Weight-bearing cone beam CT scans in the foot and ankle

Lintz, François; Netto, César de César; Barg, A.; Burssens, Arne; Richter, Martinus; Group, Weight Bearing CT International Study

doi:10.1302/2058-5241.3.170066

Cited by 132 publications

(70 citation statements)

References 46 publications

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“…Among the previously mentioned radiological methods, the measurement of the calcaneal moment arm for inframalleolar alignment The insole has a slightly elevated heel pad (asterisks), a medial wedge to correct the valgus angulation of the hindfoot (arrows) and a specific medial longitudinal support to sustain the plantar arch (arrow head) in a posterior radiographic view of the alignment of the hindfoot [16][17][18][19][20] and the medial distal tibial angle in an anterior view that uses the whole lower leg image are the most utilized. 21 In our sample of haemophilia patients, usually subjected to multiple radiographs during their life and without planned surgery, we considered that physical examination allowed us to determine adequately the indication of an orthotic treatment.…”

Section: Materials S and Me Thodsmentioning

confidence: 99%

Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment

et al. 2019

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Introduction Haemophilic arthropathy (osteoarthritis secondary to haemophilia) of the ankle may result in painful hindfoot malalignment. Purpose To analyse hindfoot alignment in subjects with haemophilic arthropathy of the ankle and evaluate the response (improvement of pain, function and alignment) to the orthotic treatment prescribed in patients with malalignment. Methods The study included 163 patients with haemophilia, all of them over 16 years of age. Hindfoot alignment and footprint were analysed in patients with and without haemophilic arthropathy of the ankle (as determined by the Pettersson score). Response to the use of an orthosis was evaluated at 6 months by means of the AOFAS Ankle‐Hindfoot Scale. Results Fifty‐six (59.5%) patients with haemophilic arthropathy presented with concomitant hindfoot malalignment. The most common abnormality was a valgus alignment combined with a neutral footprint. In 14 cases, valgus was associated with a pes planus or a pes cavus. Only 5 patients without haemophilic arthropathy (7.2%) presented with some form of malalignment. The differences between the groups were statistically significant. The probability of having malalignment increased with the degree of arthropathy. Patients with haemophilic arthropathy and malalignment were treated with an orthosis, with insoles as the most commonly used alternative (86%). Such treatment significantly improved patients’ pain and function‐related scores on the AOFAS Ankle‐Hindfoot Scale. Conclusion Given the high rates of valgus malalignment in subjects with haemophilic arthropathy of the ankle, and the good response rates obtained following individualised orthotic treatment, it seems reasonable to routinely evaluate hindfoot alignment in this group of patients.

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Section: Materials S and Me Thodsmentioning

confidence: 99%

Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment

et al. 2019

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“…In fact, bone orientation measurements in weight-bearing condition, both in absolute and relative terms, can now reveal the skeletal architecture in 3D, with the necessary accuracy and repeatability [ 16 ]. It has been also demonstrated that, with respect to standard computed tomography, radiation doses are smaller, device ergonomics and portability are better, and overall costs are smaller with the new technique [ 17 – 19 ] and these instruments are expected to be used extensively for clinical and biomechanical measurements of the foot in the next decades.…”

Section: Introductionmentioning

confidence: 99%

Correlations between weight‐bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot

