Four-Dimensional Computed Tomography Scanning for Dynamic Wrist Disorders: Prospective Analysis and Recommendations for Clinical Utility
20 May 2018
24 September 2018
14 November 2018 (eFirst)
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.
- 1 Halpenny D, Courtney K, Torreggiani WC. Dynamic four-dimensional 320 section CT and carpal bone injury - a description of a novel technique to diagnose scapholunate instability. Clin Radiol 2012; 67 (02) 185-187
- 2 Troupis JM, Amis B. Four-dimensional computed tomography and trigger lunate syndrome. J Comput Assist Tomogr 2013; 37 (04) 639-643
- 3 Kwong Y, Mel AO, Wheeler G, Troupis JM. Four-dimensional computed tomography (4DCT): A review of the current status and applications. J Med Imaging Radiat Oncol 2015; 59 (05) 545-554
- 4 Gieroba TJ, Bain GI, Cundy PJ. Review of the clinical use of fluoroscopy in hand surgery. Hand Surg 2015; 20 (02) 228-236
- 5 Bain GI, Hunt J, Mehta JA. Operative fluoroscopy in hand and upper limb surgery: first 100 cases. J Hand Surg Am 1997; 22B (05) 656-658
- 6 Galley I, Bain GI, McLean JM. Influence of lunate type on scaphoid kinematics. J Hand Surg Am 2007; 32 (06) 842-847
- 7 Maarse W, Watts AC, Bain GI. Medium-term outcome following intra-articular corticosteroid injection in first CMC joint arthritis using fluoroscopy. Hand Surg 2009; 14 (2-3): 99-104
- 8 Zhao K, Breighner R, Holmes III D, Leng S, McCollough C, An KN. A technique for quantifying wrist motion using four-dimensional computed tomography: approach and validation. J Biomech Eng 2015; 137 (07) 074501–1-5
- 9 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
- 10 Alta TD, Bell SN, Troupis JM, Coghlan JA, Miller D. The new 4-dimensional computed tomographic scanner allows dynamic visualization and measurement of normal acromioclavicular joint motion in an unloaded and loaded condition. J Comput Assist Tomogr 2012; 36 (06) 749-754
- 11 Demehri S, Hafezi-Nejad N, Morelli JN. , et al. Scapholunate kinematics of asymptomatic wrists in comparison with symptomatic contralateral wrists using four-dimensional CT examinations: initial clinical experience. Skeletal Radiol 2016; 45 (04) 437-446
- 12 Garcia-Elias M, Alomar Serrallach X, Monill Serra J. Dart-throwing motion in patients with scapholunate instability: a dynamic four-dimensional computed tomography study. J Hand Surg Eur Vol 2014; 39 (04) 346-352
- 13 Kakar S, Breighner RE, Leng S. , et al. The role of dynamic (4D) CT in the detection of scapholunate ligament injury. J Wrist Surg 2016; 5 (04) 306-310
- 14 Wassilew GI, Janz V, Heller MO. , et al. Real time visualization of femoroacetabular impingement and subluxation using 320-slice computed tomography. J Orthop Res 2013; 31 (02) 275-281
- 15 Choi YS, Lee YH, Kim S, Cho HW, Song HT, Suh JS. Four-dimensional real-time cine images of wrist joint kinematics using dual source CT with minimal time increment scanning. Yonsei Med J 2013; 54 (04) 1026-1032
- 16 Leng S, Zhao K, Qu M, An KN, Berger R, McCollough CH. Dynamic CT technique for assessment of wrist joint instabilities. Med Phys 2011; 38 (Suppl. 01) S50-S56
- 17 Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am 2009; 91 (08) 1882-1889