European Radiology

, Volume 27, Issue 2, pp 437–446 | Cite as

Evidence-based recommendations for musculoskeletal kinematic 4D-CT studies using wide area-detector scanners: a phantom study with cadaveric correlation

  • Pedro Augusto Gondim Teixeira
  • Anne-Sophie Formery
  • Gabriela Hossu
  • Daniel Winninger
  • Toufik Batch
  • Alban Gervaise
  • Alain Blum



To establish evidence-based recommendations for musculoskeletal kinematic 4D-CT on wide area-detector CT.

Materials and methods

In order to assess factors influencing image quality in kinematic CT studies, a phantom consisting of a polymethylmethacrylate rotating disk with round wells of different sizes was imaged with various acquisition protocols. Cadaveric acquisitions were performed on the ankle joint during motion in two different axes and at different speeds to allow validation of phantom data. Images were acquired with a 320 detector-row CT scanner and were evaluated by two readers.


Motion artefacts were significantly correlated with various parameters (movement axis, distance to centre, rotation speed and volume acquisition speed) (p < 0.0001). The relation between motion artefacts and distance to motion fulcrum was exponential (R2 0.99). Half reconstruction led to a 23 % increase in image noise and a 40 % decrease in motion artefacts. Cadaveric acquisitions confirmed phantom data. Based on these findings, high tube rotation speed and half reconstruction are recommended for kinematic CT. The axis of motion significantly influences image artefacts and should be considered in patient training and evaluation of acquisition protocol suitability.


This study provides evidence-based recommendations for musculoskeletal kinematic 4D-CT.

Key points

Motion artefacts can hamper the quality and interpretation of dynamic joint studies

The recommendations presented here help increase image quality

Patient training and preparation can be improved

The artefact-free distance concept helps protocol adaptation and comparison


Multidetector computed tomography Four-dimensional computed tomography Joint kinematics Motion artefacts Evidence-based practice 



The scientific guarantor of this publication is Professor Blum, Alain. The authors of this manuscript declare relationships with the following companies: Toshiba Medical systems. Two authors involved in this work, (P.A.G.T. and A.B.) participate on a non-remunerated research contract with Toshiba Medical systems for the development and clinical testing of post processing tools for MSK CT. The other authors have no potential conflicts of interest to disclose. The authors state that this work has not received any funding. One of the authors has significant statistical expertise (Hossu G). Institutional Review Board approval was not required because this was a phantom study and the cadaveric acquisitions were performed with completely anonymized cadavers donated to science.

Methodology: prospective, experimental, performed at one institution.

We kindly thank Benoit Corruble and Bruno Puyssegure for their assistance in data acquisition and image post-processing.

Supplementary material

330_2016_4362_MOESM1_ESM.mp4 (212 kb)
Supplementary digital content 1 Volume rendered 4D reconstruction showing cadaveric displacement during flexion-extension. (MP4 211 kb)
330_2016_4362_MOESM2_ESM.mp4 (140 kb)
Supplementary digital content 2 Volume rendered 4D reconstruction showing cadaveric displacement during internal-external rotation. (MP4 140 kb)


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Pedro Augusto Gondim Teixeira
    • 1
  • Anne-Sophie Formery
    • 1
  • Gabriela Hossu
    • 2
    • 3
  • Daniel Winninger
    • 4
  • Toufik Batch
    • 5
  • Alban Gervaise
    • 6
  • Alain Blum
    • 1
  1. 1.Service D’imagerie GuillozCHRU-Nancy Hôpital CentralNancyFrance
  2. 2.IADI U947Université de LorraineNancyFrance
  3. 3.INSERM, CIC-IT 1433NancyFrance
  4. 4.IDCmemNancyFrance
  5. 5.Service de radiologieHôpital de MercyMetzFrance
  6. 6.Medical Imaging DepartmentLegouest Military Instruction HospitalMetz Cedex 3France

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