Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations—a review of the literature

Brinch, Signe; Wellenberg, R.H.H.; Boesen, Mikael; Maas, Mario; Johannsen, Finn Elkjær; Nybing, Janus Damm; Turmezei, Tom; Streekstra, Geert J.; Hansen, Philip

doi:10.1007/s00256-022-04223-1

Cited by 8 publications

(7 citation statements)

References 117 publications

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“…Although this has been achieved in several previous studies [ 4 , 8 , 9 ], we have for the first time analysed the inter-operator reproducibility and test-retest repeatability of 3-D JSW measurement at the ankle, demonstrating optimum limits of agreement nearly universally at values less than the isotropic imaging voxel dimensions of 0.37 mm. Repeatability limits of agreement equate to the smallest detectable difference that can be assumed to be not from factors related to imaging acquisition or measurement, and thus represent a sensitivity threshold above which any change in JSW upon repeat imaging can be assumed to be real [ 14 ]. As an example from our results, any difference between baseline and follow-up in average JSW at the talar dome and medial gutter greater than the threshold of 0.28 mm could be assumed to be real.…”

Section: Discussionmentioning

confidence: 99%

“…Although many studies have now used WBCT to investigate foot and ankle disorders, there is still a need to understand the implications for differences in imaging acquisition protocols, e.g. with respect to joint positioning and whether weight-bearing should be unilateral or bilateral [ 14 ]. Decisions on protocol standardisation would also need to ensure scanning times are tolerable for individuals with painful conditions so that they can maintain positioning without moving.…”

Section: Discussionmentioning

confidence: 99%

“…An important part of evaluating WBCT imaging protocol suitability will be to know their reproducibility and repeatability. Although reproducibility is often cited in published studies, test-retest repeatability is rarely reported [ 14 , 19 ], yet it is critical for understanding repeat performance. To the best of our knowledge, this has not been previously reported for 3-D JSW measurements at the ankle.…”

Section: Discussionmentioning

confidence: 99%

“…The inter-operator reproducibility and test-retest repeatability of JSW measurement techniques are also rarely reported in a way that quantitatively evaluates performance, let alone in 3-D [ 11 – 13 ]. However, without quantification, performance cannot be objectively evaluated, which then has consequences for research and clinical applications [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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3-D joint space mapping at the ankle from weight-bearing CT: reproducibility, repeatability, and challenges for standardisation

et al. 2023

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Objectives We present a 3-D approach to joint space width (JSW) measurement across the ankle from weight-bearing CT (WBCT) to demonstrate inter-operator reproducibility, test-retest repeatability, and how differences in angulation affect ankle JSW distribution. Methods One side from repeat WBCT imaging of both feet and ankles was analysed from 23 individuals as part of their routine clinical care pathway. Joint space mapping was performed at four facets across the talus: talonavicular, talar dome and medial gutter (dome-medial), lateral gutter, and posterior subtalar. Inter-operator reproducibility was calculated for two users, while test-retest repeatability was calculated by comparing the two visits, both presented as Bland-Altman statistics. Statistical parametric mapping determined any significant relationships between talocrural joint space angulation and 3-D JSW distribution. Results The average ± standard deviation interval between imaging was 74.0 ± 29.6 days. Surface averaged bias ± limits of agreement were similar for reproducibility and repeatability, the latter being: talonavicular 0.01 ± 0.26 mm, dome-medial 0.00 ± 0.28 mm, lateral gutter − 0.02 ± 0.40 mm, and posterior subtalar 0.02 ± 0.34 mm. Results are presented as 3-D distribution maps, with optimum test–retest repeatability reaching a smallest detectable difference of ± 0.15 mm. Conclusions Joint space mapping is a robust approach to 3-D quantification of JSW measurement, inter-operator reproducibility, and test–retest repeatability at the ankle, with sensitivity reaching a best value of ± 0.15 mm. Standardised imaging protocols and optimised metal artefact reduction will be needed to further understand the clinical value of these 3-D measures derived from WBCT. Clinical relevance statement Weight-bearing computed tomography is an increasingly important tool in the clinical assessment of orthopaedic ankle disorders. This paper establishes the performance of measuring 3-D joint space width using this technology, which is an important surrogate marker for severity of osteoarthritis. Key Points • Joint space width values and error metrics from across the ankle measured from weight-bearing CT can be presented as 3-D maps that show topographic variation. • The best sensitivity for detecting meaningful change in 3-D joint space width at the ankle was ± 0.15 mm, a value less than the isotropic imaging voxel dimensions. • Standardised imaging protocols and optimised metal artefact reduction will be needed to understand the clinical value of 3-D measures from weight-bearing CT.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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3-D joint space mapping at the ankle from weight-bearing CT: reproducibility, repeatability, and challenges for standardisation

et al. 2023

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“…[2][3][4][5] Acquired atfoot arises when children with normal arches develop atfoot during growth, primarily due to factors such as a tight gastrocnemius-soleus complex, obesity, posterior tibial tendon dysfunction, or weakened plantar fascia and other archsupporting ligaments. [6][7][8][9][10] Previous studies have described the morphological changes in atfoot using various parameters. [11][12][13][14][15] (Table 1) These parameters, including the calcaneo bular and talo bular distances, calcaneal inclination (CIA), lateral talocalcaneal (LTCA), and talocalcaneal (TCA) angles, as well as the angle between the talus and calcaneus (TACA), are used to evaluate the relative spatial displacement of the hindfoot bones and bula.…”

