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Mourad C, Gallego Manzano L, Viry A, Booij R, Oei EHG, Becce F, Omoumi P. Chances and challenges of photon-counting CT in musculoskeletal imaging. Skeletal Radiol 2024; 53:1889-1902. [PMID: 38441616 PMCID: PMC11303444 DOI: 10.1007/s00256-024-04622-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 08/09/2024]
Abstract
In musculoskeletal imaging, CT is used in a wide range of indications, either alone or in a synergistic approach with MRI. While MRI is the preferred modality for the assessment of soft tissues and bone marrow, CT excels in the imaging of high-contrast structures, such as mineralized tissue. Additionally, the introduction of dual-energy CT in clinical practice two decades ago opened the door for spectral imaging applications. Recently, the advent of photon-counting detectors (PCDs) has further advanced the potential of CT, at least in theory. Compared to conventional energy-integrating detectors (EIDs), PCDs provide superior spatial resolution, reduced noise, and intrinsic spectral imaging capabilities. This review briefly describes the technical advantages of PCDs. For each technical feature, the corresponding applications in musculoskeletal imaging will be discussed, including high-spatial resolution imaging for the assessment of bone and crystal deposits, low-dose applications such as whole-body CT, as well as spectral imaging applications including the characterization of crystal deposits and imaging of metal hardware. Finally, we will highlight the potential of PCD-CT in emerging applications, underscoring the need for further preclinical and clinical validation to unleash its full clinical potential.
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Affiliation(s)
- Charbel Mourad
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Diagnostic Imaging and Interventional Therapeutics, Hôpital Libanais Geitaoui-CHU, Beyrouth, Lebanon
| | - Lucia Gallego Manzano
- Institute of Radiation Physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anaïs Viry
- Institute of Radiation Physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Ronald Booij
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fabio Becce
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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Athlani L, Luc É, Pauchard N, Blum A, Dautel G, Gondim Teixeira PA. Clinical, radiological and dynamic CT results of scapholunate intercarpal ligamentoplasty for scapholunate dissociation. HAND SURGERY & REHABILITATION 2024:101762. [PMID: 39127156 DOI: 10.1016/j.hansur.2024.101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/12/2024]
Abstract
A clinical, radiological and four-dimensional computed tomography (4DCT) assessment of the outcomes of scapholunate intercarpal ligamentoplasty (SLICL) was done with a minimum follow-up of 2 years. Twenty-nine patients (23 men and 6 women) with a mean age of 40 years (22-57) who had chronic scapholunate dissociation were treated with the SLICL procedure. There were 18 cases of dynamic instability and 11 of static instability. The patients were evaluated with a mean follow-up of 61 months (24-94). SLICL significantly reduced pain and increased grip strength and wrist function. On radiographs, the mean static and dynamic scapholunate gaps as well as the scapholunate and radiolunate angles improved significantly. The dorsal scaphoid displacement was always corrected. 4DCT after surgery provided a more precise analysis of the SLICL's effectiveness at restoring intracarpal alignment. Correction of the DISI deformity and dorsal scaphoid displacement was confirmed. SLICL restored a normal variation in the scapholunate gap (range value) during radioulnar deviation movement without systematically reducing the distance between the bones (mean and maximum values) which remained pathological in wrists with static instability but not in those with dynamic instability. At the final follow-up, no patients had signs of osteoarthritis due to ScaphoLunate Advanced Collapse. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Émile Gallé, Nancy University Hospital, 49 rue Hermite, 54000 Nancy, France; University of Lorraine, IADI Laboratory, Inserm U1254, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - Émeline Luc
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Nicolas Pauchard
- Hôpital privé Dijon Bourgogne, 22 avenue Françoise Giroud, 21000 Dijon, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; University of Lorraine, IADI Laboratory, Inserm U1254, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Gilles Dautel
- Centre Chirurgical ADR, 6 Rue Colette, 54100 Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; University of Lorraine, IADI Laboratory, Inserm U1254, 5 Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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Ayoub B, Sinan O, Gabriela H, Lionel A, Romain G, Alain B, Teixeira Pedro Augusto G. Post-processing of quantitative 4D-CT for initial evaluation of scapholunate Instability: Assessment of simplified approaches to data analysis. Eur J Radiol 2024; 177:111544. [PMID: 38917580 DOI: 10.1016/j.ejrad.2024.111544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 05/16/2024] [Accepted: 06/02/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To evaluate the diagnostic performance of simplified post-processing approaches for quantitative wrist 4D-CT in the assessment of scapholunate instability (SLI). METHODS A prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard. RESULTS The SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93-0.96) compared to the standard approach (ICC values 0.65-0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes). CONCLUSION Simpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.
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Affiliation(s)
- Benfaris Ayoub
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France.
| | - Orkut Sinan
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France.
| | - Hossu Gabriela
- Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
| | - Athlani Lionel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France.
| | - Gillet Romain
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
| | - Blum Alain
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France.
| | - Gondim Teixeira Pedro Augusto
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France; Université de Lorraine, Inserm, IADI, F-54000 Nancy, France.
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Teule EHS, Hummelink S, Kumaş A, Buckens CFM, Sechopoulos I, van der Heijden EPA. Automatic analysis of the scapholunate distance using 4DCT imaging: normal values in the healthy wrist. Clin Radiol 2024; 79:e1040-e1048. [PMID: 38797610 DOI: 10.1016/j.crad.2024.05.004] [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: 01/30/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Abstract
AIM Early diagnosis of scapholunate ligament (SLL) injuries is crucial to prevent progression to debilitating osteoarthritis. Four-Dimensional Computed Tomography (4DCT) is a promising dynamic imaging modality for assessing such injuries. Capitalizing on the known correlation between SLL injuries and an increased scapholunate distance (SLD), this study aims to develop a fully automatic approach to evaluate the SLD continuously during wrist motion and to apply it to a dataset of healthy wrists to establish reference values. MATERIALS AND METHODS 50 healthy wrists were analysed in this study. All subjects performed radioulnar deviation (RUD), flexion-extension (FE), and clenching fist (CF) movements during 4DCT acquisition. A novel, automatic method was developed to continuously compute the SLD at five distinct locations within the scapholunate joint, encompassing a centre, volar, dorsal, proximal, and distal measurement. RESULTS The developed algorithm successfully processed datasets from all subjects. Our results showed that the SLD remained below 2 mm and exhibited minimal changes (median ranges between 0.3 mm and 0.65 mm) during RUD and CF at all measured locations. During FE, the volar and dorsal SLD changed significantly, with median ranges of 0.90 and 1.27 mm, respectively. CONCLUSION This study establishes a unique database of normal SLD values in healthy wrists during wrist motion. Our results indicate that, aside from RUD and CF, FE may also be important in assessing wrist kinematics. Given the labour-intensive and time-consuming nature of manual analysis of 4DCT images, the introduction of this automated algorithm enhances the clinical utility of 4DCT in diagnosing dynamic wrist injuries.
