The use of 4D-CT in assessing wrist kinematics and pathology

Abstract

The wrist is a complex joint involving many small bones and complicated kinematics. It has, therefore, been traditionally difficult to image and ascertain information about kinematics when making a diagnosis. Although MRI and fluoroscopy have been used, they both have limitations. Recently, there has been interest in the use of 4D-CT in imaging the wrist. This review examines the literature regarding the use of 4D-CT in imaging the wrist to assess kinematics and its ability to diagnose pathology. Some questions remain about the description of normal ranges, the most appropriate method of measuring intercarpal stability, the accuracy compared with established standards, and the place of 4D-CT in postoperative assessment. Cite this article: Bone Joint J 2019;101-B:1325–1330.

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

“…The wrist is a complex joint consisting of numerous bones and ligamentous structures that enable complex movement while ensuring wrist stability [1,2]. An injury to the wrist may result in dynamic or static carpal instability [2] leading to degenerative arthritis if left undiagnosed and untreated for extended periods [3]. Delayed diagnosis often occurs because early changes in bone alignment and movement are difficult to detect (and require high spatial resolution) and may only be seen when the wrist is undergoing motion or loaded.…”

“…Quantitative measurements can be obtained through 4DCT and include osteokinematics (bone translation and rotation), and arthrokinematics (study of motion of joint surfaces) [1,4]. Studies using 4DCT to measure carpal kinematics have successfully been performed in vivo and in vitro but often have a small sample size, investigate a very specific pathology, and are often not validated [1,2,10]. Additionally, 4DCT, as it relies on continuous scanning of the X-ray tube, requires a higher dose than static 3DCT, but currently there is wide range of doses reported in the literature and is not consistently reported [6].…”

“…Additionally, 4DCT, as it relies on continuous scanning of the X-ray tube, requires a higher dose than static 3DCT, but currently there is wide range of doses reported in the literature and is not consistently reported [6]. As a clinical tool, 4DCT is still in its infancy and as such, there are contradictions in the literature regarding which CT scanner is best for measuring wrist motion [2].…”

Effects of axial load on in vivo scaphoid and lunate kinematics using four-dimensional computed tomography

“…Specific radiographs, such as the clenched fist view, cineradiography, computerized tomography (CT) and magnetic resonance imaging (MRI) provided an initial understanding of wrist kinematics. More recently, dynamic four-dimensional CT (4-D CT) studies have been introduced ( Athlani et al., 2020 ; Carr et al., 2019 ; de Roo et al., 2019 ; Rauch et al., 2018 ; White et al., 2019 ). Current studies using 4-D CT have focused on the gap size between the scaphoid and lunate when axial load is applied or on carpal kinematics during the dart-throwing motion ( Demehri et al., 2016 ; Edirisinghe et al., 2014 ; Garcia-Elias et al., 2014 ; Kelly et al., 2018 ).…”

Four-Dimensional CT Assessment of the Transverse Carpal Ligament Attachments-A Pilot Study

“…These 4D-CT scans are currently utilised as an alternative diagnostic modality, particularly for cases with inconclusive findings that may otherwise require invasive procedures such as wrist arthroscopy [1]. The clinical utility of 4D-CT in diagnosing wrist pathologies has been shown by Carr et al, and White et al, [2,3]. However, this technology is still developing in terms of the quantification of carpal bone motion in-vivo.…”