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European Radiology

, Volume 24, Issue 3, pp 553–558 | Cite as

Upright Cone CT of the hindfoot: Comparison of the non-weight-bearing with the upright weight-bearing position

  • Anna HirschmannEmail author
  • Christian W. A. Pfirrmann
  • Georg Klammer
  • Norman Espinosa
  • Florian M. Buck
Musculoskeletal

Abstract

Objectives

To prospectively compare computed tomography (CT) of the hindfoot in the supine non-weight-bearing position (NWBCT) with upright weight-bearing position (WBCT).

Methods

Institutional review board approval and informed consent of all patients were obtained. NWBCT and WBCT scans of the ankle were obtained in 22 patients (mean age, 46.0 ± 17.1 years; range 19–75 years) using a conventional 64-row CT for NWBCT and a novel cone-beam CT for WBCT. Two musculoskeletal radiologists independently performed the following measurements: the hindfoot alignment angle, fibulocalcaneal and tibiocalcaneal distances, lateral talocalcaneal joint space width, talocalcaneal overlap and naviculocalcaneal distance. Significant changes between NWBCT and WBCT were sought using Wilcoxon signed-rank test. P values <0.05 were considered statistically significant.

Results

Significant differences were found for all measurements except the hindfoot alignment angle and tibiocalcaneal distance. Significant measurement results were as follows (NWBCT/WBCT reader 1; NWBCT/WBCT reader 2, mean ± standard deviation): fibulocalcaneal distance 3.6 mm ± 5.2/0.3 mm ± 6.0 (P = 0.006); 1.4 mm ± 6.3/-1.1 mm ± 6.3 (P = 0.002), lateral talocalcaneal joint space width 2.9 mm ± 1.7/2.2 mm ± 1.1 (P = 0.005); 3.4 mm ± 1.9/2.4 mm ± 1.3 (P = 0.001), talocalcaneal overlap 4.1 mm ± 3.9/1.4 mm ± 3.9 (P = 0.001); 4.5 mm ± 4.3/1.4 mm ± 3.7 (P < 0.001) and naviculocalcaneal distance 13.5 mm ± 4.0/15.3 mm ± 4.7 (P = 0.037); 14.0 mm ± 4.4/15.7 mm ± 6.2 (P = 0.100). Interreader agreement was good to excellent (ICC 0.48–0.94).

Conclusion

Alignment of the hindfoot significantly changes in the upright weight-bearing CT position. Differences can be visualised and measured using WBCT.

Key Points

Cone-beam computed tomography (CBCT) offers new opportunities for musculoskeletal problems

Visualization and quantification of hindfoot alignment are possible in upright weight-bearing CBCT

Hindfoot alignment changes significantly from non-weight-bearing to weight-bearing CT

The weight-bearing position leads to a decrease in the fibulocalcaneal distance and talocalcaneal overlap

The naviculocalcaneal distance is increased in the weight-bearing position

Keywords

Hindfoot alignment Cone-beam computed tomography Weight-bearing Talocalcaneal overlap Fibulocalcaneal distance 

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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Anna Hirschmann
    • 1
    Email author
  • Christian W. A. Pfirrmann
    • 1
  • Georg Klammer
    • 2
  • Norman Espinosa
    • 2
  • Florian M. Buck
    • 1
  1. 1.Department of Radiology, Orthopaedic University Hospital BalgristUniversity of ZurichZurichSwitzerland
  2. 2.Department of Orthopedic Surgery, Orthopaedic University Hospital BalgristUniversity of ZurichZurichSwitzerland

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