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Affiliation(s)
- E H S Teule
- Radboud University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Nijmegen, the Netherlands; Radboud University Medical Centre, Orthopaedic Research Lab, Nijmegen, the Netherlands.
| | - S Hummelink
- Radboud University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Nijmegen, the Netherlands.
| | - A Kumaş
- Radboud University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Nijmegen, the Netherlands.
| | - C F M Buckens
- Radboud University Medical Centre, Department of Medical Imaging, Nijmegen, the Netherlands.
| | - I Sechopoulos
- Radboud University Medical Centre, Department of Medical Imaging, Nijmegen, the Netherlands; University of Twente, Technical Medical Centre, Enschede, the Netherlands.
| | - E P A van der Heijden
- Radboud University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Nijmegen, the Netherlands; Jeroen Bosch Hospital, Department of Plastic, Reconstructive, and Hand Surgery, 's-Hertogenbosch, the Netherlands.
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Inaba N, Oki S, Nagura T, Sato K, Jinzaki M, Iwamoto T, Nakamura M. In-vivo kinematics of the trapeziometacarpal joint in dynamic pinch motion using four-dimensional computed tomography imaging. Skeletal Radiol 2024; 53:129-140. [PMID: 37306769 DOI: 10.1007/s00256-023-04387-4] [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] [Received: 04/25/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE CT imaging precisely and quantitatively analyzes the kinematics of the carpal bones to evaluate the etiology of related osteoarthritis. Previous studies have investigated the kinematics of the trapeziometacarpal joint using static CT scans of various postures including the pinch position. This study analyzed the in-vivo kinematics of the trapeziometacarpal joint during dynamic pinch motion in young healthy volunteers using four-dimensional CT. MATERIALS AND METHODS Twelve healthy young volunteers participated in this study. Each participant held the pinch meter between their thumb and index finger and pinched it with maximum force for a period of 6 s. This series of movement was recorded using a four-dimensional CT. The surface data of the trapezium and first metacarpal of all frames were reconstructed, and bone movement at the trapeziometacarpal joint was calculated using sequential three-dimensional registration. The instantaneous pinch force of each frame was measured using a pointer on a pinch meter that was reconstructed from the CT data. RESULTS The first metacarpal was abducted (15.9 ± 8.3°) and flexed (12.2 ± 7.1°) relative to the trapezium, and significantly translated to the volar (0.8 ± 0.6 mm) and ulnar directions (0.9 ± 0.8 mm) with maximum pinch force. This movement consistently increased with the pinch force. CONCLUSION This study successfully employed 4D-CT to precisely demonstrate changes in rotation and translation at the trapeziometacarpal joint during pinch motion for various instantaneous forces.
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Affiliation(s)
- Naoto Inaba
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Satoshi Oki
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan.
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kazuki Sato
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Shinanomachi 35, Shinjuku-Ku, Tokyo, 160-8582, Japan
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Athlani L, Cuisigniez A, Weber N, Blum A, Perez M, Gondim Teixeira PA. The effect of intercarpal arthrodeses on wrist kinematics during radial and ulnar deviation: a cadaveric study using four-dimensional CT. J Hand Surg Eur Vol 2023; 48:895-902. [PMID: 37211792 DOI: 10.1177/17531934231176004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this cadaveric study, we report quantitative dynamic four-dimensional CT evaluation of the effect on wrist kinematics of three intercarpal arthrodeses during radial and ulnar deviation. In five wrists, we successively performed scaphocapitate, four-corner and two-corner fusions. Four-dimensional CT examinations were performed prior to dissection and after each arthrodesis. The lunocapitate gap, posterior lunocapitate angle, radiolunate radial gap, radiolunate ulnar gap and radiolunate angle were assessed. After scaphocapitate arthrodesis, in radial deviation, we noted midcarpal diastasis and dorsal displacement of the capitate. In ulnar deviation, there was correction of that incongruence. After four-corner and two-corner fusions, in radial deviation, we noted radial radiolunate impingement and ulnar radiolunate incongruence. In ulnar deviation, after two-corner fusion, ulnar radiolunate impingement and radial radiolunate incongruence were present contrary to four-corner fusion. Our findings confirm that the constant radiocarpal and midcarpal congruence during radioulnar deviation in normal wrists is no longer possible with intercarpal kinematic modifications after these arthrodeses.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
- Université de Lorraine, IADI Laboratory, Nancy, France
- Department of Anatomy, Faculty of Medicine, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Alain Cuisigniez
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
| | - Nicolas Weber
- Université de Lorraine, IADI Laboratory, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
| | - Manuela Perez
- Department of Anatomy, Faculty of Medicine, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
- Université de Lorraine, IADI Laboratory, Nancy, France
- Department of Anatomy, Faculty of Medicine, University of Lorraine, Vandœuvre-lès-Nancy, France
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Orkut S, Gillet R, Granero J, Hossu G, Douis N, Athlani L, Blum A, Gondim Teixeira PA. Assessment of Scapholunate Instability on 4D CT Scans in Patients with Inconclusive Conventional Images. Radiology 2023; 308:e230193. [PMID: 37698480 DOI: 10.1148/radiol.230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background Initial imaging work-up using radiography and CT arthrography sometimes can be insufficient to identify a scapholunate (SL) instability (SLI) in patients suspected of having SL ligament tears. Purpose To determine the diagnostic performance of four-dimensional (4D) CT in the identification of SLI and apply the findings to patients suspected of having SLI and with inconclusive findings on radiographs and CT arthrograms. Materials and Methods This prospective single-center study enrolled participants suspected of having SLI (recent trauma, dorsal pain, positive Watson test results, decreased grip strength) between March 2015 and March 2020. Participants with wrist fractures, substantial joint stiffness, or history of wrist surgery were excluded. Each participant underwent radiography, CT arthrography, and 4D CT on the same day. Participants were divided into three groups: those with no SLI, those with SLI, and those with inconclusive results. SL gap and radioscaphoid and lunocapitate angle were measured using semiautomatic quantitative analysis of 4D CT images by two independent readers. Receiver operating characteristic curves were used to evaluate the diagnostic performance of 4D CT. Thresholds were determined with the Youden index and were applied to the inconclusive group. Results Of the 150 included participants (mean age, 41 years ± 14 [SD]; 102 male, 48 female), there were 63 with no SLI, 48 with SLI, and 39 with inconclusive results. The maximum value and range of SL gap measurements on 4D CT scans showed high sensitivity (83% [40 of 48] and 90% [43 of 48], respectively) and high specificity (95% [59 of 62] and 81% [50 of 62], respectively) in the identification of SLI. At least one of these parameters was abnormal on 4D CT scans in 17 of 39 (44%) participants in the inconclusive group, and 10 of 17 (59%) participants had confirmed SLI. In the 22 participants in the inconclusive group with no indication of SLI at 4D CT, follow-up showed no evidence of SLI in 10 (45%) and enabled confirmation of SLI via arthroscopy in three (14%). Conclusion Scapholunate gap measurements on kinematic 4D CT scans enabled correct identification of SLI in 59% of participants with inconclusive results on conventional images. ClinicalTrials.gov registration no. NCT02401568 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Demehri and Ibad in this issue.
