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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: 14] [Impact Index Per Article: 14.0] [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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Abstract
PURPOSE OF REVIEW Imaging plays a pivotal role for diagnosis, follow-up and stratification of osteoarthritis patients in clinical trials and research. We aim to present an overview of currently available and emerging imaging techniques for osteoarthritis assessment and provide insight into relevant benefits and pitfalls of the different modalities. RECENT FINDINGS Although radiography is considered sufficient for a structural diagnosis of osteoarthritis and is commonly used to define eligibility of patients for participation in clinical trials, it has inherent limitations based on the projectional nature of the technique and inherent challenges regarding reproducibility in longitudinal assessment. MRI has changed our understanding of the disease from 'wear and tear' of cartilage to a whole organ disorder. MRI assessment of structural changes of osteoarthritis includes semi-quantitative, quantitative and compositional evaluation. Ultrasound is helpful in evaluating the degree of synovitis and has value in the assessment particularly of the patella-femoral joint. Recent development of computed tomography technology including weight-bearing systems has led to broader application of this technology in a research context. SUMMARY Advances in MRI technology have resulted in a significant improvement in understanding osteoarthritis as a multitissue disease.
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Affiliation(s)
- Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Frank W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
- Department of Radiology, VA Boston Healthcare System, Boston, Massachusetts, USA
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Ibad HA, de Cesar Netto C, Shakoor D, Sisniega A, Liu S, Siewerdsen JH, Carrino JA, Zbijewski W, Demehri S. Computed Tomography: State-of-the-Art Advancements in Musculoskeletal Imaging. Invest Radiol 2023; 58:99-110. [PMID: 35976763 PMCID: PMC9742155 DOI: 10.1097/rli.0000000000000908] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Although musculoskeletal magnetic resonance imaging (MRI) plays a dominant role in characterizing abnormalities, novel computed tomography (CT) techniques have found an emerging niche in several scenarios such as trauma, gout, and the characterization of pathologic biomechanical states during motion and weight-bearing. Recent developments and advancements in the field of musculoskeletal CT include 4-dimensional, cone-beam (CB), and dual-energy (DE) CT. Four-dimensional CT has the potential to quantify biomechanical derangements of peripheral joints in different joint positions to diagnose and characterize patellofemoral instability, scapholunate ligamentous injuries, and syndesmotic injuries. Cone-beam CT provides an opportunity to image peripheral joints during weight-bearing, augmenting the diagnosis and characterization of disease processes. Emerging CBCT technologies improved spatial resolution for osseous microstructures in the quantitative analysis of osteoarthritis-related subchondral bone changes, trauma, and fracture healing. Dual-energy CT-based material decomposition visualizes and quantifies monosodium urate crystals in gout, bone marrow edema in traumatic and nontraumatic fractures, and neoplastic disease. Recently, DE techniques have been applied to CBCT, contributing to increased image quality in contrast-enhanced arthrography, bone densitometry, and bone marrow imaging. This review describes 4-dimensional CT, CBCT, and DECT advances, current logistical limitations, and prospects for each technique.
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Affiliation(s)
- Hamza Ahmed Ibad
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Delaram Shakoor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen Liu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - John A. Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Shadpour Demehri
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kinematic Tibiofibular Syndesmotic Measurements as Indicators of Tibiotalar Osteoarthritis: Exploratory Analysis Using 4-Dimensional Computed Tomography. J Comput Assist Tomogr 2022; 46:633-637. [PMID: 35483097 DOI: 10.1097/rct.0000000000001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between 4-dimensional computed tomography (4DCT)-derived measurements of tibiofibular syndesmosis during active dorsiflexion-plantarflexion motion and the presence of tibiotalar osteoarthritis (OA). METHODS Sixteen ankle joints underwent 4DCT imaging during active dorsiflexion-plantarflexion. Syndesmotic anterior distance (SAD) and syndesmotic translation (ST) were obtained by a foot-and-ankle surgeon. We used Kellgren-Lawrence (KL) grading to determine tibiotalar OA. RESULTS Of 16 scanned ankles, 12 ankles had KL ≥2 at the tibiotalar joint. In these ankles, SAD (-0.4, P = 0.02) and ST (-0.9, P = 0.006) measurements significantly changed during the dorsiflexion-plantarflexion motion. Changes in SAD measurements were significantly correlated with the KL grades (correlation coefficient: -0.688, P = 0.003); however, the changes in ST measurements were not significantly correlated with the KL grade. CONCLUSIONS Our exploratory cross-sectional analysis shows that SAD measurement changes during motion using 4DCT are correlated with the tibiotalar OA grading. This measurement may be used but requires confirmation in larger studies including patients with actual syndesmotic injuries.
