From the Department of Radiology and Neuroradiology (L.G., J.B., S.M., G.S.), Department of Hand-, Replantation- and Microsurgery (M.P., A.E., F.E., A.A.), and Center for Clinical Research (C.G.), BG Klinikum Unfallkrankenhaus Berlin, Warener Str 7, 12683 Berlin, Germany; and Institute for Diagnostic Radiology and Neuroradiology (L.G., S.M.) and Department of Hand Surgery and Microsurgery (S.K., A.E.), Universitätsmedizin Greifswald, Greifswald, Germany.
Radiology. 2023 Sep;308(3):e230292. doi: 10.1148/radiol.230292.
Background Timely treatment of scapholunate instability depends on early identification, but current imaging methods are either intricate or fail to demonstrate the dynamic stages. Purpose To calculate the diagnostic accuracy of four-dimensional (4D) CT for diagnosing instable scapholunate ligament (SLL) tears. Materials and Methods This prospective study enrolled consecutive participants with clinically suspected SLL tears who underwent 4D CT from July 2020 to May 2022. A historical study sample diagnosed at cineradiography served as a comparison, and wrist arthroscopy was the reference standard. Scapholunate joints greater than 3 mm were interpreted as instable at index 4D CT and cineradiography. Diagnostic accuracy was expressed as sensitivity and specificity. Areas under the receiver operating characteristic curve and cutoff values for both index tests were calculated. Intraclass correlation coefficients (ICCs) were computed to compare interrater reliability. Effective radiation doses at 4D CT were measured with thermoluminescent dosimeters. Results The study included 40 participants (mean age, 43 years ± 14 [SD]; 24 male) evaluated at 4D CT and 78 patients (mean age, 45 years ± 11; 50 male) historically evaluated at cineradiography. Four-dimensional CT helped detect instable tears in 26 of 35 participants (sensitivity, 74.3% [95% CI: 56.7, 87.5]. Cineradiography revealed instable tears in 52 of 63 patients (sensitivity, 82.5% [95% CI: 70.9, 91]). Four of five participants with stable scapholunate joints were identified at 4D CT (specificity, 80.0% [95% CI: 28.4, 99.5]), and 12 of 15 patients with stable SLLs were identified at cineradiography (specificity, 80.0% [95% CI: 51.9, 95.7]). Interrater agreement of radiologic measurements on 4D CT scans was good to excellent (ICC range, 0.89-0.96). The effective radiation dose ranged from 67 to 72 mSv at the wrist and was less than 1 mSv at the head. Conclusion Four-dimensional CT results are highly reproducible. Instable scapholunate joints greater than 3 mm were detected with a sensitivity of 74.3% and a specificity of 80% in an exploratory trial. Further evidence from larger randomized trials is warranted. German Register for Clinical Trials no. DRKS00021110 (Universal Trial Number U1111-1249-7884) Published under a CC BY 4.0 license. See also the editorial by Demehri and Ibad in this issue.
背景 及时治疗舟月骨不稳定依赖于早期识别，但目前的影像学方法要么复杂，要么无法显示动态阶段。目的 计算四维（4D）CT 诊断不稳定舟月骨韧带（SLL）撕裂的诊断准确性。材料与方法 本前瞻性研究纳入了 2020 年 7 月至 2022 年 5 月期间因临床疑似 SLL 撕裂而接受 4D CT 检查的连续参与者。历史上在 X 线电影摄影术下诊断的样本作为比较，腕关节镜检查作为参考标准。在指数 4D CT 和 X 线电影摄影术下，舟月关节大于 3 mm 被解释为不稳定。诊断准确性表示为灵敏度和特异性。计算了两种指数检验的受试者工作特征曲线下面积和截断值。计算了组内相关系数（ICC）以比较观察者间的可靠性。用热释光剂量计测量 4D CT 的有效辐射剂量。结果 该研究纳入了 40 名参与者（平均年龄 43 岁±14[标准差]；24 名男性），在 4D CT 下进行评估，并纳入了 78 名在历史上在 X 线电影摄影术下评估的患者（平均年龄 45 岁±11；50 名男性）。4D CT 有助于在 35 名参与者中的 26 名中检测到不稳定的撕裂（敏感性为 74.3%[95%CI：56.7%，87.5%]）。X 线电影摄影术显示 63 名患者中的 52 名有不稳定的撕裂（敏感性为 82.5%[95%CI：70.9%，91%]）。4 名在 4D CT 下显示舟月关节稳定的参与者中，有 5 名（特异性为 80.0%[95%CI：28.4%，99.5%]）被识别，而在 X 线电影摄影术下 15 名 SLL 稳定的患者中有 12 名（特异性为 80.0%[95%CI：51.9%，95.7%]）。4D CT 扫描上放射学测量的观察者间一致性良好至极好（ICC 范围为 0.89-0.96）。手腕处的有效辐射剂量范围为 67 至 72 mSv，头部的有效辐射剂量小于 1 mSv。结论 4D CT 结果具有高度可重复性。在探索性试验中，3mm 以上的不稳定舟月骨关节的检测灵敏度为 74.3%，特异性为 80%。需要更大规模的随机试验提供进一步证据。德国临床试验注册处编号 DRKS00021110（通用试验编号 U1111-1249-7884）根据 CC BY 4.0 许可发布。请同时参阅本期杂志中 Demehri 和 Ibad 的社论。