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Affiliation(s)
- Sinan Orkut
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Romain Gillet
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Jonathan Granero
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Gabriela Hossu
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Nicolas Douis
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Lionel Athlani
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Alain Blum
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
| | - Pedro Augusto Gondim Teixeira
- From the Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France (S.O., R.G., A.B., P.A.G.T.); Université de Lorraine, Inserm, IADI, Nancy, France (R.G., G.H., N.D., P.A.G.T.); and Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France (J.G., L.A.)
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Goelz L, Pinther M, Güthoff C, Kim S, Bevanda J, Mutze S, Schüler G, Eisenschenk A, Eichenauer F, Asmus A. Assessing Diagnostic Accuracy of Four-dimensional CT for Instable Scapholunate Dissociation: The Prospective ACTION Trial. Radiology 2023; 308:e230292. [PMID: 37698479 DOI: 10.1148/radiol.230292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Background Timely treatment of scapholunate instability depends on early identification, but current imaging methods are either intricate or fail to demonstrate the dynamic stages. Purpose To calculate the diagnostic accuracy of four-dimensional (4D) CT for diagnosing instable scapholunate ligament (SLL) tears. Materials and Methods This prospective study enrolled consecutive participants with clinically suspected SLL tears who underwent 4D CT from July 2020 to May 2022. A historical study sample diagnosed at cineradiography served as a comparison, and wrist arthroscopy was the reference standard. Scapholunate joints greater than 3 mm were interpreted as instable at index 4D CT and cineradiography. Diagnostic accuracy was expressed as sensitivity and specificity. Areas under the receiver operating characteristic curve and cutoff values for both index tests were calculated. Intraclass correlation coefficients (ICCs) were computed to compare interrater reliability. Effective radiation doses at 4D CT were measured with thermoluminescent dosimeters. Results The study included 40 participants (mean age, 43 years ± 14 [SD]; 24 male) evaluated at 4D CT and 78 patients (mean age, 45 years ± 11; 50 male) historically evaluated at cineradiography. Four-dimensional CT helped detect instable tears in 26 of 35 participants (sensitivity, 74.3% [95% CI: 56.7, 87.5]. Cineradiography revealed instable tears in 52 of 63 patients (sensitivity, 82.5% [95% CI: 70.9, 91]). Four of five participants with stable scapholunate joints were identified at 4D CT (specificity, 80.0% [95% CI: 28.4, 99.5]), and 12 of 15 patients with stable SLLs were identified at cineradiography (specificity, 80.0% [95% CI: 51.9, 95.7]). Interrater agreement of radiologic measurements on 4D CT scans was good to excellent (ICC range, 0.89-0.96). The effective radiation dose ranged from 67 to 72 mSv at the wrist and was less than 1 mSv at the head. Conclusion Four-dimensional CT results are highly reproducible. Instable scapholunate joints greater than 3 mm were detected with a sensitivity of 74.3% and a specificity of 80% in an exploratory trial. Further evidence from larger randomized trials is warranted. German Register for Clinical Trials no. DRKS00021110 (Universal Trial Number U1111-1249-7884) Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Demehri and Ibad in this issue.
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Affiliation(s)
- Leonie Goelz
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Melina Pinther
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claas Güthoff
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Simon Kim
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Jelena Bevanda
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Sven Mutze
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Gabriele Schüler
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Andreas Eisenschenk
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Frank Eichenauer
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
| | - Ariane Asmus
- From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany
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9
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Wang B, Walczyk J, Ahmed M, Elkowitz S, Daniels S, Brown R, Burke CJ. Extended and weightbearing wrist 3-T MRI using a novel harness and flexible 24-channel glove coil to evaluate carpal kinematics: a pilot study in 10 volunteers. Acta Radiol 2023; 64:2570-2577. [PMID: 37470466 DOI: 10.1177/02841851231188222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Wrist pain in the extended or extended weightbearing positions may be incompletely evaluated using standard magnetic resonance imaging (MRI) with standard rigid clamshell coils in the neutral position. PURPOSE To evaluate a flexible 24-channel glove coil and harness when imaging the wrist in neutral, dorsally extended, and weightbearing positions. MATERIAL AND METHODS Ten wrists in 10 asymptomatic volunteers (mean age = 29 years) were scanned. Participants underwent 3-T MRI using the harness and flexible glove coil, acquiring sagittal turbo spin echo (TSE) and half-Fourier acquisition single-shot turbo spin echo (HASTE) pulse sequences. Static TSE images were obtained in neutral, extended, and weightbearing positions using proton density parameters and independently evaluated by two radiologists for: dorsal radiocarpal ligament thickness; radiocapitate, radiolunate, and capitatolunate angles; palmar translation of the lunate on the radius; angulation of the extensor tendons; and distance from the distal extensor retinaculum to Lister's tubercle. Cine HASTE images were dynamically acquired between neutral-maximum extension to measure the radiocapitate angle. RESULTS Good reader agreement was observed (r > 0.73) for all measurements except palmar translation in the neutral position (r = 0.27). Significant increases in dorsal radiocarpal ligament thickness; radiocapitate, radiolunate and capitolunate angulation; and extensor tendon angulation were observed between the neutral and extended positions (P < 0.001). A further significant increase in these metrics between extended and weightbearing positions was also seen (P < 0.01). CONCLUSION Significant increases in dorsal radiocarpal ligament thickness, articular and tendon angulations occur during wrist extension, that further increase with dorsal weightbearing.
