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Semin Musculoskelet Radiol 2019; 23(06): 643-656
DOI: 10.1055/s-0039-1697939
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Weight-bearing CT Technology in Musculoskeletal Pathologies of the Lower Limbs: Techniques, Initial Applications, and Preliminary Combinations with Gait-Analysis Measurements at the Istituto Ortopedico Rizzoli

Alberto Leardini
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Stefano Durante
2   Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Claudio Belvedere
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Paolo Caravaggi
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Claudio Carrara
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Lisa Berti
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Giada Lullini
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Claudia Giacomozzi
3   Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Roma, Italy
,
Gilda Durastanti
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Maurizio Ortolani
1   Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Giuseppe Guglielmi
4   Department of Radiology, University of Foggia, Foggia, Italy
,
Alberto Bazzocchi
5   Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
› Institutsangaben Funding Source Ministero della Salute: http://dx.doi.org/10.13039/501100003196, Programma 5*1000.
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Publikationsdatum:
19. November 2019 (online)

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Abstract

Musculoskeletal radiology has been mostly limited by the option between imaging under load but in two dimensions (i.e., radiographs) and three-dimensional (3D) scans but in unloaded conditions (i.e., computed tomography [CT] and magnetic resonance imaging in a supine position). Cone-beam technology is now also a way to image the extremities with 3D and weight-bearing CT. This article discusses the initial experience over a few studies in progress at an orthopaedic center. The custom design of total ankle replacements, the patellofemoral alignment after medial ligament reconstruction, the overall architecture of the foot bones in the diabetic foot, and the radiographic assessment of the rearfoot after subtalar fusion for correction of severe flat foot have all taken advantage of the 3D and weight-bearing feature of relevant CT scans. To further support these novel assessments, techniques have been developed to obtain 3D models of the bones from the scans and to merge these with state-of-the-art gait analyses.

Keywords

cone-beam CT - weight-bearing - three-dimensional bone models - gait analysis - plantar pressure
 

