Goelz Leonie, Kim Simon, Güthoff Claas, Eichenauer Frank, Eisenschenk Andreas, Mutze Sven, Asmus Ariane
Dept. of Radiology and Neuroradiology, BG Unfallkrankenhaus, Berlin, Germany.
Inst. For Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany.
BMC Musculoskelet Disord. 2021 Jan 15;22(1):84. doi: 10.1186/s12891-021-03946-x.
Early detection of scapholunate ligament (SLL) tears is essential after minor and major trauma to the wrist. The differentiation between stable and instable injuries determines therapeutic measures which aim to prevent osteoarthritis. Arthroscopy has since been the diagnostic gold standard in suspected SLL tears because non-invasive methods have failed to exclude instable injuries reliably. This prospective study aims to determine the diagnostic accuracy of dynamic, 4D computed tomography (CT) of the wrist for diagnosing instable SLL tears.
Single center, prospective trial including 40 patients with suspected SLL tears scheduled for arthroscopy. Diagnostic accuracy of 4D CT will be tested against the reference standard arthroscopy. Radiologists will be blinded to the results of arthroscopy and hand surgeons to radiological reports. A historical cohort of 80 patients which was diagnosed using cineradiography before implementation of 4D CT at the study site will serve as a comparative group.
Static imaging lacks the ability to detect instable SLL tears after wrist trauma. Dynamic methods such as cineradiography and dynamic magnetic resonance imaging (MRI) are complex and require specific technical infrastructure in specialized centers. Modern super-fast dual source CT scanners are gaining popularity and are being installed gradually in hospitals and ambulances. These scanners enable dynamic imaging in a quick and simple manner. Establishment of dynamic 4D CT of the wrist in patients with suspected SLL tears in in- and outpatient settings could improve early detection rates. Reliable identification of instable injuries through 4D CT scans might reduce the number of unnecessary diagnostic arthroscopies in the future.
This study was registered prospectively at the German Clinical Trials Register (DRKS) DRKS00021110 . Universal Trial Number (WHO-UTN): U1111-1249-7884.
手腕受到轻重伤后，早期检测舟月韧带（SLL）撕裂至关重要。稳定和不稳定损伤的区分决定了旨在预防骨关节炎的治疗措施。自那时起，关节镜检查一直是疑似SLL撕裂的诊断金标准，因为非侵入性方法未能可靠地排除不稳定损伤。这项前瞻性研究旨在确定手腕动态四维计算机断层扫描（CT）诊断不稳定SLL撕裂的诊断准确性。
单中心前瞻性试验，纳入40例计划进行关节镜检查的疑似SLL撕裂患者。将以关节镜检查这一参考标准来检验四维CT的诊断准确性。放射科医生将对关节镜检查结果不知情，手外科医生将对放射学报告不知情。在研究地点实施四维CT之前，使用动态X线摄影诊断的80例患者的历史队列将作为对照组。
静态成像缺乏检测手腕创伤后不稳定SLL撕裂的能力。动态方法如动态X线摄影和动态磁共振成像（MRI）复杂，且需要专业中心的特定技术基础设施。现代超快速双源CT扫描仪越来越受欢迎，并逐渐安装在医院和救护车上。这些扫描仪能够以快速简单的方式进行动态成像。在门诊和住院患者中建立疑似SLL撕裂患者的手腕动态四维CT检查，可能会提高早期检测率。通过四维CT扫描可靠识别不稳定损伤，未来可能会减少不必要的诊断性关节镜检查的数量。
本研究已在德国临床试验注册中心（DRKS）前瞻性注册，注册号为DRKS00021110。通用试验编号（世界卫生组织-UTN）：U1111-1249-7884。
