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Doan MK, Long JR, Verhey E, Wyse A, Patel K, Flug JA. Cone-Beam CT of the Extremities in Clinical Practice. Radiographics 2024; 44:e230143. [PMID: 38421913 DOI: 10.1148/rg.230143] [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: 03/02/2024]
Abstract
Cone-beam CT (CBCT) is a promising tool with increasing applications in musculoskeletal imaging due to its ability to provide thin-section CT images of the appendicular skeleton and introduce weight bearing, which accounts for loading forces that typically interact with and affect this anatomy. CBCT devices include an x-ray source directly opposite a digital silicon detector panel that performs a single rotation around an object of interest, obtaining thin-section images. Currently, the majority of research has been focused on the utility of CBCT with foot and ankle pathologic abnormalities, due to the complex architectural arrangement of the tarsal bones and weight-bearing nature of the lower extremities. Associated software can provide a variety of options for image reconstruction, including metal artifact reduction, three-dimensional biometric measurements, and digitally reconstructed radiographs. Advancements in this technology have allowed imaging of the knee, hip, hand, and elbow. As more data are published, it is becoming evident that CBCT provides many additional benefits, including fast imaging time, low radiation dose, lower cost, and small equipment footprint. These benefits allow placement of CBCT units outside of the traditional radiology department, including the orthopedic clinic setting. These technologic developments have motivated clinicians to define the scope of CBCT for diagnostics, surgical planning, and longitudinal imaging. As efforts are made to create standardized protocol and measurements, the current understanding and surgical approach for various orthopedic pathologic conditions will continue to shift, with the hope of improving outcomes. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Matthew K Doan
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Jeremiah R Long
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Erik Verhey
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Aaron Wyse
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Karan Patel
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
| | - Jonathan A Flug
- From Mayo Clinic Alix School of Medicine, 5777 East Mayo Blvd, Scottsdale, AZ 85054 (M.K.D., E.V.); and Departments of Radiology (J.R.L., A.W., J.A.F.) and Orthopedic Surgery (K.P.), Mayo Clinic Arizona, Phoenix, Ariz
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Stewart HL, Siewerdsen JH, Selberg KT, Bills KW, Kawcak CE. Cone-beam computed tomography produces images of numerically comparable diagnostic quality for bone and inferior quality for soft tissues compared with fan-beam computed tomography in cadaveric equine metacarpophalangeal joints. Vet Radiol Ultrasound 2023; 64:1033-1036. [PMID: 37947254 DOI: 10.1111/vru.13309] [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: 03/02/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/12/2023] Open
Abstract
Cone-beam computed tomography (CBCT) is an emerging modality for imaging of the equine patient. The objective of this prospective, descriptive, exploratory study was to assess visualization tasks using CBCT compared with conventional fan-beam CT (FBCT) for imaging of the metacarpophalangeal joint in equine cadavers. Satisfaction scores were numerically excellent with both CBCT and FBCT for bone evaluation, and FBCT was numerically superior for soft tissue evaluation. Preference tests indicated FBCT was numerically superior for soft tissue evaluation, while preference test scoring for bone was observer-dependent. Findings from this study can be used as background for future studies evaluating CBCT image quality in live horses.
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Affiliation(s)
- Holly L Stewart
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Jeffrey H Siewerdsen
- Department of Imaging Physics, Neurosurgery, and Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Kurt T Selberg
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Kathryn W Bills
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Christopher E Kawcak
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations-a review of the literature. Skeletal Radiol 2022; 52:1073-1088. [PMID: 36350387 DOI: 10.1007/s00256-022-04223-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
Weight bearing CT (WBCT) of the lower extremity is gaining momentum in evaluation of the foot/ankle and knee. A growing number of international studies use WBCT, which is promising for improving our understanding of anatomy and biomechanics during natural loading of the lower extremity. However, we believe there is risk of excessive enthusiasm for WBCT leading to premature application of the technique, before sufficiently robust protocols are in place e.g. standardised limb positioning and imaging planes, choice of anatomical landmarks and image slices used for individual measurements. Lack of standardisation could limit benefits from introducing WBCT in research and clinical practice because useful imaging information could become obscured. Measurements of bones and joints on WBCT are influenced by joint positioning and magnitude of loading, factors that need to be considered within a 3-D coordinate system. A proportion of WBCT studies examine inter- and intraobserver reproducibility for different radiological measurements in the knee or foot with reproducibility generally reported to be high. However, investigations of test-retest reproducibility are still lacking. Thus, the current ability to evaluate, e.g. the effects of surgery or structural disease progression, is questionable. This paper presents an overview of the relevant literature on WBCT in the lower extremity with an emphasis on factors that may affect measurement reproducibility in the foot/ankle and knee. We discuss the caveats of performing WBCT without consensus on imaging procedures and measurements.
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Geijer M, Inci F, Solidakis N, Szaro P, Al-Amiry B. The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica. Acta Radiol 2021; 62:1460-1472. [PMID: 34664508 PMCID: PMC8647486 DOI: 10.1177/02841851211050866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.