  • References

  • 1 Verhelst P, Verstraete L, Shaheen E. , et al. Three-dimensional cone beam computed tomography analysis protocols for condylar remodelling following orthognathic surgery: a systematic review. Int J Oral Maxillofac Surg 2019 ; June 17 (Epub ahead of print)
    PubMedGoogle Scholar
  • 2 Aydin U, Gormez O, Yildirim D. Cone-beam computed tomography imaging of dentoalveolar and mandibular fractures. Oral Radiol 2019 ; May 17 (Epub ahead of print)
    PubMedGoogle Scholar
  • 3 Swennen GR, Schutyser F. Three-dimensional cephalometry: spiral multi-slice vs cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2006; 130 (03) 410-416
    CrossrefPubMedGoogle Scholar
  • 4 Ricci PM, Boldini M, Bonfante E. , et al. Cone-beam computed tomography compared to X-ray in diagnosis of extremities bone fractures: a study of 198 cases. Eur J Radiol Open 2019; 6: 119-121
    CrossrefPubMedGoogle Scholar
  • 5 Ludlow J, Ivanovic M. Weightbearing CBCT, MDCT, and 2D imaging dosimetry of the foot and ankle. Int J Diagnostic Imaging 2014 1(02):
    PubMedGoogle Scholar
  • 6 Ludlow JB. Hand-wrist, knee, and foot-ankle dosimetry and image quality measurements of a novel extremity imaging unit providing CBCT and 2D imaging options. Med Phys 2018; 45 (11) 4955-4963
    CrossrefPubMedGoogle Scholar
  • 7 Barg A, Bailey T, Richter M. , et al. Weightbearing computed tomography of the foot and ankle: emerging technology topical review. Foot Ankle Int 2018; 39 (03) 376-386
    CrossrefPubMedGoogle Scholar
  • 8 Lintz F, de Cesar Netto C, Barg A, Burssens A, Richter M. ; Weight Bearing CT International Study Group. Weight-bearing cone beam CT scans in the foot and ankle. EFORT Open Rev 2018; 3 (05) 278-286
    CrossrefPubMedGoogle Scholar
  • 9 Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: clinical applications. Insights Imaging 2018; 9 (01) 35-45
    CrossrefPubMedGoogle Scholar
  • 10 Hamard M, Neroladaki A, Bagetakos I, Dubois-Ferrière V, Montet X, Boudabbous S. Accuracy of cone-beam computed tomography for syndesmosis injury diagnosis compared to conventional computed tomography. Foot Ankle Surg 2019 ; April 1 (Epub ahead of print)
    PubMedGoogle Scholar
  • 11 Lamm BM, Stasko PA, Gesheff MG, Bhave A. normal foot and ankle radiographic angles, measurements, and reference points. J Foot Ankle Surg 2016; 55 (05) 991-998
    CrossrefPubMedGoogle Scholar
  • 12 Parr WC, Chatterjee HJ, Soligo C. Calculating the axes of rotation for the subtalar and talocrural joints using 3D bone reconstructions. J Biomech 2012; 45 (06) 1103-1107
    CrossrefPubMedGoogle Scholar
  • 13 Kai S, Sato T, Koga Y. , et al. Automatic construction of an anatomical coordinate system for three-dimensional bone models of the lower extremities—pelvis, femur, and tibia. J Biomech 2014; 47 (05) 1229-1233
    CrossrefPubMedGoogle Scholar
  • 14 Renault J-B, Aüllo-Rasser G, Donnez M, Parratte S, Chabrand P. Articular-surface-based automatic anatomical coordinate systems for the knee bones. J Biomech 2018; 80: 171-178
    CrossrefPubMedGoogle Scholar
  • 15 Saltzman CL, Nawoczenski DA, Talbot KD. Measurement of the medial longitudinal arch. Arch Phys Med Rehabil 1995; 76 (01) 45-49
    CrossrefPubMedGoogle Scholar
  • 16 Thomas JL, Kunkel MW, Lopez R, Sparks D. Radiographic values of the adult foot in a standardized population. J Foot Ankle Surg 2006; 45 (01) 3-12
    CrossrefPubMedGoogle Scholar
  • 17 Rungprai C, Goetz JE, Arunakul M. , et al. Validation and reproducibility of a biplanar imaging system versus conventional radiography of foot and ankle radiographic parameters. Foot Ankle Int 2014; 35 (11) 1166-1175
    CrossrefPubMedGoogle Scholar
  • 18 Maynou C, Szymanski C, Thiounn A. The adult cavus foot. EFORT Open Rev 2017; 2 (05) 221-229
    CrossrefPubMedGoogle Scholar
  • 19 Menz HB, Munteanu SE, Zammit GV, Landorf KB. Foot structure and function in older people with radiographic osteoarthritis of the medial midfoot. Osteoarthritis Cartilage 2010; 18 (03) 317-322
    CrossrefPubMedGoogle Scholar
  • 20 Gwani AS, Asari MA, Mohd Ismail ZI. How the three arches of the foot intercorrelate. Folia Morphol (Warsz) 2017; 76 (04) 682-688
    CrossrefPubMedGoogle Scholar
  • 21 Zhou Y, Zhou B, Liu J. , et al. A prospective study of midfoot osteotomy combined with adjacent joint sparing internal fixation in treatment of rigid pes cavus deformity. J Orthop Surg Res 2014; 9: 44
    CrossrefPubMedGoogle Scholar
  • 22 Giannini S, Leardini A, O'Connor J. Total ankle replacement: review of the designs and of the current status. Foot Ankle Surg 2000; 6 (02) 77-88
    CrossrefPubMedGoogle Scholar
