Reliability and correlation analysis of computed methods to convert conventional 2D radiological hindfoot measurements to a 3D setting using weightbearing CT

Burssens, Arne; Peeters, Johannes M.; Peiffer, Matthias; Marien, R; Lenaerts, Tom; Vandeputte, Geoffroy; Victor, Jan

doi:10.1007/s11548-018-1727-5

Cited by 60 publications

(44 citation statements)

References 50 publications

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“…9,17 Computer Aided Design (CAD) operations in 3-matic v12 (Materialise, Haasrode, Belgium) computed the anatomical landmarks and axes. 8,46 The apex malleolus lateralis, anterior tubercle, and posterior tubercle were respectively computed as the most distal, anterior, and posterior point of the distal fibula ( Figure 4A). The fibular shaft axis was computed as the fibular best-fit longitudinal axis.…”

Section: Specimensmentioning

confidence: 99%

Comparison of External Torque to Axial Loading in Detecting 3-Dimensional Displacement of Syndesmotic Ankle Injuries

et al. 2020

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Background: Current imaging techniques try to quantify 3-dimensional displacement of syndesmotic ankle injuries using 2-dimensional measurements, which may obscure an exact diagnosis. Therefore, our aim was to determine 3-dimensional displacement of syndesmotic ankle injuries under load and torque using a weightbearing computed tomography (WBCT) and to assess the relation with previously established 2-dimensional measurements. Methods: Seven paired cadaver specimens were mounted into a radiolucent frame. WBCT scans were obtained to generate 3-dimensional models after different patterns of axial load (0 kg, 85 kg) combined with external torque (0, 10 Nm). Sequential imaging was repeated in ankles containing intact syndesmotic ligaments, sectioning of the anterior inferior tibiofibular ligament (AITFL; condition 1A), deltoid ligament (DL; condition 1B), combined AITFL+DL (condition 2), and AITFl+DL+interosseous membrane (condition 3). Reference anatomical landmarks were established relative to the intact position of the fibula to quantify displacement. A subsequent correlation analysis was performed between the obtained 2- and 3-dimensional measurements. Results: Axial load increased lateral translation (mean = −0.9 mm, 95% confidence interval [CI]: 1.3, –0.1) significantly in condition 2 relative to the intact ankle ( P < .05) but did not demonstrate other significant displacements. External torque increased displacement significantly in all directions ( P < .05), except for dorsal translation of the fibula ( P > .05). The highest displacement could be detected when external torque was applied in condition 3 and consisted of posterior translation (mean = −3.1 mm; 95% CI: –4.8, –2.7) and external rotation (mean = −4.7 degrees; 95% CI: –5.6, –2.9). Pearson correlation coefficients between the 2-dimensional and 3-dimensional measurements were moderate and ranged from 0.31 to 0.56 ( P < .05). Conclusion: External torque demonstrated superiority over axial load in detecting syndesmotic ankle instability. Axial load increased lateral translation; however, differences were submillimeter in magnitude until torque was applied. A moderate correlation was found with previously established 2-dimensional measurements. Clinical Relevance: In clinical practice these findings substantiate application of external torque in current imaging modalities to improve detection of syndesmotic ankle injuries.

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Section: Specimensmentioning

confidence: 99%

Comparison of External Torque to Axial Loading in Detecting 3-Dimensional Displacement of Syndesmotic Ankle Injuries

et al. 2020

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“…4,7,10,15,16 Recent studies have shown how the different angles used to assess HA may differ substantially between radiographs, traditional CT, and WBCT, suggesting that 3D weightbearing measurements represent a major step forward to detect the “true alignment.” 9,13,22 In addition, this technology can provide a digitally reconstructed radiograph, similar to traditional radiography with the advantage of no rotation bias. 4,8 Common measurements, such as the long axial view (termed HACT), can be taken using this reconstruction to evaluate HA.…”

Section: Introductionmentioning

confidence: 99%

“…9,13,22 In addition, this technology can provide a digitally reconstructed radiograph, similar to traditional radiography with the advantage of no rotation bias. 4,8 Common measurements, such as the long axial view (termed HACT), can be taken using this reconstruction to evaluate HA.…”