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Affiliation(s)
- Bili Wang
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, NY, USA
| | - Jerzy Walczyk
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, NY, USA
| | - Mohammad Ahmed
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Stuart Elkowitz
- Department of Orthopedic Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven Daniels
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Ryan Brown
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, New York University Grossman School of Medicine, New York, NY, USA
| | - Christopher J Burke
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
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10
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Norman E, Mistry MR, Lalone E, Suh N. A Kinematic Analysis of Wrist and Carpal Function Using Four-Dimensional Computed Tomography Technology: A Dynamic Perspective. J Hand Surg Am 2023:S0363-5023(23)00386-6. [PMID: 37598324 DOI: 10.1016/j.jhsa.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE An emerging imaging modality, four-dimensional computed tomography, can provide dynamic evaluation of carpal motion, which allows for a better understanding of how the carpals work together to achieve range of motion. The objective of this work was to examine kinematic motion of the carpus through a flexion/extension arc of motion using four-dimensional computed tomography. METHODS A convenience sample of 20 uninjured participants underwent a four-dimensional computed tomography scanning protocol through a complete arc of flexion/extension motion. Kinematic changes in motion were quantified using helical axes motion data for each carpal. Rotation angles were compared between bones to identify differences in kinematic motion between bones. RESULTS The bones within the proximal carpal row, the lunate, scaphoid, and triquetrum, rotate significantly to differing magnitudes at the ends of motion (40° of flexion and 40° of extension). The scaphoid rotates to the highest magnitude, followed by the triquetrum, and lastly, the lunate. The distal carpal row bones rotate to similar magnitudes throughout the entire range of motion. CONCLUSIONS This work describes the kinematics of the carpals throughout dynamic in vivo flexion and extension. CLINICAL RELEVANCE This study adds to an understanding of wrist mechanics and the possible clinical implications of pathological deviation from baseline kinematics.
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Affiliation(s)
- Elizabeth Norman
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Manisha R Mistry
- Department of Surgery, Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Canada
| | - Emily Lalone
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, Canada; Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada
| | - Nina Suh
- Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Canada; Department of Orthopaedics, Emory University, Atlanta, GA.
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11
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Orkut S, Gillet R, Hossu G, Lombard C, Blum A, Athlani L, Gondim Teixeira PA. Kinematic 4D CT case-control study of wrist in dart throwing motion "in vivo": comparison with other maneuvers. Eur Radiol 2022; 32:7590-7600. [PMID: 35445824 DOI: 10.1007/s00330-022-08746-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare the diagnostic performance of scapholunate gap (SLG) measurements acquired with dart throwing (DT), radio-ulnar deviation (RUD), and clenching fist (CF) maneuvers on 4D CT for the identification of scapholunate instability. METHODS In this prospective study, 47 patients with suspected scapholunate interosseous ligament (SLIL) tears were evaluated from March 2015 to March 2020 with semiautomatic quantitative analysis on 4D CT. Five parameters (median, maximal value, range, and coefficient of variation) for SLG, lunocapitate angle (LCA), and radioscaphoid angle (RSA) obtained during DT maneuver were evaluated in patients with and without SLIL tears. CT arthrography was used as the gold standard for the SLIL status. The SLG values obtained were also compared with those obtained during CF and RUD maneuvers. RESULTS Significant differences in all SLG- and LCA-derived parameters are found between patients with and without SLIL tears with DT (p < 0.003). The best diagnostic performance for the diagnosis of SLIL tears was obtained with median and maximal SLG values (sensitivity and specificity of 86-89% and 95%) and with maximal and range LCA values (sensitivity and specificity of 86% and 74%). No significant differences were observed for RSA values (p > 0.275). The SLG range obtained with DT maneuver was the only dynamic parameter statistically different between patients with partial and complete torn SLIL (p = 0.037). CONCLUSION 4D CT of the wrist during DT showed a similar performance than RUD and a better performance than CF for the differentiation between patients with and without SLIL tears. KEY POINTS • Four-dimensional computed tomography can dynamically assess scapholunate instability. • The best results for differentiating between patients with and without SLIL tears were obtained with SLG median and maximal values. • The dart throwing and radio-ulnar deviation maneuvers yielded the best results for the dynamic evaluation of scapholunate instability.
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Affiliation(s)
- Sinan Orkut
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, Cedex, France.
| | - Romain Gillet
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, Cedex, France
| | - Gabriela Hossu
- Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
| | - Charles Lombard
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, Cedex, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, Cedex, France
| | - Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, Cedex, France.,Université de Lorraine, Inserm, IADI, F-54000, Nancy, France
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12
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Munn AB, Furey AJ, Hopkins JG, Smith NC, Chang N, Squire DS. Radiographic Evaluation of Carpal Mechanics and the Scapholunate Angle in a Clenched Fist with Dynamic Computed Tomography Imaging. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 5:6-10. [PMID: 36704376 PMCID: PMC9870799 DOI: 10.1016/j.jhsg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The long-term consequences of injuries to the scapholunate joint can severely limit hand function, and the potential for posttraumatic deformity makes early recognition of these injuries important. The purpose of this study was to evaluate the motion of the scapholunate joint in normal wrists through the radial and ulnar deviation using novel dynamic computed tomography (CT) imaging. Methods Fifteen participants consented to have their uninjured wrists scanned. A protocol was designed to ensure adequate time, yet limited exposure, for volunteers. Participants began with the hand in a relaxed fist position and then proceeded to clench the hand in a full fist and relax. Once relaxed again, the wrist was maximally ulnarly deviated and then maximally radially deviated in a fluid motion. Dynamic CT imaging was captured throughout the range of motion. Results The scapholunate angle was measured on dynamic wrist images. The mean range of the scapholunate angle that the wrists moved through was 37.2°-45.9°, and the mean midpoint angle was 41.2° ± 0.4°. All wrists had small, measurable differences in the scapholunate angle when moving from the maximum ulnar deviation to the maximal radial deviation. The average maximum angle change through the range is 11.7°, whereas the average minimum angle change was 0.9°. Conclusions In this study, scapholunate angle calculations using dynamic wrist CT scans were within the range of accepted normal for the angle in uninjured wrists. With the increased focus on dynamic imaging for wrist motion, it may be possible to derive a standardized protocol for mapping the carpal motion that is clinically applicable and reproducible. Type of study/level of evidence Diagnostic IV.
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Affiliation(s)
- Alexandra B. Munn
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada,Corresponding author: Alexandra B. Munn, MSc, Division of Orthopedic Surgery, Memorial University of Newfoundland, H 1385, Health Sciences Centre, 300 Prince Philip Drive, St. John’s, Newfoundland and Labrador, Canada A1B 3V6.
| | - Andrew J. Furey
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - John G. Hopkins
- Division of Radiology, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Nick C. Smith
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Nicholas Chang
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Daniel S. Squire
- Division of Orthopedic Surgery, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
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13
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The dynamic rotation axis of ulnohumeral joint during active flexion-extension: an in vivo 4-dimensional computed tomography analysis. BMC Musculoskelet Disord 2022; 23:152. [PMID: 35172787 PMCID: PMC8848841 DOI: 10.1186/s12891-022-05102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background As the collateral ligament reconstruction becomes more common to perform, the knowledge between the collateral ligament reconstruction and the elbow rotation axis is still ambiguous. The purpose of this study was to investigate the location of the intersections between the elbow rotation axis and medial and lateral aspect of the humerus. Methods Four-dimensional computed tomography (4D CT) scan was designed to obtain the images from 8 participants. The instantaneous rotation axis was created according to the trochlea notch of the ulna in the Rapidform XO software. Then the intersections between the instantaneous rotation axis and the medial and lateral aspect of the humerus were identified in the Geomagic Wrap software. Landmark coordinate systems of the distal humerus was created. Result The intersections in the medial aspect of the humerus were mostly located in the superior and posterior quadrant and showed the trend from anterior-superior to posterior-superior with the increment of the elbow flexion. The intersections in the lateral aspect of the humerus were mostly located in the middle half of the anterior quadrant and showed the trend from posterior-inferior to anterior-superior with the increment of the elbow flexion. Conclusion There’s no isometric point for medial collateral ligament (MCL) and lateral ulnar collateral ligament (LUCL) reconstruction. The isometric area for MCL reconstruction should be considered at the superior and posterior quadrant of the medial aspect of the humerus. The isometric area for LUCL reconstruction should be considered at the middle half of the anterior quadrant of the lateral aspect of the humerus. Trial registration This work was supported by the National Natural Science Foundation of China [No.81911540488] in 07/01/2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05102-5.