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Kreulen RT, Nayar SK, Alfaki Y, LaPorte D, Demehri S. Advanced Imaging of Ulnar Wrist Pain. Hand Clin 2021; 37:477-486. [PMID: 34602127 DOI: 10.1016/j.hcl.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Ulnar-sided wrist pain can be a diagnostic challenge for clinicians and radiologists. The ulnar wrist has complex morphology and is composed of many small bone and soft tissue structures. Within these structures, a wide variety of pathologic conditions can occur. To successfully diagnose and treat these pathologic conditions, clinicians and radiologists must have a strong understanding of the advanced imaging techniques available to them. In this review, the authors present a brief review of the normal ulnar wrist anatomy, discuss the differential diagnosis of ulnar-sided wrist pain, and examine the indications for different advanced imaging modalities.
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Affiliation(s)
- R Timothy Kreulen
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA.
| | - Suresh K Nayar
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Yasmin Alfaki
- Johns Hopkins University, 3400 North Charles Street, Mason Hall, Baltimore, MD 21218, USA
| | - Dawn LaPorte
- Johns Hopkins Department of Orthopaedic Surgery, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
| | - Shadpour Demehri
- Johns Hopkins Department of Musculoskeletal Radiology, 601 North Caroline Street 5th Floor, Baltimore, MD 21205, USA
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Kimura H, Sato K, Matsumura N, Suzuki T, Iwamoto T, Ohori K, Yamada Y, Matsumoto M, Nakamura M, Jinzaki M, Nagura T. Evaluation of Dynamic Carpal Arch Stability following Carpal Tunnel Release Using Four-Dimensional Computed Tomography. J Hand Microsurg 2021; 13:138-142. [PMID: 34511829 PMCID: PMC8426082 DOI: 10.1055/s-0040-1718969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction This study aimed to assess the carpal arch dynamics during active finger and wrist motion following carpal tunnel release using four-dimensional computed tomography (4D-CT). Materials and Methods Four patients who diagnosed with bilateral carpal tunnel syndrome and underwent unilateral carpal tunnel release were prospectively included. 4D-CT of the bilateral wrists during active finger and wrist motion was performed for 10 seconds at five frames per second. The distances between the tip of tuberosity of the scaphoid and the volar ridge of the pisiform (S-P distance) and volar ridge of trapezium and the tip of hook of hamate (T-H distance) were measured at each position and the values of S-P and T-H distances were compared between the postoperative and contralateral wrists. Results During finger motion, the S-P and T-H distances were not different at any position between the postoperative side and contralateral side. Conversely, S-P and T-H distances gradually increased in the postoperative wrists. The differences between the sides of S-P distance were significant, with >0 degrees of wrist extension, and differences of T-H distance were significant with >15 degrees of wrist extension. Conclusion This study demonstrated the carpal arch dynamics using 4D-CT and revealed that the carpal arch was widened with the wrist in extension after carpal tunnel release. This study suggests that the transverse carpal ligament plays an important role in maintaining carpal arch stability.