Section: Introductionmentioning

confidence: 99%

Morphological Changes in Flatfoot: A 3D Analysis Using Weight-Bearing CT Scans

Cai,

Zhao,

Huang

et al. 2024

Preprint

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Background Flatfoot is a condition resulting from complex three-dimensional (3D) morphological changes. Previous studies have been constrained by using two-dimensional radiographs and non-weight-bearing conditions. The deformity in flatfoot is associated with the 3D morphology of the bone. These morphological changes affect the force line conduction of the hindfoot/midfoot/forefoot, leading to further morphological alterations. Given that a two-dimensional plane axis overlooks the 3D structural information, it is essential to measure the 3D model of the entire foot in conjunction with the definition under the standing position. This study aims to analyze the morphological changes in flatfoot using 3D measurements from weight-bearing CT (WBCT). Method WBCT scans were conducted on 32 patients with flatfoot and 30 healthy individuals in a standing position. The distance, angle in sagittal/transverse/coronal planes, and volume of the two groups were compared on reconstructed 3D models using the t-test. Logistic regression was used to identify flatfoot risk factors, which were then analyzed using receiver operating characteristic curves and nomogram. Result The flatfoot group exhibited significantly lower values for calcaneofibular distance (p = 0.001), sagittal and transverse calcaneal inclination angle (p < 0.001), medial column height (p < 0.001), sagittal talonavicular coverage angle (p < 0.001), and sagittal (p < 0.001) and transverse (p = 0.015) Hibb angle. In contrast, the sagittal lateral talocalcaneal angle (p = 0.013), sagittal (p < 0.001) and transverse (p = 0.004) talocalcaneal angle, transverse talonavicular coverage angle (p < 0.001), coronal Hibb angle (p < 0.001), and sagittal (p < 0.001) and transverse (p = 0.001) Meary’s angle were significantly higher in the flatfoot group. The sagittal Hibb angle (B = −0.379, OR = 0.684) and medial column height (B = −0.990, OR = 0.372) were identified as significant risk factors for flatfoot. Conclusion The findings validate the 3D spatial position alterations in flatfoot. These include excessive pronation of the forefoot, the arch collapsed, subluxation of the talonavicular joint in the midfoot, adduction and valgus of the calcaneus, adduction and plantar ward movement of the talus in the hindfoot, along with the first metatarsal’s abduction and dorsiflexion in the forefoot.

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Reliability and correlation of weight-bearing cone beam CT and Foot Posture Index (FPI) for measurements of foot posture: a test-retest study

et al. 2023

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Objective To assess test-retest reliability and correlation of weight-bearing (WB) and non-weight-bearing (NWB) cone beam CT (CBCT) foot measurements and Foot Posture Index (FPI) Materials and methods Twenty healthy participants (age 43.11±11.36, 15 males, 5 females) were CBCT-scanned in February 2019 on two separate days on one foot in both WB and NWB positions. Three radiology observers measured the navicular bone position. Plantar (ΔNAVplantar) and medial navicular displacements (ΔNAVmedial) were calculated as a measure of foot posture changes under loading. FPI was assessed by two rheumatologists on the same two days. FPI is a clinical measurement of foot posture with 3 rearfoot and 3 midfoot/forefoot scores. Test-retest reproducibility was determined for all measurements. CBCT was correlated to FPI total and subscores. Results Intra- and interobserver reliabilities for navicular position and FPI were excellent (intraclass correlation coefficient (ICC) .875–.997). In particular, intraobserver (ICC .0.967–1.000) and interobserver reliabilities (ICC .946–.997) were found for CBCT navicular height and medial position. Interobserver reliability of ΔNAVplantar was excellent (ICC .926 (.812; .971); MDC 2.22), whereas the ΔNAVmedial was fair-good (ICC .452 (.385; .783); MDC 2.42 mm). Using all observers’ measurements, we could calculate mean ΔNAVplantar (4.25±2.08 mm) and ΔNAVmedial (1.55±0.83 mm). We demonstrated a small day-day difference in ΔNAVplantar (0.64 ±1.13mm; p<.05), but not for ΔNAVmedial (0.04 ±1.13mm; p=n.s.). Correlation of WBCT (WB navicular height - ΔNAVmedial) with total clinical FPI scores and FPI subscores, respectively, showed high correlation (ρ: −.706; ρ: −.721). Conclusion CBCT and FPI are reliable measurements of foot posture, with a high correlation between the two measurements.

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Weight-bearing cone-beam CT: the need for standardised acquisition protocols and measurements to fulfill high expectations—a review of the literature

Cited by 8 publications

References 117 publications

3-D joint space mapping at the ankle from weight-bearing CT: reproducibility, repeatability, and challenges for standardisation

3-D joint space mapping at the ankle from weight-bearing CT: reproducibility, repeatability, and challenges for standardisation

Morphological Changes in Flatfoot: A 3D Analysis Using Weight-Bearing CT Scans

Reliability and correlation of weight-bearing cone beam CT and Foot Posture Index (FPI) for measurements of foot posture: a test-retest study

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