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Affiliation(s)
- Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, 70712University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fatih Inci
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nektarios Solidakis
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, 70712University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bariq Al-Amiry
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Dartus J, Jacques T, Martinot P, Pasquier G, Cotten A, Migaud H, Morel V, Putman S. The advantages of cone-beam computerised tomography (CT) in pain management following total knee arthroplasty, in comparison with conventional multi-detector CT. Orthop Traumatol Surg Res 2021; 107:102874. [PMID: 33647454 DOI: 10.1016/j.otsr.2021.102874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/08/2020] [Accepted: 10/05/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Revision of total knee arthroplasty (TKA) requires preoperative assessment to identify the causes of failure. Multidetector computerised tomography (MDCT) is a commonly used imaging technique, but is sensitive to certain artifacts, such as metal implants, limiting its use. Cone-beam CT (CBCT) is a new technique dedicated to musculoskeletal imaging that is less sensitive to artifacts and could be utilised in knee implantation surgery. CBCT has not yet been validated for this indication, and we therefore undertook a retrospective assessment of MDCT versus CBCT, comparing: 1) image quality; 2) reproducibility of angle measurements; 3) effectiveness in screening for periprosthetic radiolucency and implant loosening; and 4) radiation dose. HYPOTHESIS This study hypothesised that CBCT provides better image quality, angle measurement reproducibility, and screening for radiolucency and implant loosening at lower doses of radiation than MDCT. PATIENTS AND METHOD Between October 2017 and March 2018, 28 patients, with a mean age of 61±11.6 years [range, 45-85 years] underwent both MDCT and CBCT for pain following TKA. Two radiologists performed angle measurements on both devices: patellofemoral tilt (PFT), rotation angle of the femoral component (RAFC) and rotation angle of the tibial component (RATC). They also screened for pathological radiolucency and/or implant loosening, and assessed image quality at the various bone/implant interfaces. The mean CT dose index per examination was recorded. RESULTS Intraclass correlation coefficients for angles and radiolucency screening on MDCT and on CBCT were respectively good (0.73) and excellent (0.82) for PFT, borderline (0.28) and moderate (0.44) for RAFC, excellent (0.82) and excellent (0.96) for RATC, and moderate (0.45) and excellent (0.84) for radiolucency screening. The inter-observer kappa correlation coefficients for diagnosis of implant loosening and image quality assessment for MDCT and CBCT were respectively moderate (0.45) and excellent (0.93) for tibial loosening and low (0.19) and borderline (0.38) for femoral loosening. The mean image quality at the various interfaces for MDCT and CBCT was respectively 2.2/3 and 2.75/3 at the tibia/tibial implant interface, 1/3 and 2.3/3 at the trochlear region/femoral implant interface, 0.9/3 and 2/3 at the femoral condyle/femoral implant interface, and 1.25/3 and 2.1/3 at the patella/patellar medallion interface. The mean CT dose index was significantly lower, by a factor of 1.24, on CBCT (4.138 mGy) than MDCT (5.125 mGy) (p<00396). CONCLUSION The results of the present study revealed added value for CBCT in the etiological work-up for pain following a TKA. It was reliable and reproducible for the rotation measurement and diagnosis of implant loosening, due to enhanced image quality despite a lower radiation dose than conventional MDCT. LEVEL OF EVIDENCE III; retrospective comparative study.
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Affiliation(s)
- Julien Dartus
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France.
| | - Thibaut Jacques
- Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Pierre Martinot
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France; Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Gilles Pasquier
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France
| | - Anne Cotten
- Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Henri Migaud
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France
| | - Vincent Morel
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service d'imagerie musculo-squelettique, CHU de Lille, Centre de consultations et d'imagerie de l'appareil locomoteur, 59000 Lille, France
| | - Sophie Putman
- Département universitaire de chirurgie orthopédique et traumatologique, Université de Lille, CHU de Lille, ULR 4490, 59000 Lille, France; Service de chirurgie orthopédique, CHU de Lille, Hôpital Roger-Salengro, 59000 Lille, France
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Barnsley L, Barnsley L. Detection of aseptic loosening in total knee replacements: a systematic review and meta-analysis. Skeletal Radiol 2019; 48:1565-1572. [PMID: 30976835 DOI: 10.1007/s00256-019-03215-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/26/2019] [Accepted: 03/25/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic accuracy of nuclear imaging modalities in the detection of aseptic loosening of total knee arthroplasty (TKA). MATERIALS AND METHODS MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched from database inception to December 2018 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies compared the results of a single imaging modality against an appropriate reference standard of prosthetic TKA loosening, with sufficient information to determine either sensitivity and/or specificity. The methodological quality of the studies was assessed using the QUADAS-2 tool. RESULTS The search strategy identified 572 abstracts. Of these, 12 studies comprising 401 patients across four modalities (bone scintigraphy, 18F-FDG-PET, SPECT/CT arthrogram, radionuclide arthrogram) met the inclusion criteria. All included studies used operative findings, a period of clinical or radiographic observation or both as a reference standard for aseptic loosening. Sixteen comparisons with the reference standards were extracted. All studies were at risk of bias across patient selection, the index test, reference standard, and flow and timing of patients. The most accurate test for diagnosis of aseptic loosening in TKA was SPECT/CT arthrography demonstrated by the summary receiver operating characteristic curve. CONCLUSIONS The best available evidence suggests the most accurate modality for the detection of aseptic loosening in TKA is SPECT/CT arthrography. However, the available evidence has a high risk of bias, and total number of patients studied for each modality is small so further studies are warranted.
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Affiliation(s)
- Lara Barnsley
- Orthopaedic Department, Western Health, 160 Gordon Street, Footscray, Victoria, 3011, Australia.
| | - Les Barnsley
- Department of Medicine, University of Sydney, Sydney, Australia.,Department of Rheumatology, Concord Hospital, Hospital Rd, Concord, NSW, 2139, Australia
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