  • 23 Leardini A, O'Connor JJ, Catani F, Giannini S. Mobility of the human ankle and the design of total ankle replacement. Clin Orthop Relat Res 2004; (424) 39-46
    PubMedGoogle Scholar
  • 24 Leardini A, O'Connor JJ, Giannini S. Biomechanics of the natural, arthritic, and replaced human ankle joint. J Foot Ankle Res 2014; 7 (01) 8
    CrossrefPubMedGoogle Scholar
  • 25 Omar IM, Abboud SF, Youngner JM. Imaging of total ankle arthroplasty: normal imaging findings and hardware complications. Sem Musculoskelet Radiol 2019; 23 (02) 177-194
    PubMedGoogle Scholar
  • 26 Liverani E, Fortunato A, Leardini A. , et al. Fabrication of Co–Cr–Mo endoprosthetic ankle devices by means of Selective Laser Melting (SLM). Materials Design 2016; 106: 60-68
    PubMedGoogle Scholar
  • 27 Wang X, Xu S, Zhou S. , et al. Topological design and additive manufacturing of porous metals for bone scaffolds and orthopaedic implants: a review. Biomaterials 2016; 83: 127-141
    CrossrefPubMedGoogle Scholar
  • 28 Belvedere C, Siegler S, Fortunato A. , et al. New comprehensive procedure for custom-made total ankle replacements: medical imaging, joint modeling, prosthesis design, and 3D printing. J Orthop Res 2019; 37 (03) 760-768
    CrossrefPubMedGoogle Scholar
  • 29 Giannini S, Romagnoli M, O'Connor JJ, Malerba F, Leardini A. Total ankle replacement compatible with ligament function produces mobility, good clinical scores, and low complication rates: an early clinical assessment. Clin Orthop Relat Res 2010; 468 (10) 2746-2753
    CrossrefPubMedGoogle Scholar
  • 30 Durastanti G, Leardini A, Siegler S, Durante S, Bazzocchi A, Belvedere C. Comparison of ankle articular surfaces among morphological models derived from different medical imaging technologies. Quant Imaging Med Surg. In press
    PubMedGoogle Scholar
  • 31 Giacomozzi C, Leardini A, Caravaggi P. Correlates between kinematics and baropodometric measurements for an integrated in-vivo assessment of the segmental foot function in gait. J Biomech 2014; 47 (11) 2654-2659
    CrossrefPubMedGoogle Scholar
  • 32 Hirschmann A, Pfirrmann CW, Klammer G, Espinosa N, Buck FM. Upright cone CT of the hindfoot: comparison of the non-weight-bearing with the upright weight-bearing position. Eur Radiol 2014; 24 (03) 553-558
    CrossrefPubMedGoogle Scholar
  • 33 Giacomozzi C, Martelli F, Nagel A, Schmiegel A, Rosenbaum D. Cluster analysis to classify gait alterations in rheumatoid arthritis using peak pressure curves. Gait Posture 2009; 29 (02) 220-224
    CrossrefPubMedGoogle Scholar
  • 34 Caravaggi P, Leardini A, Giacomozzi C. Multiple linear regression approach for the analysis of the relationships between joints mobility and regional pressure-based parameters in the normal-arched foot. J Biomech 2016; 49 (14) 3485-3491
    CrossrefPubMedGoogle Scholar
  • 35 Leardini A, Benedetti MG, Berti L, Bettinelli D, Nativo R, Giannini S. Rear-foot, mid-foot and fore-foot motion during the stance phase of gait. Gait Posture 2007; 25 (03) 453-462
    CrossrefPubMedGoogle Scholar
  • 36 Portinaro N, Leardini A, Panou A, Monzani V, Caravaggi P. Modifying the Rizzoli foot model to improve the diagnosis of pes-planus: application to kinematics of feet in teenagers. J Foot Ankle Res 2014; 7 (01) 754
    PubMedGoogle Scholar
  • 37 Caravaggi P, Lullini G, Berti L, Giannini S, Leardini A. Functional evaluation of bilateral subtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up. Gait Posture 2018; 64: 152-158
    CrossrefPubMedGoogle Scholar
  • 38 Caravaggi P, Giangrande A, Berti L, Lullini G, Leardini A. Pedobarographic and kinematic analysis in the functional evaluation of two post-operative forefoot offloading shoes. J Foot Ankle Res 2015; 8 (01) 59
    CrossrefPubMedGoogle Scholar
  • 39 Caravaggi P, Giangrande A, Lullini G, Padula G, Berti L, Leardini A. In shoe pressure measurements during different motor tasks while wearing safety shoes: the effect of custom made insoles vs. prefabricated and off-the-shelf. Gait Posture 2016; 50: 232-238
    CrossrefPubMedGoogle Scholar
  • 40 Steel III MW, Johnson KA, DeWitz MA, Ilstrup DM. Radiographic measurements of the normal adult foot. Foot Ankle 1980; 1 (03) 151-158
    Google Scholar
  • 41 Gentili A, Masih S, Yao L, Seeger LL. Pictorial review: foot axes and angles. Br J Radiol 1996; 69 (826) 968-974
    CrossrefPubMedGoogle Scholar
  • 42 Marzo J, Kluczynski M, Notino A, Bisson L. Comparison of a novel weightbearing cone beam computed tomography scanner versus a conventional computed tomography scanner for measuring patellar instability. Orthop J Sports Med 2016; 4 (12) 2325967116673560