Belvedere

Giacomozzi

Carrara

et al. 2020

Journal of Foot and Ankle Research

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Background Measurements of plantar loading reveal foot-to-floor interaction during activity, but information on bone architecture cannot be derived. Recently, cone-beam computer tomography (CBCT) has given visual access to skeletal structures in weight-bearing. The combination of the two measures has the potential to improve clinical understanding and prevention of diabetic foot ulcers. This study explores the correlations between static 3D bone alignment and dynamic plantar loading. Methods Sixteen patients with diabetes were enrolled (group ALL): 15 type 1 with (N, 7) and without (D, 8) diabetic neuropathy, and 1 with latent autoimmune diabetes. CBCT foot scans were taken in single-leg upright posture. 3D bone models were obtained by image segmentation and aligned in a foot anatomical reference frame. Absolute inclination and relative orientation angles and heights of the bones were calculated. Pressure patterns were also acquired during barefoot level walking at self-selected speed, from which regional peak pressure and absolute and normalised pressure-time integral were worked out at hallux and at first, central and fifth metatarsals (LOAD variables) as averaged over five trials. Correlations with 3D alignments were searched also with arch index, contact time, age, BMI, years of disease and a neuropathy-related variable. Results Lateral and 3D angles showed the highest percentage of significant (p < 0.05) correlations with LOAD. These were weak-to-moderate in the ALL group, moderate-to-strong in N and D. LOAD under the central metatarsals showed moderate-to-strong correlation with plantarflexion of the 2nd and 3rd phalanxes in ALL and N. LOAD at the hallux increased with plantarflexion at the 3rd phalanx in ALL, at 1st phalanx in N and at 5th phalanx in D. Arch index correlated with 1st phalanx plantarflexion in ALL and D; contact time showed strong correlation with 2nd and 3rd metatarsals and with 4th phalanx dorsiflexion in D. Conclusion These preliminary original measures reveal that alteration of plantar dynamic loading patterns can be accounted for peculiar structural changes of foot bones. Load under the central metatarsal heads were correlated more with inclination of the corresponding phalanxes than metatarsals. Further analyses shall detect to which extent variables play a role in the many group-specific correlations.

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“…With the excellent depiction of the osseous tissue and the establishment of dedicated extremity scanners, CBCT provides several advantages over conventional multidetector CT (MDCT), particularly for trauma imaging [4]. Current literature on CBCT is mostly focused on lower extremity and spine imaging under weight-bearing conditions [5][6][7]; however, upper extremity imaging benefits from CBCT as well.…”

Section: Introductionmentioning

confidence: 99%

3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

et al. 2020

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Background Elbow imaging is challenging with conventional multidetector computed tomography (MDCT), while cone-beam CT (CBCT) provides superior options. We compared intra-individually CBCT versus MDCT image quality in cadaveric elbows. Methods A twin robotic x-ray system with new CBCT mode and a high-resolution clinical MDCT were compared in 16 cadaveric elbows. Both systems were operated with a dedicated low-dose (LD) protocol (equivalent volume CT dose index [CTDIvol(16 cm)] = 3.3 mGy) and a regular clinical scan dose (RD) protocol (CTDIvol(16 cm) = 13.8 mGy). Image quality was evaluated by two radiologists (R1 and R2) on a seven-point Likert scale, and estimation of signal intensity in cancellous bone was conducted. Wilcoxon signed-rank tests and intraclass correlation coefficient (ICC) statistics were used. Results The CBCT prototype provided superior subjective image quality compared to MDCT scans (for RD, p ≤ 0.004; for LD, p ≤ 0.001). Image quality was rated very good or excellent in 100% of the cases by both readers for RD CBCT, 100% (R1) and 93.8% (R2) for LD CBCT, 62.6% and 43.8% for RD MDCT, and 0.0% and 0.0% for LD MDCT. Single-measure ICC was 0.95 (95% confidence interval 0.91–0.97; p < 0.001). Software-based assessment supported subjective findings with less “undecided” pixels in CBCT than dose-equivalent MDCT (p < 0.001). No significant difference was found between LD CBCT and RD MDCT. Conclusions In cadaveric elbow studies, the tested cone-beam CT prototype delivered superior image quality compared to high-end multidetector CT and showed a potential for considerable dose reduction.

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Weight-bearing cone beam CT scans in the foot and ankle

Cited by 132 publications

References 46 publications

Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment

Hindfoot malalignment in adults with haemophilic ankle arthropathy: The importance of early detection and orthotic treatment

Correlations between weight‐bearing 3D bone architecture and dynamic plantar pressure measurements in the diabetic foot

3D cone-beam CT with a twin robotic x-ray system in elbow imaging: comparison of image quality to high-resolution multidetector CT

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