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01-08-2012 | Scientific Article

Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries

Authors: Reeta Ramdhian-Wihlm, Jean-Marie Le Minor, Matthieu Schmittbuhl, Jeremy Jeantroux, Peter Mac Mahon, Francis Veillon, Jean-Claude Dosch, Jean-Louis Dietemann, Guillaume Bierry

Published in: Skeletal Radiology | Issue 8/2012

Abstract

Purpose

Cone-beam computed tomography (CBCT) has become an important modality in dento-facial imaging but remains poorly used in the exploration of the musculoskeletal system. The purpose of this study was to prospectively evaluate the performance and radiation exposure of CBCT arthrography in the evaluation of ligament and cartilage injuries in cadaveric wrists, with gross pathology findings as the standard of reference.

Materials and methods

Conventional arthrography was performed under fluoroscopic guidance on 10 cadaveric wrists, followed by MDCT acquisition and CBCT acquisition. CBCT arthrography and MDCT arthrography images were independently analyzed by two musculoskeletal radiologists working independently and then in consensus. The following items were observed: scapholunate and lunotriquetral ligaments, triangular fibrocartilage complex (TFCC) (tear, integrity), and proximal carpal row cartilage (chondral tears). Wrists were dissected and served as the standard of reference for comparisons. Interobserver agreement, sensitivity, specificity, and accuracy were determined. Radiation dose (CTDI) of both modalities was recorded.

Results

CBCT arthrography provides equivalent results to MDCT arthrography in the evaluation of ligaments and cartilage with sensitivity and specificity between 82 and 100%, and interobserver agreement between 0.83 and 0.97. However, radiation dose was significantly lower (p < 0.05) for CBCT arthrography than for MDCT arthrography with a mean CTDI of 2.1 mGy (range 1.7–2.2) versus a mean of 15.1 mGy (range 14.7–16.1).

Conclusion

CBCT arthrography appears to be an innovative alternative to MDCT arthrography of the wrist as it allows an accurate and low radiation dose evaluation of ligaments and cartilage.

Watanabe A, Souza F, Vezeridis PS, Blazar P, Yoshioka H. Ulnar-sided wrist pain. II. Clinical imaging and treatment. Skeletal Radiol. 2010;39:837–57.PubMedCrossRef

Sofka CM, Potter HG. Magnetic resonance imaging of the wrist. Semin Musculoskelet Radiol. 2001;5:217–26.PubMedCrossRef

Pretorius ES, Epstein RE, Dalinka MK. MR imaging of the wrist. Radiol Clin North Am. 1997;35:145–61.PubMed

Saupe N, Pfirrmann CWA, Schmid MR, Schertler T, Manestar M, Weishaupt D. MR imaging of cartilage in cadaveric wrists: comparison between imaging at 1.5 and 3.0 T and gross pathologic inspection. Radiology. 2007;243:180–7.PubMedCrossRef

Moser T, Dosch J-C, Moussaoui A, Dietemann J-L. Wrist ligament tears: evaluation of MRI and combined MDCT and MR arthrography. AJR Am J Roentgenol. 2007;188:1278–86.PubMedCrossRef

Zanetti M, Saupe N, Nagy L. Role of MR imaging in chronic wrist pain. Eur Radiol. 2007;17:927–38.PubMedCrossRef

Maizlin ZV, Brown JA, Clement JJ, Grebenyuk J, Fenton DM, Smith DE, et al. MR arthrography of the wrist: controversies and concepts. Hand (N Y). 2009;4:66–73.CrossRef

Zanetti M, Bräm J, Hodler J. Triangular fibrocartilage and intercarpal ligaments of the wrist: does MR arthrography improve standard MRI? J Magn Reson Imaging. 1997;7:590–4.PubMedCrossRef

Theumann NH, Pfirrmann CWA, Chung CB, Antonio GE, Trudell DJ, Resnick D. Ligamentous and tendinous anatomy of the intermetacarpal and common carpometacarpal joints: evaluation with MR imaging and MR arthrography. J Comput Assist Tomogr. 2002;26:145–52.PubMedCrossRef

10.

Schmid MR, Schertler T, Pfirrmann CW, Saupe N, Manestar M, Wildermuth S, et al. Interosseous ligament tears of the wrist: comparison of multi-detector row CT arthrography and MR imaging. Radiology. 2005;237:1008–13.PubMedCrossRef

11.

Quinn SF, Belsole RS, Greene TL, Rayhack JM. Work in progress: postarthrography computed tomography of the wrist: evaluation of the triangular fibrocartilage complex. Skeletal Radiol. 1989;17:565–9.PubMedCrossRef

12.

Brix G, Nagel HD, Stamm G, Veit R, Lechel U, Griebel J, et al. Radiation exposure in multi-slice versus single-slice spiral CT: results of a nationwide survey. Eur Radiol. 2003;13:1979–91.PubMedCrossRef

13.

Roth JS. CBCT technology: endodontics and beyond, part 2. Dent Today. 2011;30(78):80–3.

14.

Fahrig R, Dixon R, Payne T, Morin RL, Ganguly A, Strobel N. Dose and image quality for a cone-beam C-arm CT system. Med Phys. 2006;33:4541–50.PubMedCrossRef

15.

De Cock J, Mermuys K, Goubau J, Van Petegem S, Houthoofd B, Casselman JW. Cone-beam computed tomography: a new low dose, high resolution imaging technique of the wrist, presentation of three cases with technique. Skeletal Radiol. 2011;Epub May 21

16.