Section: Introductionmentioning

confidence: 99%

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

et al. 2019

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Background: Weightbearing computed tomography (WBCT) is a useful tool for the assessment of hindfoot alignment (HA). Foot ankle offset (FAO) is a recently introduced parameter, determined from WBCT images using semiautomatic software. The aim of this study was to determine the clinical relevance and reproducibility of FAO for the evaluation of HA. Methods: A prospective comparative study was performed on consecutive patients requiring bilateral WBCT between September 2017 and April 2018. Based on the clinical assessment of HA, patients were divided into 3 groups: (1) normal alignment group (G1), (2) valgus (G2), and (3) varus (G3). FAO and long axial view (HACT) were measured on WBCT images, and the groups were compared. The reproducibility of FAO and HACT was determined through intraclass correlation coefficients (ICCs). Regression analysis was performed to investigate the correlation between the 2 methods. Overall, 249 feet (126 patients) were included (G1 = 115, G2 = 78, and G3 = 56 feet). Results: The mean values for FAO and HACT were 1.2% ± 2.8% and 3.9 ± 3.1, respectively, in G1; 8.1% ± 3.7% and 9.7 ± 4.9 in G2; and −6.6% ± 4.8% and −8.2 ± 6.6 in G3. Intra- and interobserver reliability was 0.987 and 0.988 for FAO and 0.949 and 0.949 for HACT, respectively. There was a good linear correlation between HACT and FAO ( R2 = 0.744), with a regression slope of 1.064. Conclusions: WBCT was a useful method for the characterization of HA. FAO was reproducible and correlated well with physical examination. Level of Evidence: Level II, prospective comparative study.

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“…(An alternative approach, not considered here, could involve redefinition of anatomical measurements using features more readily tractable by image analysis than morphological landmarks. 15 )…”

Section: Introductionmentioning

confidence: 99%

“…The proposed algorithm is applied to data of 24 subject volunteers acquired with a specialized extremity CBCT scanner. 23 Extremity CBCT systems provide the unique capability for weight-bearing three-dimensional (3-D) imaging of the knee 4,15,24 and foot. 15,24,25 Development of diagnostic applications of this new modality will benefit from improvements in the workflow, repeatability, and reliability of anatomical measurements that are anticipated with the automatic algorithm.…”

Section: Introductionmentioning

confidence: 99%

Atlas-based algorithm for automatic anatomical measurements in the knee

et al. 2019

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We present an algorithm for automatic anatomical measurements in tomographic datasets of the knee. The algorithm uses a set of atlases, each consisting of a knee image, surface segmentations of the bones, and locations of landmarks required by the anatomical metrics. A multistage volume-to-volume and surface-tovolume registration is performed to transfer the landmarks from the atlases to the target volume. Manual segmentation of the target volume is not required in this approach. Metrics were computed from the transferred landmarks of a best-matching atlas member (different for each bone), identified based on a mutual information criterion. Leave-one-out validation of the algorithm was performed on 24 scans of the knee obtained using extremity cone-beam computed tomography. Intraclass correlation (ICC) between the algorithm and the expert who generated atlas landmarks was above 0.95 for all metrics. This compares favorably to inter-reader ICC, which varied from 0.19 to 0.95, depending on the metric. Absolute agreement with the expert was also good, with median errors below 0.25 deg for measurements of tibial slope and static alignment, and below 0.2 mm for tibial tuberosity-trochlear groove distance and medial tibial depth. The automatic approach is anticipated to improve measurement workflow and mitigate the effects of operator experience and training on reliability of the metrics.

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Reliability and correlation analysis of computed methods to convert conventional 2D radiological hindfoot measurements to a 3D setting using weightbearing CT

Cited by 60 publications

References 50 publications

Comparison of External Torque to Axial Loading in Detecting 3-Dimensional Displacement of Syndesmotic Ankle Injuries

Comparison of External Torque to Axial Loading in Detecting 3-Dimensional Displacement of Syndesmotic Ankle Injuries

3D Biometrics for Hindfoot Alignment Using Weightbearing Computed Tomography

Atlas-based algorithm for automatic anatomical measurements in the knee

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