Abstract：
OBJECTIVE: To evaluate the diagnostic performance of simplified post-processing approaches for quantitative wrist 4D-CT in the assessment of scapholunate instability (SLI).
METHODS: A prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard.
RESULTS: The SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93-0.96) compared to the standard approach (ICC values 0.65-0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes).
CONCLUSIONS: Simpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.
METHODS: A prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard.
RESULTS: The SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93-0.96) compared to the standard approach (ICC values 0.65-0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes).
CONCLUSIONS: Simpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.
摘要：
目的：评估用于定量腕关节4D-CT的简化后处理方法在评估肩胛骨不稳定（SLI）中的诊断性能。
方法：一项前瞻性单中心病例对照研究包括60例疑似创伤后肩胛骨韧带（SLL）撕裂和持续性疼痛的患者。其中,40例患者出现SLL泪液,分为两组，每组20个：一组韧带完全撕裂，另一组韧带部分撕裂。剩下的20个病人,其SLL完好无损，作为控制。进行了4D-CT和CT关节造影，并由两名读者使用三种方法进行后处理：具有完整数据评估和专用软件的标准方法，使用后处理软件（骨锁定）进行部分数据评估，和部分数据评估，无需后处理软件（无骨锁定）。以毫米为单位测量了肩胛骨间隙（SLG）参数，以评估半径尺偏差（RUD）期间的肩胛骨舒张。CT关节造影上的肩胛骨韧带状态被认为是金标准。
结果：SLG派生参数（范围，意思是，和最大值）在所有后处理方法中均具有完整和撕裂的肩胛骨韧带的患者中均显着增加（P值在0.001至0.004之间）。SLG范围是诊断SLL撕裂的最佳参数，三种后处理方法的ROCAUC值范围为0.7至0.88。与标准方法（ICC值0.65-0.72）相比，替代方法（ICC值0.93-0.96）的观察者间可重复性更好。此外,替代方法的后处理时间更短，特别是当不使用特定软件时（从10分钟减少到3分钟）。
结论：与标准方法相比，更简单的腕部4D-CT数据分析方法产生了可接受的诊断性能和改善的观察者间可重复性。
方法：一项前瞻性单中心病例对照研究包括60例疑似创伤后肩胛骨韧带（SLL）撕裂和持续性疼痛的患者。其中,40例患者出现SLL泪液,分为两组，每组20个：一组韧带完全撕裂，另一组韧带部分撕裂。剩下的20个病人,其SLL完好无损，作为控制。进行了4D-CT和CT关节造影，并由两名读者使用三种方法进行后处理：具有完整数据评估和专用软件的标准方法，使用后处理软件（骨锁定）进行部分数据评估，和部分数据评估，无需后处理软件（无骨锁定）。以毫米为单位测量了肩胛骨间隙（SLG）参数，以评估半径尺偏差（RUD）期间的肩胛骨舒张。CT关节造影上的肩胛骨韧带状态被认为是金标准。
结果：SLG派生参数（范围，意思是，和最大值）在所有后处理方法中均具有完整和撕裂的肩胛骨韧带的患者中均显着增加（P值在0.001至0.004之间）。SLG范围是诊断SLL撕裂的最佳参数，三种后处理方法的ROCAUC值范围为0.7至0.88。与标准方法（ICC值0.65-0.72）相比，替代方法（ICC值0.93-0.96）的观察者间可重复性更好。此外,替代方法的后处理时间更短，特别是当不使用特定软件时（从10分钟减少到3分钟）。
结论：与标准方法相比，更简单的腕部4D-CT数据分析方法产生了可接受的诊断性能和改善的观察者间可重复性。