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Affiliation(s)
- Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kuniaki Ohori
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Robinson S, Straatman L, Lee TY, Suh N, Lalone E. Evaluation of Four-Dimensional Computed Tomography as a Technique for Quantifying Carpal Motion. J Biomech Eng 2021; 143:061011. [PMID: 33564841 DOI: 10.1115/1.4050129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Indexed: 11/08/2022]
Abstract
Delayed diagnosis of dynamic carpal instability often occurs because early changes in bone alignment and movement are difficult to detect and manifest mainly during a dynamic/functional task. Current diagnostic tools are only able to examine the carpal bones under static or sequential-static conditions. Four-dimensional (three dimensions + time) computed tomography (4DCT) enables quantification of carpal mechanics through 3D volume sequences of the wrist in motion. A comprehensive understanding of carpal mechanics is needed to define normal function and structure and provide targets for treatment of carpal injuries. In this study, measurements of scaphoid translation and joint congruency were taken by creating models from the CT scans of the carpals in extreme frames of motion, registering those models to the neutral position, transforming the models into a local coordinate system, and using software to calculate the joint surface areas (JSA). Results indicated that the centroid of the scaphoid translated 6.4 ± 1.3 mm and extended from extreme radial to extreme ulnar deviation. Results are consistent with the literature. An additional study was performed to measure the responsiveness of the 4DCT technique presented. Bone models from each frame of motion for radio ulnar deviation (RUD) and flexion extension (FE) were created and distinct differences between their JSA were measured qualitatively and quantitatively. The results show that there was statistically significantly different JSA within carpal joints between RUD and FE. These studies provide the first step in developing the methodology when using 4DCT scanning to measure subtle abnormalities in the wrist.
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Affiliation(s)
- Sydney Robinson
- School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada
| | - Lauren Straatman
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada; Graduate Program of Health and Rehabilitation Science, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Ting-Yim Lee
- Robarts Research Institute, 100 Perth Dr, London, ON N6A 5K8, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Department of Medical Biophysics, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada; Schulich School of Medicine and Dentistry,Western University, 1151 Richmond St, London, ON N6A 3K7, Canada
| | - Emily Lalone
- School of Biomedical Engineering, Western University, 1151 Richmond St, London, ON N6A 3K7, Canada; Roth McFarlane Hand and Upper Limb Centre, St Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada
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Roemer FW, Demehri S, Omoumi P, Link TM, Kijowski R, Saarakkala S, Crema MD, Guermazi A. State of the Art: Imaging of Osteoarthritis—Revisited 2020. Radiology 2020; 296:5-21. [DOI: 10.1148/radiol.2020192498] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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9
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Sisniega A, Thawait GK, Shakoor D, Siewerdsen JH, Demehri S, Zbijewski W. Motion compensation in extremity cone-beam computed tomography. Skeletal Radiol 2019; 48:1999-2007. [PMID: 31172206 PMCID: PMC6814492 DOI: 10.1007/s00256-019-03241-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/29/2019] [Accepted: 05/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the improvement in extremity cone-beam computed tomography (CBCT) image quality in datasets with motion artifact using a motion compensation method based on maximizing image sharpness. METHODS Following IRB approval, retrospective analysis of 308 CBCT scans of lower extremities was performed by a fellowship-trained musculoskeletal radiologist to identify images with moderate to severe motion artifact. Twenty-four scans of 22 patients (18 male, four female; mean, 32 years old, range, 21-74 years old) were chosen for inclusion. Sharp (bone) and smooth (soft tissue) reconstructions were processed using the motion compensation algorithm. Two experts rated visualization of trabecular bone, cortical bone, joint spaces, and tendon on a nine-level Likert scale with and without motion compensation (a total of 96 datasets). Visual grading characteristics (VGC) was used to quantitatively determine the difference in image quality following motion compensation. Intra-class correlation coefficient (ICC) was obtained to assess inter-observer agreement. RESULTS Motion-compensated images exhibited appreciable reduction in artifacts. The observer study demonstrated the associated improvement in diagnostic quality. The fraction of cases receiving scores better than "Fair" increased from less than 10% without compensation to 40-70% following compensation, depending on the task. The area under the VGC curve was 0.75 (tendon) to 0.85 (cortical bone), confirming preference for motion compensated images. ICC values showed excellent agreement between readers before (ICC range, 0.8-0.91) and after motion compensation (ICC range, 0.92-0.97). CONCLUSIONS The motion compensation algorithm significantly improved the visualization of bone and soft tissue structures in extremity CBCT for cases exhibiting patient motion.
