Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: initial clinical experience

Demehri, Shadpour; Hafezi-Nejad, Nima; Morelli, John N.; Thakur, Uma; Lifchez, Scott D.; Means, Kenneth R.; Eng, John; Shores, Jaimie T.

doi:10.1007/s00256-015-2308-0

Cited by 39 publications

(29 citation statements)

References 30 publications

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“…Dynamic CT has been used for the evaluation of in vivo carpal motion, but most studies were based on subjective motion description and manual punctual measurements (16,18,28). In our study, the in vivo variation of RSA and LCA in normal wrists was measured in all time points of radioulnar deviation motion cycle with a semiautomatic postprocessing and a low-dose acquisition protocol (effective dose of ,0.02 mSv).…”

Section: Discussionmentioning

confidence: 99%

“…Four-dimensional (4D) CT with wide-area detectors allows a kinematic assessment of active wrist motion depicting slight positional bone changes with high temporal and spatial resolution. This technique has shown potential for the evaluation of carpal instability, particularly in cases of inconclusive initial assessment (14)(15)(16)(17)(18). Recently, commercially available postprocessing tools allowing semiautomatic quantitative angular measurement with 4D CT joint studies became available for clinical use (19)(20)(21).…”

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confidence: 99%

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Four-dimensional CT Analysis of Wrist Kinematics during Radioulnar Deviation

Rauch¹,

Arab²,

Dap³

et al. 2018

Radiology

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To determine the technical feasibility of four-dimensional (4D) CT for analysis of the variation of radioscaphoid angle (RSA) and lunocapitate angle (LCA) during wrist radioulnar deviation. Materials and Methods: In this prospective study, 37 participants suspected of having scapholunate instability were evaluated from January 2015 to December 2016 with 4D CT and CT arthrography (mean age 6 standard deviation, 42.3 years 6 15; range, 21-75 years; 27 men [mean age, 44 years 6 15] and 10 women [mean age, 38 years 6 14]). Five angular parameters for RSA and LCA variation during radioulnar deviation were calculated by two independent readers. CT arthrography was used as the reference standard method for scapholunate ligament tear identification. Results: In the control group (n = 23), the mean values for RSA were 103° 6 8 and 104° 6 9, whereas the mean values for LCA were 86° 6 9° and 90° 6 11° with a coefficient of variation of 11% and 13% for reader 1 and reader 2, respectively. The interobserver and intraobserver agreements were excellent for RSA and substantial to excellent for LCA. In the pathologic group (n = 14), LCA amplitude, standard deviation, and maximal angle were lower for both readers with respect to the control group, measuring 36% and 44% (P = .003), 37% and 44% (P = .002), and 13% and 19% (P = .003), respectively. RSA amplitude did not show statistically significant results in the pathologic group (P. .13). LCA yielded the highest sensitivity (71%-93%), whereas RSA yielded the highest specificity (87%-100%). Conclusion: Semiautomatic four-dimensional CT analysis of the wrist during radioulnar deviation is technically feasible and reproducible for evaluation of carpal kinematic abnormalities.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Four-dimensional CT Analysis of Wrist Kinematics during Radioulnar Deviation

Rauch¹,

Arab²,

Dap³

et al. 2018

Radiology

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“…Research to date has demonstrated the feasibility of 4D CT for use in imaging upper limb joints and for the diagnosis and surgical planning of costoclavicular impingement, scapholunate instability, capitate subluxation, pisotriquetral instability, acromioclavicular dislocation, and snapping scapula. [10][11][12][13][14] The technique has also been shown to produce images with high spatial and temporal resolution. 15,16…”

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confidence: 99%

Four-Dimensional Computed Tomography Scanning for Dynamic Wrist Disorders: Prospective Analysis and Recommendations for Clinical Utility

et al. 2018

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Background Four-dimensional computed tomography (4D CT) is a rapidly developing diagnostic tool in the assessment of dynamic upper limb disorders. Functional wrist anatomy is incompletely understood, and traditional imaging methods are often insufficient in the diagnosis of dynamic disorders. Technique This study has developed a protocol for 4D CT of the wrist, with the aim of reviewing the clinical utility of this technology in surgical assessment. A Toshiba Aquilion One Vision scanner was used in the protocol, in which two- and three-dimensional “static” images, as well as 4D “dynamic” images were produced and assessed in the clinical context of each patient. These consisted of a series of multiple 7-second movement clips exploring the nature and range of joint motion. Patients and Methods Nineteen patients with symptoms of dynamic instability were included in the study. Patients were assessed clinically by two orthopaedic surgeons, and qualitative data were obtained from radiological interpretation. Results The study demonstrated varied abnormalities of joint movement attributed to a range of wrist pathology, including degenerative arthritis, ligamentous injuries, Kienbock's disease, and pain following previous surgical reconstructive procedures. Interpretation of the 4D CT scan changed the clinical diagnosis in 13 cases (68.4%), including the primary (15.8%) or secondary diagnosis (52.6%). In all cases, the assessment of the dynamic wrist motion assisted in understanding the clinical problem and led to a change in management in 11 cases (57.9%). The mean effective radiation dose for the scan was calculated at 0.26 mSv. Conclusion We have found that the clinical utility of 4D CT lies in its ability to provide detailed information about dynamic joint pathology not seen in traditional imaging, targeting surgical treatment. Limitations to the use of 4D CT scan include lack of availability of the technology, potential radiation dose, and radiographer training requirements, as well as limited understanding of the nature of normal motion.

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“…Multiple different maneuvers can be performed with a single bolus of contrast. 79 KCT with or without arthrography can be used to assess intra-articular ligaments under stress, for example in the assessment of carpal instability, 83 and it can also be used to evaluate surgical outcomes after carpal ligament repair. 81 KCT may have a role in the evaluation of joint stability, assessment of the integrity of intra-articular ligaments, and in bony tracking abnormalities.…”

Section: Kinematic Ctmentioning

confidence: 99%

Musculoskeletal Imaging: Current Practice and Future Directions

Farrell

Adams

Walsh

et al. 2018

Semin Musculoskelet Radiol

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Musculoskeletal (MSK) radiology plays a crucial role in the diagnosis and management of MSK disorders and has rapidly expanded in tandem with advances in technology and improved access to imaging. Although anatomical imaging remains the mainstay of MSK radiology, significant progress has been made in functional and molecular imaging as well as in hybrid imaging with an expanding armament of technologies becoming available or in development. A vast array of research is occurring in MSK imaging, and this review article highlights some of the most promising current and future clinical applications in development in each of the major imaging modalities. Identifying the clinical utility of these technologies in an era of rising health care costs is an important challenge for MSK radiologists.

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Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: initial clinical experience

Abstract: In patients with wrist pain suspicious for SLIL injury and inconclusive radiographs, SL interval increase can be detected with 4DCT in the symptomatic wrist compared to the asymptomatic wrist.

Cited by 39 publications

References 30 publications

Four-dimensional CT Analysis of Wrist Kinematics during Radioulnar Deviation

Four-dimensional CT Analysis of Wrist Kinematics during Radioulnar Deviation

Four-Dimensional Computed Tomography Scanning for Dynamic Wrist Disorders: Prospective Analysis and Recommendations for Clinical Utility

Musculoskeletal Imaging: Current Practice and Future Directions

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