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Kinematic 4D CT case-control study of wrist in dart throwing motion “in vivo”: comparison with other maneuvers

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To compare the diagnostic performance of scapholunate gap (SLG) measurements acquired with dart throwing (DT), radio-ulnar deviation (RUD), and clenching fist (CF) maneuvers on 4D CT for the identification of scapholunate instability.

Methods

In this prospective study, 47 patients with suspected scapholunate interosseous ligament (SLIL) tears were evaluated from March 2015 to March 2020 with semiautomatic quantitative analysis on 4D CT. Five parameters (median, maximal value, range, and coefficient of variation) for SLG, lunocapitate angle (LCA), and radioscaphoid angle (RSA) obtained during DT maneuver were evaluated in patients with and without SLIL tears. CT arthrography was used as the gold standard for the SLIL status. The SLG values obtained were also compared with those obtained during CF and RUD maneuvers.

Results

Significant differences in all SLG- and LCA-derived parameters are found between patients with and without SLIL tears with DT (p < 0.003). The best diagnostic performance for the diagnosis of SLIL tears was obtained with median and maximal SLG values (sensitivity and specificity of 86–89% and 95%) and with maximal and range LCA values (sensitivity and specificity of 86% and 74%). No significant differences were observed for RSA values (p > 0.275). The SLG range obtained with DT maneuver was the only dynamic parameter statistically different between patients with partial and complete torn SLIL (p = 0.037).

Conclusion

4D CT of the wrist during DT showed a similar performance than RUD and a better performance than CF for the differentiation between patients with and without SLIL tears.

Key Points

• Four-dimensional computed tomography can dynamically assess scapholunate instability.

• The best results for differentiating between patients with and without SLIL tears were obtained with SLG median and maximal values.

• The dart throwing and radio-ulnar deviation maneuvers yielded the best results for the dynamic evaluation of scapholunate instability.

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Abbreviations

CF:

Clenching fist

CT:

Computerized tomography

CTDI:

CT dose index

CV:

Coefficient of variation

DLP:

Dose-length product

DT:

Dart throwing

ICC:

Intraclass correlation coefficient

kVp:

Kilovoltage peak

LCA:

Lunocapitate angle

mA:

Milliampere

mAs:

Milliampere-second

mGy:

Milligray

MR:

Magnetic resonance

ROC:

Receiver operating characteristic

RSA:

Radioscaphoid angle

RUD:

Radioulnar deviation

SL:

Scapholunate

SLG:

Scapholunate gap

SLI:

Scapholunate instability

SLIL:

Scapholunate interosseous ligament

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Acknowledgements

We express our gratitude for the support provided by Ms. Demange-Viardin J, in the data collection patient inclusion processes.

Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, Cedex, France

    Sinan Orkut, Romain Gillet, Charles Lombard, Alain Blum & Pedro Augusto Gondim Teixeira

  2. Université de Lorraine, Inserm, IADI, F-54000, Nancy, France

    Gabriela Hossu & Pedro Augusto Gondim Teixeira

  3. Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU de Nancy, Nancy, France

    Lionel Athlani

Authors
  1. Sinan Orkut
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  2. Romain Gillet
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  3. Gabriela Hossu
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  4. Charles Lombard
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  5. Alain Blum
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  6. Lionel Athlani
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  7. Pedro Augusto Gondim Teixeira
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Corresponding author

Correspondence to Sinan Orkut.

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Guarantor

The scientific guarantor of this publication is Pedro Augusto Gondim Teixeira.

Conflict of Interest:

One of the authors involved in this work (Pedro Augusto Gondim Teixeira) participated on a non-remunerated research contract with Canon Medical Systems for the development and clinical testing of post-processing tools for musculoskeletal CT. The other authors have no potential conflicts of interest to disclose.

Statistics and Biometry

One of the authors (Dr. Gabriela Hossu) has significant statistical expertise.

Informed Consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical Approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported in prior studies in our institution.

Methodology

• Prospective study

• diagnostic or prognostic study

• performed at one institution

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Supplementary information

Video 1

– The video displays the acquisition procedure with 4D CT during dart throwing motion. (MP4 22031 kb)

Video 2a

– Volume-rendered image 4D datasets show a large variation of the scapholunate gap during dart throwing (A) and radio-ulnar deviation (B), and a slight variation with clenching fist (C) in a 47-year-old man with complete SLL tears at the left wrist following a fall on an outstretched hand 6 months ago. STARD 2015 Checklist (MP4 3678 kb)

Video 2b

(B), and a slight variation with clenching fist

Video 2c

(C) in a 47-years-old man with complete SLL tears at the left wrist following a fall on an outstretched hand 6 months ago.

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Orkut, S., Gillet, R., Hossu, G. et al. Kinematic 4D CT case-control study of wrist in dart throwing motion “in vivo”: comparison with other maneuvers. Eur Radiol 32, 7590–7600 (2022). https://doi.org/10.1007/s00330-022-08746-y

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  • DOI: https://doi.org/10.1007/s00330-022-08746-y

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