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Affiliation(s)
- Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Gaurav K Thawait
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
- Russel H Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, 21278, USA
| | - Delaram Shakoor
- Russel H Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, 21278, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
- Russel H Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, 21278, USA
| | - Shadpour Demehri
- Russel H Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, 21278, USA
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA.
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Abstract
The wrist is a complex joint involving many small bones and complicated kinematics. It has, therefore, been traditionally difficult to image and ascertain information about kinematics when making a diagnosis. Although MRI and fluoroscopy have been used, they both have limitations. Recently, there has been interest in the use of 4D-CT in imaging the wrist. This review examines the literature regarding the use of 4D-CT in imaging the wrist to assess kinematics and its ability to diagnose pathology. Some questions remain about the description of normal ranges, the most appropriate method of measuring intercarpal stability, the accuracy compared with established standards, and the place of 4D-CT in postoperative assessment. Cite this article: Bone Joint J 2019;101-B:1325–1330.
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Affiliation(s)
- Jordy White
- University of Queensland, St Lucia, Australia
| | - Greg Couzens
- Brisbane Hand and Upper Limb Research Institute, Spring Hill, Australia
- Princess Alexandra Hospital, Brisbane, Australia
- Field Orthopaedics Research Group, Spring Hill, Australia
| | - Chris Jeffery
- Princess Alexandra Hospital, Brisbane, Australia
- Field Orthopaedics Research Group, Spring Hill, Queensland, Australia
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Kinematic Analysis of the Distal Radioulnar Joint in Asymptomatic Wrists Using 4-Dimensional Computed Tomography-Motion Pattern and Interreader Reliability. J Comput Assist Tomogr 2019; 43:392-398. [PMID: 30762658 DOI: 10.1097/rct.0000000000000839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine the normal measurement values and interobserver performance of the distal radioulnar joint during wrist pronation-supination using 4-dimensional computed tomography (CT). METHODS Four-dimensional CT examinations were performed on the asymptomatic contralateral wrists of 10 patients with unilateral chronic wrist pain. Measurements were conducted using the modified radioulnar (mRU) line and epicenter (Epi) methods. Volar subluxation of the ulnar head was demonstrated with negative values. Wilcoxon rank sum test was used to determine the measurement changes. Interobserver agreements were assessed using interclass correlation coefficients. RESULTS In pronation, mRU line measurements (median, 0.09; interquartile range, 0-0.15) were significantly larger than in supination (median, -0.1; interquartile range, -0.18 to 0; P = 0.008).The Epi measurements were not significantly different in pronation (median, 0.03; interquartile range, 0.01-0.07) and supination (median, 0.06; interquartile range, 0.01-0.1; P = 0.799). There was an excellent inter-observer agreement between the two readers using mRU and Epi methods in pronation (0.982, 0.898), midpoint (0.994, 0.827) and supination (0.989, 0.972) positions, respectively. CONCLUSIONS Using 4-dimensional CT examination, distal radioulnar joint kinematics in asymptomatic wrists demonstrate excellent interobserver agreements with increased volar ulnar subluxation with supination as detected using mRU, but not the Epi method.
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The Impact of Dose Reduction in Quantitative Kinematic CT of Ankle Joints Using a Full Model-Based Iterative Reconstruction Algorithm: A Cadaveric Study. AJR Am J Roentgenol 2018; 210:396-403. [DOI: 10.2214/ajr.17.18562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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13
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Diagnosis and Characterization of Patellofemoral Instability: Review of Available Imaging Modalities. Sports Med Arthrosc Rev 2017; 25:64-71. [DOI: 10.1097/jsa.0000000000000148] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Chae HD, Yoo HJ, Hong SH, Choi JY, Kang HS. Assessment of pisotriquetral misalignment with magnetic resonance imaging: Is it associated with trauma? Eur Radiol 2016; 27:3033-3041. [PMID: 27921157 DOI: 10.1007/s00330-016-4624-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our objective was to determine whether there is an association between pisotriquetral (PT) malalignment and acute distal radius fracture by using magnetic resonance imaging (MRI). METHODS We evaluated 138 patients who underwent 3-T MRI of the wrists. Group A comprised 85 patients with acute distal radius fracture, and group B comprised 53 patients without trauma. PT interval and angle and pisiform excursion were measured on oblique axial and sagittal multiplanar reformats. The presence of abnormalities in the flexor carpi ulnaris tendon (FCU), pisometacarpal ligament (PML), and pisohamate ligament (PHL) were evaluated. RESULTS PT interval was wider in group A on both the axial and sagittal planes (P < 0.001). Axial PT angle opened more radially in group A (P < 0.001), and the absolute value of the sagittal PT angle in group A was wider than that in group B (P = 0.006). Abnormalities in FCU, PML, and PHL were more frequently observed in group A (P < 0.001). On multiple linear regression, distal radius fracture remained significant after adjusting for the patient's age and PT osteoarthritis. CONCLUSIONS Acute distal radius fracture can affect normal alignment of the PT joint, resulting in associated injuries to the primary PT joint stabilizers. KEY POINTS • Acute distal radius fracture is associated with malalignment of PT joints. • Acute distal radius fracture is associated with abnormalities of PT stabilizers. • PT joint alignment can be evaluated with MRI with 3D sequences. • Wrist MRI is useful for evaluating primary PT stabilizer injuries.