Lofthag-Hansen S, Gröndahl K, Ekestubbe A. Cone-beam CT for preoperative implant planning in the posterior mandible: visibility of anatomic landmarks. Clin Implant Dent Relat Res. 2009;11:246–55.PubMedCrossRef

17.

Saupe N. 3-Tesla high-resolution MR imaging of the wrist. Semin Musculoskelet Radiol. 2009;13:29–38.PubMedCrossRef

18.

van Dijke CF, Wiarda BM. High resolution wrist MR arthrography at 1.5 T. JBR-BTR. 2009;92:53–9.PubMed

19.

Moser T, Khoury V, Harris PG, Bureau NJ, Cardinal E, Dosch J-C. MDCT arthrography or MR arthrography for imaging the wrist joint? Semin Musculoskelet Radiol. 2009;13:39–54.PubMedCrossRef

20.

Alam F, Schweitzer ME, Li XX, Malat J, Hussain SM. Frequency and spectrum of abnormalities in the bone marrow of the wrist: MR imaging findings. Skeletal Radiol. 1999;28:312–7.PubMedCrossRef

21.

Saupe N, Prüssmann KP, Luechinger R, Bösiger P, Marincek B, Weishaupt D. MR imaging of the wrist: comparison between 1.5- and 3-T MR imaging–preliminary experience. Radiology. 2005;234:256–64.PubMedCrossRef

22.

Haims AH, Moore AE, Schweitzer ME, Morrison WB, Deely D, Culp RW, et al. MRI in the diagnosis of cartilage injury in the wrist. AJR Am J Roentgenol. 2004;182:1267–70.PubMed

23.

Yoshioka H, Ueno T, Tanaka T, Shindo M, Itai Y. High-resolution MR imaging of triangular fibrocartilage complex (TFCC): comparison of microscopy coils and a conventional small surface coil. Skeletal Radiol. 2003;32:575–81.PubMedCrossRef

24.

Oneson SR, Timins ME, Scales LM, Erickson SJ, Chamoy L. MR imaging diagnosis of triangular fibrocartilage pathology with arthroscopic correlation. AJR Am J Roentgenol. 1997;168:1513–8.PubMed

25.

Schmitt R, Christopoulos G, Meier R, Coblenz G, Fröhner S, Lanz U, et al. Direct MR arthrography of the wrist in comparison with arthroscopy: a prospective study on 125 patients. Rofo. 2003;175:911–9.PubMedCrossRef

26.

Beaulieu CF, Ladd AL. MR arthrography of the wrist: scanning-room injection of the radiocarpal joint based on clinical landmarks. AJR Am J Roentgenol. 1998;170:606–8.PubMed

27.

Hodler J. Technical errors in MR arthrography. Skeletal Radiol. 2008;37:9–18.PubMedCrossRef

28.

Buckwalter KA. CT arthrography. Clin Sports Med. 2006;25:899–915.PubMedCrossRef

29.

Theumann N, Favarger N, Schnyder P, Meuli R. Wrist ligament injuries: value of post-arthrography computed tomography. Skeletal Radiol. 2001;30:88–93.PubMedCrossRef

30.

Hein I, Taguchi K, Silver MD, Kazama M, Mori I. Feldkamp-based cone-beam reconstruction for gantry-tilted helical multislice CT. Med Phys. 2003;30:3233–42.PubMedCrossRef

31.

Ishikura R, Ando K, Nagami Y, Yamamoto S, Miura K, Pande AR, et al. Evaluation of vascular supply with cone-beam computed tomography during intraarterial chemotherapy for a skull base tumor. Radiat Med. 2006;24:384–7.PubMedCrossRef

32.

Hirota S, Nakao N, Yamamoto S, Kobayashi K, Maeda H, Ishikura R, et al. Cone-beam CT with flat-panel-detector digital angiography system: early experience in abdominal interventional procedures. Cardiovasc Intervent Radiol. 2006;29:1034–8.PubMedCrossRef

33.

Mozzo P, Procacci C, Tacconi A, Martini PT, Andreis IA. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Eur Radiol. 1998;8:1558–64.PubMedCrossRef

34.

Quereshy FA, Barnum G, Demko C, Horan M, Palomo JM, Baur DA, et al. Use of cone beam computed tomography to volumetrically assess alveolar cleft defects—preliminary results. J Oral Maxillofac Surg. 2011;Epub May 18

35.

Lofthag-Hansen S, Thilander-Klang A, Ekestubbe A, Helmrot E, Gröndahl K. Calculating effective dose on a cone beam computed tomography device: 3D Accuitomo and 3D Accuitomo FPD. Dentomaxillofac Radiol. 2008;37:72–9.PubMedCrossRef

36.

Daly MJ, Siewerdsen JH, Moseley DJ, Jaffray DA, Irish JC. Intraoperative cone-beam CT for guidance of head and neck surgery: assessment of dose and image quality using a C-arm prototype. Med Phys. 2006;33:3767–80.PubMedCrossRef

37.

Kim S, Song H, Samei E, Yin F-F, Yoshizumi TT. Computed tomography dose index and dose length product for cone-beam CT: Monte Carlo simulations. J Appl Clin Med Phys. 2011;12:3384–95.

Title: Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries
Authors: Reeta Ramdhian-Wihlm
Jean-Marie Le Minor
Matthieu Schmittbuhl
Jeremy Jeantroux
Peter Mac Mahon
Francis Veillon
Jean-Claude Dosch
Jean-Louis Dietemann
Guillaume Bierry
Publication date: 01-08-2012
Publisher: Springer-Verlag
Published in: Skeletal Radiology / Issue 8/2012
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI: https://doi.org/10.1007/s00256-011-1305-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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