Scapholunate instability: improved detection with semi-automated kinematic CT analysis during stress maneuvers
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To evaluate the diagnostic performance of radioulnar deviation (RUD) and clenching fist (CF) maneuvers for the evaluation of scapholunate dissociation (SLD) using quantitative kinematic CT.
Thirty-seven patients with suspected scapholunate instability were prospectively evaluated with kinematic CT. Two radiologists independently evaluated the SLD during RUD and CF maneuvers. Various dynamic parameters describing SLD were compared (maximal value, variation coefficient and range) in patients with and without scapholunate ligament ruptures confirmed by CT arthrography.
SLD in CF varied from 3.17 ± 0.38 to 3.24 ± 0.80 mm in controls and from 4.11 ± 0.77 and 4.01 ± 0.85 mm in patients with scapholunate ligament ruptures for reader 1 and 2 (p < 0.009). SLD in RUD varied from 3.35 ± 0.51 and 3.01 ± 0.78 mm in controls and from 4.51 ± 1.26 to 4.42 ± 1.75 mm in patients with scapholunate ligament ruptures for reader 1 and 2 (p varied from 0.001 to 0.002). The inter-observer variability was better for RUD (ICC = 0.85 versus 0.6 for RUD and CF respectively).
Analysis of SLD using kinematic CT has shown significant measurement differences between the groups with or without scapholunate instability with good diagnostic performance.
• Kinematic CT can quantitatively assess scapholunate dissociation.
• SLD analysis on kinematic CT has excellent reproducibility with radioulnar deviation maneuver.
• Scapholunate dissociation was significantly different in patients with and without instability.
• Diagnostic performance for scapholunate instability identification was better with radioulnar deviation.
KeywordsFour-dimensional computed tomography Multidetector computed tomography Wrist injury Kinematics Joint instability
Coefficient of variation
CT dose index
Intraclass correlation coefficient
Magnetic resonance imaging
Radial ulnar deviation
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Pedro Augusto Gondim Teixeira.
Conflict of interest
Two authors involved in this work (Pedro Augusto Gondim Teixeira and Alain Blum) participate on a non-remunerated research contract with TOSHIBA 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
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional review board approval was obtained.
• diagnostic or prognostic study
• performed at one institution