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Affiliation(s)
- Hee-Dong Chae
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 110-744, Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 110-744, Korea.
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 110-744, Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-Ro, Jongno-Gu, Seoul, 110-744, Korea
| | - Heung Sik Kang
- Department of Radiology, Seoul National University Bundang Hospital, 300 Gumidong, Bundang-Gu, Seongnam-City, Gyeongi-Do, 463-707, Korea
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Kakar S, Breighner RE, Leng S, McCollough CH, Moran SL, Berger RA, Zhao KD. The Role of Dynamic (4D) CT in the Detection of Scapholunate Ligament Injury. J Wrist Surg 2016; 5:306-310. [PMID: 27777822 PMCID: PMC5074832 DOI: 10.1055/s-0035-1570463] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
Background Scapholunate (SL) interosseus ligament injuries detected at an early stage could allow the surgeon to prevent progression through the spectrum of injury that leads to instability, and eventually osteoarthritis. We contend that early instability following injury can be detected by visualizing the relative motions and distances between the involved carpal bones (scaphoid and lunate) during wrist movement in vivo. The purpose of this study is to demonstrate the utility of dynamic CT (i.e., 4DCT) in diagnosing SL interosseus ligament injuries in two patients with clinical suspicion of SL interosseus ligament injury during flexion-extension (FE), radial-ulnar (RU) deviation, and dart thrower's (DT) motions. Case Description 4DCT images obtained from two individual cases were analyzed to assess the proximity between the scaphoid and lunate during wrist motion using standard image processing techniques. Proximity maps representing the distances between the scaphoid and lunate bones during each phase of wrist motion were determined. These maps provide insight into the severity of diastasis (large separation) and location of diastasis at the SL joint. The patients' proximity maps indicated dorsal diastasis and subtle uniform diastasis. Literature Review Complex musculoskeletal abnormalities, such as wrist joint instabilities, elude diagnosis during 2D fluoroscopy due to the 3D geometry of the anatomy and the inherent 3D nature of the bony kinematics. Even the most recent advances with MR arthrography lack good correlation with wrist arthroscopy. Wrist arthroscopy remains the gold standard for diagnosis to assess for intercarpal laxity. However, arthroscopy is an invasive procedure subjecting patients to the risk of infection, nerve injury, pain, and stiffness. Clinical Relevance 4DCT allows noninvasive characterization of where ligament injuries likely occur; this may allow for a more selective surgical treatment directed at the specific location of the tear.
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Affiliation(s)
- Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kristin D. Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Demehri S, Guermazi A, Kwoh CK. Diagnosis and Longitudinal Assessment of Osteoarthritis: Review of Available Imaging Techniques. Rheum Dis Clin North Am 2016; 42:607-620. [PMID: 27742017 DOI: 10.1016/j.rdc.2016.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Osteoarthritis (OA) is a major chronic and global health care problem. Recent technological advances in imaging and postprocessing techniques have enhanced the understanding and characterization of the pathophysiology of this chronic and prevalent disease. Although plain radiograph remains the modality of choice for initial assessment of OA, recent studies have shown that advanced cross-sectional imaging can improve the early detection, grading, structural damage quantification, and risk stratification of OA. This article discusses the currently available evidence regarding both the conventional and novel imaging modalities that can be used for evaluation of patients with OA and its longitudinal assessment.