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14
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Correlation Between Dynamic 4-Dimensional Computed Tomography Data and Arthroscopic Testing of Scapholunate Instability: A Preliminary Study. J Hand Surg Am 2022; 48:509.e1-509.e8. [PMID: 35016786 DOI: 10.1016/j.jhsa.2021.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 08/24/2021] [Accepted: 10/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to test the validity and reliability of the assessments of scapholunate (SL) instability status on 4-dimensional (4D) computed tomography (CT) using wrist arthroscopy as a reference standard. METHODS Thirty-three patients (16 men, 17 women; mean age, 48 ± 13 years) with suspected SL instability were evaluated prospectively with 4D-CT and wrist arthroscopy. Based on the arthroscopic testing of SL joint, 2 groups were defined: group 1 (n = 8) consisted of patients who had no, or slight, SL malalignment in the midcarpal space and group 2 (n = 25) consisted of patients who had moderate or severe SL malalignment. Two independent readers, who did not know the arthroscopic findings, used 4D-CT to evaluate the SL gap, lunocapitate angle (LCA), and radioscaphoid angle (mean and range values) during radioulnar deviation. RESULTS The interobserver reliability was deemed good or excellent for most of the 4D-CT variables, except for the LCA range (moderate) and SL gap range (poor). For both readers, the SL gap mean, maximum, and minimum values were significantly higher (+67%, +78%, and +39%, respectively) and the LCA mean was significantly lower (-17%) in group 2 than in group 1. The radioscaphoid angle range values were lower (-34%) and the radioscaphoid angle mean values slightly higher (+4%) in group 2, but there was no significant difference between the 2 groups. The SL gap range values were also higher (+86% for R1 and +40% for R2) and the LCA range values also lower (-50% for R1 and -31% for R2) in group 2. CONCLUSIONS Quantitative 4D-CT data corresponded well with the arthroscopic dynamic analysis of the SL joint in patients with suspected chronic SL instability. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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15
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Seah RB, Mak WK, Bryant K, Korlaet M, Dwyer A, Bain GI. Four-dimensional computed tomography scan for dynamic elbow disorders: recommendations for clinical utility. JSES Int 2022; 6:182-186. [PMID: 35141694 PMCID: PMC8811401 DOI: 10.1016/j.jseint.2021.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Four-dimensional computed tomography (4D CT) is rapidly emerging as a diagnostic tool for the investigation of dynamic upper limb disorders. Dynamic elbow pathologies are challenging to diagnose, and at present, limitations exist in current imaging modalities. OBJECTIVE We aimed to assess the clinical utility of 4D CT in detecting potential dynamic elbow disorders. METHODS Twenty-eight elbow joints from 26 patients with symptoms of dynamic elbow pathology were included in this study. They were first assessed by a senior orthopedic surgeon with subsequent qualitative data obtained via a Siemens Force Dual Source CT scanner (Erlangen, Germany), producing two- and three-dimensional "static" images and 4D dynamic "movie" images for assessment in each clinical scenario. Clinical assessment before and after scan was compared. RESULTS Use of 4D CT scan resulted in a change of diagnosis in 16 cases (57.14%). This included a change in primary diagnosis in 2 cases (7.14%) and secondary diagnosis in 14 cases (50%). In 25 cases (89.29%), the 4D CT scan allowed us to understand the pathological anatomy in greater detail which led to a change in the management plan of 15 cases (53.57%). CONCLUSION 4D CT is a promising diagnostic tool in the management of dynamic elbow disorders and may be considered in clinical practice. Future studies need to compare it with other diagnostic modalities such as three-dimensional CT.
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Affiliation(s)
| | - Wai-Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore
| | - Kimberley Bryant
- Clinical and Research Imaging Centre, SAHMRI, Adelaide, SA, Australia
| | - Mishelle Korlaet
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Andrew Dwyer
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
| | - Gregory I. Bain
- Department of Orthopaedic Surgery and Trauma, Flinders University, Bedford Park, SA, Australia
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16
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Keelson B, Buzzatti L, Ceranka J, Gutiérrez A, Battista S, Scheerlinck T, Van Gompel G, De Mey J, Cattrysse E, Buls N, Vandemeulebroucke J. Automated Motion Analysis of Bony Joint Structures from Dynamic Computer Tomography Images: A Multi-Atlas Approach. Diagnostics (Basel) 2021; 11:diagnostics11112062. [PMID: 34829409 PMCID: PMC8621122 DOI: 10.3390/diagnostics11112062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
Dynamic computer tomography (CT) is an emerging modality to analyze in-vivo joint kinematics at the bone level, but it requires manual bone segmentation and, in some instances, landmark identification. The objective of this study is to present an automated workflow for the assessment of three-dimensional in vivo joint kinematics from dynamic musculoskeletal CT images. The proposed method relies on a multi-atlas, multi-label segmentation and landmark propagation framework to extract bony structures and detect anatomical landmarks on the CT dataset. The segmented structures serve as regions of interest for the subsequent motion estimation across the dynamic sequence. The landmarks are propagated across the dynamic sequence for the construction of bone embedded reference frames from which kinematic parameters are estimated. We applied our workflow on dynamic CT images obtained from 15 healthy subjects on two different joints: thumb base (n = 5) and knee (n = 10). The proposed method resulted in segmentation accuracies of 0.90 ± 0.01 for the thumb dataset and 0.94 ± 0.02 for the knee as measured by the Dice score coefficient. In terms of motion estimation, mean differences in cardan angles between the automated algorithm and manual segmentation, and landmark identification performed by an expert were below 1°. Intraclass correlation (ICC) between cardan angles from the algorithm and results from expert manual landmarks ranged from 0.72 to 0.99 for all joints across all axes. The proposed automated method resulted in reproducible and reliable measurements, enabling the assessment of joint kinematics using 4DCT in clinical routine.
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Affiliation(s)
- Benyameen Keelson
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium; (A.G.); (G.V.G.); (J.D.M.); (N.B.); (J.V.)
