Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
J Clin Densitom. 2020 Jul-Sep;23(3):432-442. doi: 10.1016/j.jocd.2019.08.003. Epub 2019 Aug 16.
Diagnosing scaphoid fractures remains challenging. High-resolution peripheral quantitative computed tomography (HR-pQCT) might be a potential imaging technique, but no data are available on its feasibility to scan the scaphoid bone in vivo.
Patients (≥18 years) with a clinically suspected scaphoid fracture received an HR-pQCT scan of the scaphoid bone (three 10.2-mm stacks, 61-μm voxel size) with their wrist immobilized with a cast. Scan quality assessment and bone contouring were performed using methods originally developed for HR-pQCT scans of radius and tibia. The contouring algorithm was applied on coarse hand-drawn pre-contours of the scaphoid bone, and the resulting contours (AUTO) were manually corrected (sAUTO) when visually deviating from bone margins. Standard morphologic analyses were performed on the AUTO- and sAUTO-contoured bones.
Ninety-one patients were scanned. Two out of the first five scans were repeated due to poor scan quality (40%) based on standard quality assessment during scanning, which decreased to three out of the next 86 scans (3.5%) when using an additional thumb cast. Nevertheless, after excluding one scan with an incompletely scanned scaphoid bone, post hoc grading revealed a poor quality in 14.9% of the stacks and 32.9% of the scans in the remaining 85 patients. After excluding two scans with contouring problems due to scan quality, bone indices obtained by AUTO- and sAUTO-contouring were compared in 83 scans. All AUTO-contours were manually corrected, resulting in significant but small differences in densitometric and trabecular indices (<1.0%).
In vivo HR-pQCT scanning of the scaphoid bone is feasible in patients with a clinically suspected scaphoid fracture when using a cast with thumb part. The proportion of poor-quality stacks is similar to radius scans, and AUTO-contouring appears appropriate in good- and poor-quality scans . Thus, HR-pQCT may be promising for diagnosis of and microarchitectural evaluations in suspected scaphoid fractures.
诊断舟状骨骨折仍然具有挑战性。高分辨率外周定量 CT（HR-pQCT）可能是一种潜在的成像技术，但尚无关于其在体内扫描舟状骨的可行性的数据。
临床疑似舟状骨骨折的患者（≥18 岁）接受 HR-pQCT 扫描（三个 10.2mm 堆栈，61-μm 体素大小），手腕用石膏固定。使用最初为桡骨和胫骨 HR-pQCT 扫描开发的方法进行扫描质量评估和骨轮廓勾画。轮廓勾画算法应用于粗手画的舟状骨预轮廓，然后当轮廓明显偏离骨边缘时，手动纠正（sAUTO）得到的轮廓（AUTO）。对 AUTO 和 sAUTO 勾画的骨骼进行标准形态分析。
共扫描了 91 例患者。根据扫描过程中的标准质量评估，前 5 次扫描中有 2 次（40%）因扫描质量差而重复，当使用额外的拇指石膏时，减少到接下来的 86 次扫描中的 3 次（3.5%）。然而，在排除 1 例不完全扫描的舟状骨扫描后，事后分级显示在其余 85 例患者中，有 14.9%的堆栈和 32.9%的扫描质量较差。在排除由于扫描质量问题导致的 2 次扫描后，比较了 AUTO 和 sAUTO 轮廓勾画的骨骼指数。所有 AUTO 轮廓都进行了手动修正，导致密度和小梁指数的差异显著但较小（<1.0%）。
当使用带有拇指部分的石膏时，临床疑似舟状骨骨折的患者体内 HR-pQCT 扫描舟状骨是可行的。质量差的堆栈比例与桡骨扫描相似，AUTO 轮廓勾画在质量好和质量差的扫描中均适用。因此，HR-pQCT 可能有望用于疑似舟状骨骨折的诊断和微观结构评估。
