Evaluation of Four-Dimensional Computed Tomography as a Technique for Quantifying Carpal Motion

Abstract

Delayed diagnosis of dynamic carpal instability often occurs because early changes in bone alignment and movement are difficult to detect and manifest mainly during a dynamic/functional task. Current diagnostic tools are only able to examine the carpal bones under static or sequential-static conditions. Four-dimensional (three dimensions + time) computed tomography (4DCT) enables quantification of carpal mechanics through 3D volume sequences of the wrist in motion. A comprehensive understanding of carpal mechanics is needed to define normal function and structure and provide targets for treatment of carpal injuries. In this study, measurements of scaphoid translation and joint congruency were taken by creating models from the CT scans of the carpals in extreme frames of motion, registering those models to the neutral position, transforming the models into a local coordinate system, and using software to calculate the joint surface areas (JSA). Results indicated that the centroid of the scaphoid translated 6.4 ± 1.3 mm and extended from extreme radial to extreme ulnar deviation. Results are consistent with the literature. An additional study was performed to measure the responsiveness of the 4DCT technique presented. Bone models from each frame of motion for radioulnar deviation (RUD) and flexion extension (FE) were created and distinct differences between their JSA were measured qualitatively and quantitatively. The results show that there was statistically significantly different JSA within carpal joints between RUD and FE. These studies provide the first step in developing the methodology when using 4DCT scanning to measure subtle abnormalities in the wrist.

Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases

“…13 4DCT or quasi-dynamic CT has been used to assess SL biomechanics in uninjured participants, those with SL injuries preoperatively, and in cadaveric studies of SL biomechanics. 24,[27][28][29][30][31][32][33][34]51 This work builds on previous studies to demonstrate the applicability of 4DCT as a diagnostic and evaluation tool to reveal arthrokinematic changes at the radioscaphoid joint and SL intervals. While studies have evaluated the diagnostic utility of 4DCT, 31,52 this work highlights its role in postsurgical evaluation, especially in discerning subtle arthrokinematic changes.…”

“…Over the past decade, four-dimensional CT (4DCT)—standard 3DCT captured over motion cycles—has been introduced to capture CT volumes at evenly spaced time points during wrist motion with high spatial and temporal resolution. 24 25 26 27 28 29 30 31 32 33 34 35 This may allow identification of early ligamentous injuries and influence treatment strategy. 24…”

“…23 Over the past decade, four-dimensional CT (4DCT)-standard 3DCT captured over motion cycles-has been introduced to capture CT volumes at evenly spaced time points during wrist motion with high spatial and temporal resolution. [24][25][26][27][28][29][30][31][32][33][34][35] This may allow identification of early ligamentous injuries and influence treatment strategy. 24 We present the emerging use of 4DCT in a case series of two patients with surgically treated unilateral SLIL injuries to evaluate its utility in diagnosis and interpret changes in arthrokinematics, specifically interosseous proximities, following injury and 1-year postoperatively.…”

Reproducibility and repeatability of a semi-automated pipeline to quantify trapeziometacarpal joint angles using dynamic computed tomography

“…Dynamic CT provides 3D images over time, allowing for more accurate estimates of hand joint kinematics than is possible with motion capture systems. Several recent studies have utilized dynamic CT for various musculoskeletal applications and have demonstrated the feasibility of dynamic CT imaging for measuring joint motion (i.e., rotations and translations), displacements, and even estimates of joint contact [10][11][12][13][14]. However, post-processing methods for dynamic CT datasets published to date are time intensive, reducing the practicality of applying this technique to larger clinical studies.…”

Distance mapping in three-dimensional virtual surgical planning in hand, wrist and forearm surgery: a tool to avoid mistakes

“…Studies in this field used distance mapping to illustrate distances between the scaphoid and the lunate [ 13 , 14 ]. Recently, Robinson et al used colour-coded distance mapping as joint congruency maps of the radioscaphoid and scapholunate joint in extreme radial and ulnar deviation to illustrate the contact areas in the joint during motion using 4D-CT [ 15 ].…”