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- IMEC, Kapeldreef 75, B-3002 Leuven, Belgium
- Correspondence:
| | - Luca Buzzatti
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Vrije Universiteit Brussel (VUB), Vrije Universiteit, 1090 Brussel, Belgium; (L.B.); (E.C.)
| | - Jakub Ceranka
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- IMEC, Kapeldreef 75, B-3002 Leuven, Belgium
| | - Adrián Gutiérrez
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium; (A.G.); (G.V.G.); (J.D.M.); (N.B.); (J.V.)
| | - Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Campus of Savona, University of Genova, 17100 Savona, Italy;
| | - Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium;
| | - Gert Van Gompel
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium; (A.G.); (G.V.G.); (J.D.M.); (N.B.); (J.V.)
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium; (A.G.); (G.V.G.); (J.D.M.); (N.B.); (J.V.)
| | - Erik Cattrysse
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Vrije Universiteit Brussel (VUB), Vrije Universiteit, 1090 Brussel, Belgium; (L.B.); (E.C.)
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium; (A.G.); (G.V.G.); (J.D.M.); (N.B.); (J.V.)
| | - Jef Vandemeulebroucke
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium; (A.G.); (G.V.G.); (J.D.M.); (N.B.); (J.V.)
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), 1050 Brussels, Belgium;
- IMEC, Kapeldreef 75, B-3002 Leuven, Belgium
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17
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Dietrich TJ, Toms AP, Cerezal L, Omoumi P, Boutin RD, Fritz J, Schmitt R, Shahabpour M, Becce F, Cotten A, Blum A, Zanetti M, Llopis E, Bień M, Lalam RK, Afonso PD, Mascarenhas VV, Sutter R, Teh J, Pracoń G, de Jonge MC, Drapé JL, Mespreuve M, Bazzocchi A, Bierry G, Dalili D, Garcia-Elias M, Atzei A, Bain GI, Mathoulin CL, Del Piñal F, Van Overstraeten L, Szabo RM, Camus EJ, Luchetti R, Chojnowski AJ, Grünert JG, Czarnecki P, Corella F, Nagy L, Yamamoto M, Golubev IO, van Schoonhoven J, Goehtz F, Klich M, Sudoł-Szopińska I. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol 2021; 31:9446-9458. [PMID: 34100996 PMCID: PMC8589813 DOI: 10.1007/s00330-021-08073-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Objectives The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. Methods Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists. Results Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available. Conclusions Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability. Key Points • Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.
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Affiliation(s)
- Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH 9007, St. Gallen, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Andoni Paul Toms
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Luis Cerezal
- Radiology Department, DMC-Diagnóstico Médico Cantabria, Castilla 6-Bajo, 39002, Santander, Spain
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Robert Downey Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA
| | - Rainer Schmitt
- Klinikum der Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Radiologie, Marchioninistraße 15, D-81377, München, Germany
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Anne Cotten
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU de Lille, 59800, Lille, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, UDL, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Marco Zanetti
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Department of Musculoskeletal Radiology, Clinic Hirslanden Zurich, Witellikerstrasse 40, 8008, Zurich, Switzerland
| | - Eva Llopis
- Hospital de la Ribera, IMSKE, Valencia, Paseo Ciudadela 13, 46003, Valencia, Spain
| | - Maciej Bień
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Radhesh Krishna Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.,Hospital Particular da Madeira, HPA, Funchal, Madeira, Portugal
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.,AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal
| | - Reto Sutter
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Grzegorz Pracoń
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland.,Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - Jean-Luc Drapé
- Service de Radiologie B, Groupe Hospitalier Cochin, AP-HP Centre, Université de Paris, 75014, Paris, France
| | - Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Guillaume Bierry
- MSK Imaging, University Hospital, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Danoob Dalili
- Epsom & St Helier University Hospitals NHS Trust Radiology Department, Dorking Road, Epsom, London, KT18 7EG, UK
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Creu Blanca, P° Reina Elisenda 57, 08022, Barcelona, Spain
| | - Andrea Atzei
- Pro-Mano, Treviso, Italy and Ospedale Koelliker, Corso G. Ferraris 247, 10134, Torino, Italy
| | - Gregory Ian Bain
- Department of Orthopaedic Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | | | - Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Serrano 58 1B, 28001, Madrid, Spain
| | - Luc Van Overstraeten
- Hand and Foot Surgery Unit (HFSU) SPRL, Rue Pierre Caille 9, 7500, Tournai, Belgium.,Department of Orthopaedics and Traumatology, Erasme University Hospital, Route de Lennik, 808, Brussels, Belgium
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California Davis, Health System, 4800 Y Street, Sacramento, CA, 95817, USA
| | - Emmanuel J Camus
- Hand Surgery Unit, Clinique de Lille Sud, 96 Rue Gustave Delory, Lesquin, France
| | | | - Adrian Julian Chojnowski
- Orthopaedics and Trauma Department, Hand and Upper Limb Surgery, Norfolk and Norwich University NHS Trust Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Jörg G Grünert
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Piotr Czarnecki
- Traumatology, Orthopaedics and Hand Surgery Department, Poznan University of Medical Sciences, ul. 28 Czerwca 1956r. nr 135/147, 61-545, Poznań, Poland
| | - Fernando Corella
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Vía del Este N° 80, 28031, Madrid, Spain.,Hand Surgery Unit, Hospital Universitario Quirónsalud Madrid, Madrid, Spain.,Surgery Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ladislav Nagy
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Division for Hand Surgery and Surgery of Peripheral Nerves, Balgrist University Hospital, University of Zurich, Forchstrasse, 340, 8008, Zurich, Switzerland
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Igor O Golubev
- Hand and Microsurgery Division, National Medical Research Centre of Traumatology and Orthopaedic named after N.N. Priorov, Moscow, Russia
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Maciej Klich
- Department of Traumatology and Orthopaedics, Postgraduate Medical Center, A. Gruca Teaching Hospital, Otwock, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
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Athlani L, Granero J, Rouizi K, Hossu G, Blum A, Dautel G, Gondim Teixeira PA. Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability. J Wrist Surg 2021; 10:234-240. [PMID: 34109067 PMCID: PMC8169173 DOI: 10.1055/s-0040-1722571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
Background In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI). Methods Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI ( n = 16), negative SLI ( n = 19), and questionable SLI ( n = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation. Results The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCA mean . The LCA max values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCA cv (7% vs. 12%, p = 0.02) and LCA range (18 vs. 27 degrees, p = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCA cv ( p = 0.03) and LCA range ( p = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCA cv and LCA range threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively. Conclusion In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings. Level of evidence This is a Level III study.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
- IADI Laboratory, INSERM U1254, Université de Lorraine, Nancy, France
| | - Jonathan Granero
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
| | - Kamel Rouizi
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
| | - Gabriela Hossu
- IADI Laboratory, INSERM U1254, Université de Lorraine, Nancy, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
- IADI Laboratory, INSERM U1254, Université de Lorraine, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