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Affiliation(s)
- Shadpour Demehri
- Division of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, School of Medicine, 601 North Caroline Street, JHOC 5165, Baltimore, MD 21287, USA.
| | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - C Kent Kwoh
- Division of Rheumatology, University of Arizona Arthritis Center, University of Arizona, Tucson, AZ, USA
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Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: initial clinical experience. Skeletal Radiol 2016; 45:437-46. [PMID: 26659662 DOI: 10.1007/s00256-015-2308-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/04/2015] [Accepted: 11/30/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Using four-dimensional CT scan (4DCT), we aimed at showing the kinematics of scapholunate (SL) interval in asymptomatic wrists in comparison with symptomatic contralateral wrists with inconclusive radiographic findings. METHODS This is an IRB approved, HIPPA compliant, retrospective study. Patients suspected of SL interosseous ligament (SLIL) injuries were referred for further evaluation of chronic wrist pain (>3 months). Twelve wrists (11 subjects) with chronic symptoms and inconclusive plain radiographs and 10 asymptomatic wrists (in 10 different subjects) were scanned using 4DCT. The minimum SL interval was measured during three wrist motions: relaxed-to-clenched fist, flexion-to-extension, and radial-to-ulnar-deviation. Changes were recorded using double-oblique multiplanar reformation technique. RESULTS We extracted the normal limits of the SL interval as measured by dynamic CT scanning during active motion in asymptomatic wrists. In asymptomatic wrists, the average SL interval was observed to be smaller than 1 mm during all motions. In symptomatic wrists, during exams performed with clenched fist (SL interval (mean ± SD) = 2.53 ± 1.19 mm), extension (2.54 ± 1.48 mm) or ulnar deviation (2.06 ± 1.12 mm), the average SL interval was more than 2 mm. In contrast to symptomatic wrists, no significant change in SL interval measurements was detected during wrist motions in asymptomatic wrists. There was a mild to moderate correlation between SL interval change and presence/absence of symptoms (point-biserial correlation coefficients: 0.29-0.55). CONCLUSION In patients with wrist pain suspicious for SLIL injury and inconclusive radiographs, SL interval increase can be detected with 4DCT in the symptomatic wrist compared to the asymptomatic wrist.
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Conventional and novel imaging modalities in osteoarthritis: current state of the evidence. Curr Opin Rheumatol 2015; 27:295-303. [PMID: 25803224 DOI: 10.1097/bor.0000000000000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Imaging modalities are currently an inseparable part of osteoarthritis diagnosis. In this review, we describe the current state of evidence regarding conventional and novel imaging modalities in evaluation of osteoarthritis. Modalities including radiography (qualitative and semi-quantitative assessments), ultrasonography, computed tomography [CT; conventional multidetector CT (MDCT), cone-beam CT (CBCT) and four-dimensional CT (4DCT)], MRI (MRI; semi-quantitative, quantitative and compositional) and PET and their applications are reviewed. RECENT FINDINGS Radiography is the modality of choice for initial assessment of osteoarthritis. However, due to its low sensitivity and specificity, numerous recent investigations have proposed MRI as a powerful addition to detect and grade osteoarthritis features, which are not apparent in radiography. Semi-quantitative MRI measurements are feasible to perform in routine clinical practice. Quantitative and compositional MRI measurements have extended the amount of information an MRI examination can provide regarding the three-dimensional shape and tissue composition of articular cartilage. 4DCT and CBCT are introduced as imaging examinations that may reveal biomechanical cartilage abnormalities in osteoarthritis joint by dynamic and weight-bearing evaluations, respectively. Recent PET studies may unveil the underlying metabolic activities that can be associated with osteoarthritis. SUMMARY In addition to the established role of radiographs, MRI is the advanced modality of choice for detection and quantification of various osteoarthritis features. 4DCT and CBCT may have specified applications when diagnosis of underlying motion abnormality or dynamic changes in weight-bearing situation is suspected. Future studies should elucidate the specific clinical applications of ultrasonography and PET.
