Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability.
Fiche publication
Date publication
juin 2021
Journal
Journal of wrist surgery
Auteurs
Membres identifiés du Cancéropôle Est :
Pr TEIXEIRA GONDIM Pedro
Tous les auteurs :
Athlani L, Granero J, Rouizi K, Hossu G, Blum A, Dautel G, Gondim Teixeira PA
Lien Pubmed
Résumé
In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI). Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI ( = 16), negative SLI ( = 19), and questionable SLI ( = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation. The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCA . The LCA values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCA (7% vs. 12%, = 0.02) and LCA (18 vs. 27 degrees, = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCA ( = 0.03) and LCA ( = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCA and LCA threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively. In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings. This is a Level III study.
Mots clés
carpal instability, dorsal intercalated segment instability, four-dimensional computed tomography, kinematics, scapholunate ligament
Référence
J Wrist Surg. 2021 Jun;10(3):234-240