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19
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Goelz L, Kim S, Güthoff C, Eichenauer F, Eisenschenk A, Mutze S, Asmus A. ACTION trial: a prospective study on diagnostic Accuracy of 4D CT for diagnosing Instable ScaphOlunate DissociatioN. BMC Musculoskelet Disord 2021; 22:84. [PMID: 33451307 PMCID: PMC7811226 DOI: 10.1186/s12891-021-03946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Early detection of scapholunate ligament (SLL) tears is essential after minor and major trauma to the wrist. The differentiation between stable and instable injuries determines therapeutic measures which aim to prevent osteoarthritis. Arthroscopy has since been the diagnostic gold standard in suspected SLL tears because non-invasive methods have failed to exclude instable injuries reliably. This prospective study aims to determine the diagnostic accuracy of dynamic, 4D computed tomography (CT) of the wrist for diagnosing instable SLL tears. Methods Single center, prospective trial including 40 patients with suspected SLL tears scheduled for arthroscopy. Diagnostic accuracy of 4D CT will be tested against the reference standard arthroscopy. Radiologists will be blinded to the results of arthroscopy and hand surgeons to radiological reports. A historical cohort of 80 patients which was diagnosed using cineradiography before implementation of 4D CT at the study site will serve as a comparative group. Discussion Static imaging lacks the ability to detect instable SLL tears after wrist trauma. Dynamic methods such as cineradiography and dynamic magnetic resonance imaging (MRI) are complex and require specific technical infrastructure in specialized centers. Modern super-fast dual source CT scanners are gaining popularity and are being installed gradually in hospitals and ambulances. These scanners enable dynamic imaging in a quick and simple manner. Establishment of dynamic 4D CT of the wrist in patients with suspected SLL tears in in- and outpatient settings could improve early detection rates. Reliable identification of instable injuries through 4D CT scans might reduce the number of unnecessary diagnostic arthroscopies in the future. Trial registration This study was registered prospectively at the German Clinical Trials Register (DRKS) DRKS00021110. Universal Trial Number (WHO-UTN): U1111–1249-7884.
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Affiliation(s)
- Leonie Goelz
- Dept. of Radiology and Neuroradiology, BG Unfallkrankenhaus, Berlin, Germany. .,Inst. For Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany.
| | - Simon Kim
- Dept. of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Unfallkrankenhaus, Berlin, Germany
| | - Frank Eichenauer
- Dept. of Hand-, Replantation- and Microsurgery, BG Unfallkrankenhaus, Berlin, Germany
| | - Andreas Eisenschenk
- Dept. of Hand Surgery and Microsurgery, University Medicine Greifswald, Greifswald, Germany.,Dept. of Hand-, Replantation- and Microsurgery, BG Unfallkrankenhaus, Berlin, Germany
| | - Sven Mutze
- Dept. of Radiology and Neuroradiology, BG Unfallkrankenhaus, Berlin, Germany.,Inst. For Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Ariane Asmus
- Dept. of Hand-, Replantation- and Microsurgery, BG Unfallkrankenhaus, Berlin, Germany
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20
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Evaluation of Dorsal Scaphoid Displacement Using Posterior Radioscaphoid Angle in Patients With Suspected Scapholunate Instability: A Preliminary Study. J Hand Surg Am 2021; 46:10-16. [PMID: 33191036 DOI: 10.1016/j.jhsa.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the validity and reliability of the posterior radioscaphoid angle (PRSA), an indicator of dorsal displacement of the scaphoid, in distinguishing wrists with and without chronic scapholunate instability (SLI). METHODS We prospectively evaluated 40 patients (22 men and 18 women; mean age, 46 ± 13 years) with suspected SLI with radiographs and computed tomography arthrography. Based on these data, 3 groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). An independent reader measured the PRSA on sagittal computed tomography images using the same procedure. RESULTS The PRSA median values were significantly lower in the negative SLI group (98°) compared with the positive SLI (110°) and questionable SLI (111°) groups. The difference between the positive SLI and questionable SLI groups was not significant. The best differentiation between patients with and without SLI was obtained with a PRSA threshold value of 103° (specificity of 86% and sensitivity of 79%). CONCLUSIONS In this preliminary study, PRSA analysis offers a quantitative tool for the evaluation of dorsal scaphoid displacement in cases of SLI, including for patients presenting with questionable initial radiography findings. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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21
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Brinkhorst M, Streekstra G, van Rosmalen J, Strackee S, Hovius S. Effects of axial load on in vivo scaphoid and lunate kinematics using four-dimensional computed tomography. J Hand Surg Eur Vol 2020; 45:974-980. [PMID: 32746687 PMCID: PMC7583439 DOI: 10.1177/1753193420943400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This in vivo study investigated the effect of axial load on lunate and scaphoid kinematics during flexion-extension and radial-ulnar deviation of the uninjured wrist using four-dimensional computed tomography. We found that applying axial load to the wrist results in a more flexed, radially deviated and pronated position of the lunate and scaphoid during flexion-extension of the wrist compared with when no load is applied. A larger pronation and supination range of the lunate and scaphoid was seen when the wrist was flexed and extended under axial load, whereas a larger flexion and extension range of the lunate and scaphoid occurred during radial-ulnar deviation of the wrist when axial load was applied.
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Affiliation(s)
- Michelle Brinkhorst
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands,Michelle Brinkhorst, PO Box 2040, Room Na-2206, 3000 CA Rotterdam, The Netherlands.
| | - Geert Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, The Netherlands,Department of Radiology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Simon Strackee
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Steven Hovius
- Xpert Clinic, Hand and Wrist Clinic, Nijmegen, The Netherlands,Department of Plastic, Reconstructive and Hand Surgery, Radboudumc, Nijmegen, The Netherlands
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22
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Blum A, Gillet R, Rauch A, Urbaneja A, Biouichi H, Dodin G, Germain E, Lombard C, Jaquet P, Louis M, Simon L, Gondim Teixeira P. 3D reconstructions, 4D imaging and postprocessing with CT in musculoskeletal disorders: Past, present and future. Diagn Interv Imaging 2020; 101:693-705. [PMID: 33036947 DOI: 10.1016/j.diii.2020.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 12/30/2022]
Abstract
Three-dimensional (3D) imaging and post processing are common tasks used daily in many disciplines. The purpose of this article is to review the new postprocessing tools available. Although 3D imaging can be applied to all anatomical regions and used with all imaging techniques, its most varied and relevant applications are found with computed tomography (CT) data in musculoskeletal imaging. These new applications include global illumination rendering (GIR), unfolded rib reformations, subtracted CT angiography for bone analysis, dynamic studies, temporal subtraction and image fusion. In all of these tasks, registration and segmentation are two basic processes that affect the quality of the results. GIR simulates the complete interaction of photons with the scanned object, providing photorealistic volume rendering. Reformations to unfold the rib cage allow more accurate and faster diagnosis of rib lesions. Dynamic CT can be applied to cinematic joint evaluations a well as to perfusion and angiographic studies. Finally, more traditional techniques, such as minimum intensity projection, might find new applications for bone evaluation with the advent of ultra-high-resolution CT scanners. These tools can be used synergistically to provide morphologic, topographic and functional information and increase the versatility of CT.