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Demehri S, Hafezi-Nejad N, Thakur U, Morelli J, Lifchez S, Means K, Shores J. Evaluation of pisotriquetral motion pattern using four-dimensional CT: initial clinical experience in asymptomatic wrists. Clin Radiol 2015; 70:1362-9. [DOI: 10.1016/j.crad.2015.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/09/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
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Xing SG, Chen YR, Xie RG, Tang JB. In Vivo Contact Characteristics of Distal Radioulnar Joint With Malunited Distal Radius During Wrist Motion. J Hand Surg Am 2015; 40:2243-8. [PMID: 26442798 DOI: 10.1016/j.jhsa.2015.07.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 07/31/2015] [Accepted: 07/31/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether distal radioulnar joint (DRUJ) contact characteristics were altered in patients with malunited distal radius fractures. METHODS We obtained computed tomography scans at 5 positions of both wrists of 6 patients who had unilateral malunited distal radius fractures with dorsal angulation from 10° to 20° and ulnar variance less than 3 mm. We reconstructed 3-dimensional images and mapped contact regions of DRUJ by calculating the shortest distance between the 2 opposing bones. The contact areas of the DRUJ were measured and the contact region centers were calculated and analyzed. The values of the malunited side were compared with those of the contralateral uninjured side. RESULTS In the uninjured wrist, the contact areas of the DRUJ increased slightly from wrist flexion to extension and ulnar deviation. In the malunited wrist, we found the contact areas of DRUJ to be progressively reduced from 20° flexion to neutral, 40° extension, and 20° extension, to ulnar deviation. The centroid of this area on the sigmoid notch moved to distal from flexion to extension. Compared with the contralateral uninjured wrist, the contact area significantly decreased during wrist extension and ulnar deviation, and significantly increased during wrist flexion. The centroids of this area on sigmoid notch all moved volarly in all selected wrist positions. CONCLUSIONS The contact areas of the DRUJ and the centroid of contact area on sigmoid notch are altered in patients with malunited distal radius fractures. The contact area of the DRUJ increases during wrist flexion and decreases during wrist extension and ulnar deviation. The centroids of the contact area on sigmoid notch move volarly during wrist flexion-extension and ulnar deviation. CLINICAL RELEVANCE The in vivo findings suggest that alterations in joint mechanics may have an important role in the dysfunction associated with these injuries.
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Affiliation(s)
- Shu Guo Xing
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu
| | - Yan Rong Chen
- Department of Orthopaedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Ren Guo Xie
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu
| | - Jin Bo Tang
- Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu.
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Zhao K, Breighner R, Holmes D, Leng S, McCollough C, An KN. A technique for quantifying wrist motion using four-dimensional computed tomography: approach and validation. J Biomech Eng 2015; 137:2279319. [PMID: 25901447 DOI: 10.1115/1.4030405] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Indexed: 12/21/2022]
Abstract
Accurate quantification of subtle wrist motion changes resulting from ligament injuries is crucial for diagnosis and prescription of the most effective interventions for preventing progression to osteoarthritis. Current imaging techniques are unable to detect injuries reliably and are static in nature, thereby capturing bone position information rather than motion which is indicative of ligament injury. A recently developed technique, 4D (three dimensions + time) computed tomography (CT) enables three-dimensional volume sequences to be obtained during wrist motion. The next step in successful clinical implementation of the tool is quantification and validation of imaging biomarkers obtained from the four-dimensional computed tomography (4DCT) image sequences. Measures of bone motion and joint proximities are obtained by: segmenting bone volumes in each frame of the dynamic sequence, registering their positions relative to a known static posture, and generating surface polygonal meshes from which minimum distance (proximity) measures can be quantified. Method accuracy was assessed during in vitro simulated wrist movement by comparing a fiducial bead-based determination of bone orientation to a bone-based approach. The reported errors for the 4DCT technique were: 0.00-0.68 deg in rotation; 0.02-0.30 mm in translation. Results are on the order of the reported accuracy of other image-based kinematic techniques.
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