    PubMedGoogle Scholar
  • 43 Carrara C, Caravaggi P, Belvedere C, Leardini A. Radiographic angular measurements of the foot and ankle in weight-bearing: a literature review. Foot Ankle Surg 2019 ; July 31 (Epub ahead of print)
    PubMedGoogle Scholar
  • 44 Gonzalez TA, Ehrlichman LK, Macaulay AA. , et al. Determining measurement error for Bohler's angle and the effect of X-ray obliquity on accuracy. Foot Ankle Spec 2016; 9 (05) 409-416
    CrossrefPubMedGoogle Scholar
  • 45 Neri T, Barthelemy R, Tourné Y. Radiologic analysis of hindfoot alignment: comparison of Méary, long axial, and hindfoot alignment views. Orthop Traumatol Surg Res 2017; 103 (08) 1211-1216
    CrossrefPubMedGoogle Scholar
  • 46 Barg A, Harris MD, Henninger HB. , et al. Medial distal tibial angle: comparison between weightbearing mortise view and hindfoot alignment view. Foot Ankle Int 2012; 33 (08) 655-661
    CrossrefPubMedGoogle Scholar
  • 47 Dayton P, Feilmeier M, Hirschi J, Kauwe M, Kauwe JS. Observed changes in radiographic measurements of the first ray after frontal plane rotation of the first metatarsal in a cadaveric foot model. J Foot Ankle Surg 2014; 53 (03) 274-278
    CrossrefPubMedGoogle Scholar
  • 48 Buck FM, Hoffmann A, Mamisch-Saupe N, Espinosa N, Resnick D, Hodler J. Hindfoot alignment measurements: rotation-stability of measurement techniques on hindfoot alignment view and long axial view radiographs. AJR Am J Roentgenol 2011; 197 (03) 578-582
    CrossrefPubMedGoogle Scholar
  • 49 Leardini A, Caravaggi P, Theologis T, Stebbins J. Multi-segment foot models and their use in clinical populations. Gait Posture 2019; 69: 50-59
    CrossrefPubMedGoogle Scholar
  • 50 Caravaggi P, Matias AB, Taddei UT, Ortolani M, Leardini A, Sacco ICN. Reliability of medial-longitudinal-arch measures for skin-markers based kinematic analysis. J Biomech 2019; 88: 180-185
    CrossrefPubMedGoogle Scholar
  • 51 Shereff MJ, DiGiovanni L, Bejjani FJ, Hersh A, Kummer FJ. A comparison of nonweight-bearing and weight-bearing radiographs of the foot. Foot Ankle 1990; 10 (06) 306-311
    CrossrefPubMedGoogle Scholar
  • 52 Shelton T, Singh S, Kreulen C, Giza E. The influence of percentile weight bearing on foot radiographs. Foot Ankle Spec 2018 ; October 21 (Epub ahead of print)
    PubMedGoogle Scholar
  • 53 Guo C, Zhu Y, Hu M, Deng L, Xu X. Reliability of measurements on lateral ankle radiographs. BMC Musculoskelet Disord 2016; 17 (01) 297
    CrossrefPubMedGoogle Scholar
  • 54 Saltzman CL, Brandser EA, Berbaum KS. , et al. Reliability of standard foot radiographic measurements. Foot Ankle Int 1994; 15 (12) 661-665
    CrossrefPubMedGoogle Scholar
  • 55 Lin CS, Wu TY, Wang TM, Hou SM, Shih KS, Liaw CK. A new technique to increase reliability in measuring the axis of bone. J Foot Ankle Surg 2016; 55 (01) 106-111
    CrossrefPubMedGoogle Scholar
  • 56 Carrara C. 3D measurements of foot bone architecture in weight-bearing by cone-beam computed tomography. Paper presented at: Congress XXVII of the International Society of Biomechanics; July 31, 2019 ; Calgary, Canada
    PubMedGoogle Scholar
  • 57 Matsiushevich K, Belvedere C, Leardini A, Durante S. Quantitative comparison of freeware software for bone mesh from DICOM files. J Biomech 2019; 84: 247-251
    CrossrefPubMedGoogle Scholar
  • 58 Peiffer M, Belvedere C, Clockaerts S. , et al; WBCT ISG. Three-dimensional displacement after a medializing calcaneal osteotomy in relation to the osteotomy angle and hindfoot alignment. Foot Ankle Surg 2018 ; December 7 (Epub ahead of print)
    PubMedGoogle Scholar
  • 59 Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol 2008; 37 (02) 63-71
    CrossrefPubMedGoogle Scholar
  • 60 Belvedere C, Cadossi M, Mazzotti A, Giannini S, Leardini A. Fluoroscopic and gait analyses for the functional performance of a custom-made total talonavicular replacement. J Foot Ankle Surg 2017; 56 (04) 836-844
    CrossrefPubMedGoogle Scholar
  • 61 Giannini S, Cadossi M, Mazzotti A, Ramponi L, Belvedere C, Leardini A. Custom-made total talonavicular replacement in a professional rock climber. J Foot Ankle Surg 2016; 55 (06) 1271-1275
    CrossrefPubMedGoogle Scholar
  • 62 Lintz F, Welck M, Bernasconi A. , et al. 3D biometrics for hindfoot alignment using weightbearing CT. Foot Ankle Int 2017; 38 (06) 684-689
    CrossrefPubMedGoogle Scholar
  • 63 Zhang JZ, Lintz F, Bernasconi A, Zhang S, Zhang S. ; Weight Bearing CT International Study Group. 3D biometrics for hindfoot alignment using weightbearing computed tomography. Foot Ankle Int 2019; 40 (06) 720-726
    CrossrefPubMedGoogle Scholar