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Affiliation(s)
- A Blum
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France; Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, 54511 Vandœuvre-lès-Nancy, France.
| | - R Gillet
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - A Rauch
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - A Urbaneja
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - H Biouichi
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - G Dodin
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - E Germain
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - C Lombard
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - P Jaquet
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - M Louis
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - L Simon
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France
| | - P Gondim Teixeira
- Guilloz Imaging Department, CHRU of Nancy, 54000 Nancy, France; Unité INSERM U1254 Imagerie Adaptative Diagnostique et Interventionnelle (IADI), CHRU of Nancy, 54511 Vandœuvre-lès-Nancy, France
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23
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Grunz JP, Gietzen CH, Grunz K, Bley T, Schmitt R. Imaging of Carpal Instabilities. ROFO-FORTSCHR RONTG 2020; 193:139-150. [DOI: 10.1055/a-1219-8158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The term “carpal instability” describes different debilitating wrist conditions, in which the carpus is unable to maintain its physiological range of motion and load transfer. Depending on the cause and location of the dysfunction, four groups can be defined: dissociative, non-dissociative, complex, and adaptive carpal instability. As the most common form by far, dissociative carpal instability can further be categorized as dorsal or palmar intercalated segment instability, contingent on the afflicted interosseous ligament.Method This review article outlines the different entities of carpal instability, their pathophysiology, and their clinical presentation. It further discusses the diagnostic significance of different imaging methods as well as the established treatment options for each form of instability in context with the current literature.Results and Conclusion Early detection and treatment of carpal instability are essential for preventing carpal osteoarthritis. Traumatic lesions of the scapholunate interosseous ligament are the most frequent cause of instability. They can occur in an isolated fashion or in context with other carpal injuries. While stress imaging and fluoroscopy facilitate the differentiation between dynamic and static forms of carpal instability, only MRI and CT/MR arthrography can directly reveal the extent of ligament discontinuity.Key Points:Citation Format
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Katharina Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Thorsten Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
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24
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Evaluation of Dorsal Subluxation of the Scaphoid in Patients With Scapholunate Ligament Tears: A 4D CT Study. AJR Am J Roentgenol 2020; 216:141-149. [PMID: 32755179 DOI: 10.2214/ajr.20.22855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the variation of the posterior radioscaphoid (RS) angle in patients with and without scapholunate ligament (SLL) tears during wrist radioulnar deviation. SUBJECTS AND METHODS. Seventy-three patients with clinically suspected scapholunate instability were prospectively evaluated with 4D CT and CT arthrography from February 2015 to April 2018. The posterior RS angle is formed between the articular surface of the scaphoid fossa of the radius and the most posterior point of the scaphoid in the sagittal plane. Two independent radiologists calculated this angle during radioulnar deviation. Posterior RS angles were correlated with the SLL status and the presence of a scapholunate diastasis on conventional stress radiographs. RESULTS. Readers 1 and 2 found mean posterior RS angles of 99° and 98°, respectively, in patients without and 107° and 111°, respectively, in patients with a scapholunate diastasis. The posterior RS angle amplitude varied 7.6-9.3° in the subgroups studied. The reproducibility of posterior RS angle measurement was considered good (intraclass correlation coefficient, 0.73). Mean posterior RS angles increased 6-10% and 12-14% when patients with an intact SLL were compared with those with partial tears and full tears, respectively (p < 0.001). These values also increased 8-13% when patients with diastasis were compared with those without (p < 0.0001). A dynamic acquisition was not necessary to assess this angle, with neutral posterior RS angles yielding a sensitivity of 64% and 72% and specificity of 79% and 94% for the diagnosis of SLL tears by readers 1 and 2, respectively. CONCLUSION. Posterior RS angle tended to increase with the severity of SLL tears and with the presence of scapholunate instability and yielded high sensitivity and specificity for the detection of SLL tears.
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Athlani L, Rouizi K, Granero J, Hossu G, Blum A, Dautel G, Gondim Teixeira PA. Assessment of scapholunate instability with dynamic computed tomography. J Hand Surg Eur Vol 2020; 45:375-382. [PMID: 31842675 DOI: 10.1177/1753193419893890] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We performed a prospective study to evaluate the values of dynamic four-dimensional computed tomography in assessing suspected chronic scapholunate instability. Forty patients were evaluated with radiographs, arthrography, and four-dimensional computed tomography. On plain radiographs and computed tomography, we found 16 patients with definite scapholunate instability, five with questionable scapholunate instability, and 19 with absence of scapholunate instability. We used four-dimensional computed tomography to evaluate the size of the scapholunate gap during radioulnar deviation. The mean and maximal values of the gap size were lowest in the patients with absence of scapholunate instability and highest in those with definite scapholunate instability. When comparing the scapholunate gap sizes of the patients with absent and questionable scapholunate instability, the range of the gap sizes was significantly higher in the patients with questionable scapholunate instability. We conclude that four-dimensional computed tomography aids assessment of chronic scapholunate instability, which allows the differentiation between patients without and those with definite or questionable scapholunate instability. Level of evidence: II.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Nancy University Hospital, Nancy, France
| | | | - Jonathan Granero
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Nancy University Hospital, Nancy, France
| | | | - Alain Blum
- Guilloz Imaging Department, Nancy University Hospital, Nancy, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Nancy University Hospital, Nancy, France
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Pallaver A, Honigmann P. The Role of Cone-Beam Computed Tomography (CBCT) Scan for Detection and Follow-Up of Traumatic Wrist Pathologies. J Hand Surg Am 2019; 44:1081-1087. [PMID: 31610905 DOI: 10.1016/j.jhsa.2019.07.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Abstract
Emergency diagnostics demand fast, easily available, and cost-effective procedures. The higher the accuracy of radiological imaging, the better it supports the surgeon in decision-making for further treatment. Cone-beam computed tomography has been proven to be a reliable tool in diagnosing fractures of the hand and distal forearm. It can be easily installed, has a high spatial resolution, and a potentially lower radiation dose when compared with multislice computed tomography or a series of plain x-rays. This review focuses on the value of conventional radiography, cone-beam computed tomography, and multislice computed tomography for diagnosing traumatic wrist pathologies.
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Affiliation(s)
- Armin Pallaver
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
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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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