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Review
. 2022 Jun 14;65(3):E388-E393.
doi: 10.1503/cjs.023420. Print 2022 May-Jun.

Four-dimensional computed tomography: musculoskeletal applications

Murray T Wong  1 , Charmaine Wiens  1 , Michael Kuczynski  1 , Sarah Manske  1 , Prism S Schneider  2
Affiliations
Review

Four-dimensional computed tomography: musculoskeletal applications

Murray T Wong et al. Can J Surg. .

Abstract
in English, French

Four-dimensional computed tomography (4DCT), or dynamic CT, is an emerging modality with a wealth of orthopedic applications for both clinical practice and research. This technology creates CT volumes of a moving structure at multiple time points to depict real-time motion. Recent advances in acquisition technology and reduction in radiation dosage have allowed for increased adoption of the modality and have made imaging of joint motion feasible and safe. Musculoskeletal 4DCT has been used primarily to investigate wrist motion; however, the utility of 4DCT has been shown in other areas, including the shoulder, elbow, hip, knee and ankle. Imaging these joints through a full range of motion provides new insight into dynamic phenomena such as instability, impingement and joint kinematics. Although 4DCT has not yet been widely adopted in orthopedic practice and research, future use has the potential to enable a deeper understanding of musculoskeletal conditions and to improve patient care.

La tomodensitométrie quadridimensionnelle (TDM-4D), ou TDM dynamique, est une modalité d’imagerie émergente qui comporte une foule d’applications en orthopédie, tant dans la pratique clinique qu’en recherche. Cette technologie de TDM crée des volumes qui permettent de visualiser une structure mobile à différents moments pour capter le mouvement en temps réel. Les avancées récentes des technologies d’acquisition et la réduction des doses de radiation ont permis à cette modalité d’être utilisée plus largement et ont rendu l’imagerie des articulations mobiles plus facile à réaliser et sécuritaire. La TDM-4D de l’appareil musculosquelettique a été principalement utilisée pour explorer le mouvement du poignet; mais son utilité a été démontrée pour d’autres sites anatomiques, comme l’épaule, le coude, la hanche, le genou et la cheville. Une modalité d’imagerie couvrant toute l’amplitude de mouvement de ces articulations offre de nouvelles pistes pour étudier des phénomènes dynamiques, comme l’instabilité et le pincement articulaires ou la cinématique. Même si l’orthopédie n’a pas encore largement adopté la TDM-4D dans la pratique et pour la recherche, son utilisation future permettrait d’approfondir les connaissances sur les maladies de l’appareil musculosquelettique et d’améliorer les soins aux patients.

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Conflict of interest statement

Competing interests: Prism Schneider reports research grants from the Canadian Institutes of Health Research, the Orthopaedic Trauma Association and Johnson & Johnson, outside the submitted work. She has received consulting fees and honoraria for presentations and educational events from Amgen. She is a member of Osteoporosis Canada’s Scientific Advisory Council. No other competing interests were declared.

Figures

Fig. 1
Fig. 1
Coronal 4-dimensional computed tomography (4DCT) images showing relative position of the trapeziometacarpal joint at 3 positions of progressive thumb adduction. Three-dimensional bony models can be registered to 4DCT volumes to quantify changes in relative positions during motion.
Fig. 2
Fig. 2
Axial 4-dimensional computed tomography images showing syndesmotic reduction in plantar flexion (left) and dorsiflexion (right) as measured by the anterior (AN), middle (MN) and posterior (PN) syndesmosis distances.
Fig. 3
Fig. 3
Axial 4-dimensional computed tomography images showing that substantial motion artifact occurs in the forefoot during ankle plantar flexion and dorsiflexion if the tibia remains stationary. Motion artifact can be minimized by holding the area of interest in a fixed position and moving the body or limb relative to that area of interest.
Fig. 4
Fig. 4
Axial 4-dimensional computed tomography images showing an ankle with metal implants after open reduction internal fixation of an ankle fracture. The metal artifact disrupts image-processing routines and obscures the anatomy.
See this image and copyright information in PMC

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