coefficients [ICC]: 0.767-0.995, p<0.001-0.020). The ICC values for SAD were not statistically significant (ICC=0.548 and 0.569 for dorsi and plantarflexion respectively, p=0.1). Among the five measurements, only ST measurements had significant changes during active motion (median [interquartile range] for change: -0.70 mm [-1.6-0.10]; p=0.012). Of the above measurements, only the ST measurements demonstrated a negative linear association with the tibiocalcaneal angle during active motion (beta=-2.5, p=0.04). CONCLUSIONS Reliable quantitative kinematic assessment of ankle syndesmosis can be performed using 4DCT examination. Syndesmotic measurements remain unchanged during ankle motion except for the syndesmotic translation, which tends to decrease during plantar flexion.
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Affiliation(s)
- A Mousavian
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - D Shakoor
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA.
| | - N Hafezi-Nejad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - A Haj-Mirzaian
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - C de Cesar Netto
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - J Orapin
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - L C Schon
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
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