Jnl Wrist Surg 2019; 08(02): 161-167
DOI: 10.1055/s-0038-1675564
Emerging Technologies and New Technological Concepts
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Renee Carr
1  College of Medicine and Public Health, Flinders University, Adelaide, Australia
Simon MacLean
2  Department of Orthopaedic and Upper Limb Surgery, Tauranga Hospital, Tauranga, New Zealand
John Slavotinek
3  Department of Medical Imaging, Repatriation General Hospital, Daw Park, South Australia, Australia
Gregory I. Bain
4  Division of Hand and Upper Limb Surgery, Department of Orthopaedic Surgery, Flinders University, Adelaide, Australia
› Author Affiliations
Further Information

Publication History

20 May 2018

24 September 2018

Publication Date:
14 November 2018 (online)


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.