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Four-Dimensional CT Analysis Using Sequential 3D-3D Registration

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Four-dimensional computed tomography and trigger lunate syndrome.

John M Troupis¹, Benjamin Amis

¹Department of Diagnostic Imaging, Monash Medical Centre, Melbourne, Australia.

Journal of Computer Assisted Tomography

|July 19, 2013

Summary

A novel radiographic finding in midcarpal instability reveals abnormal lunate motion, characterized by a triggering phenomenon. This "clunking" sensation, previously unobserved on imaging, offers new diagnostic insights.

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Area of Science:

Orthopedics
Radiology
Biomechanics

Background:

A 22-year-old male presented with right wrist pain and clicking, diagnosed as midcarpal instability.
Standard imaging (plain films, ultrasound, MRI) was normal, necessitating advanced evaluation.

Observation:

4-dimensional computed tomography (4D CT) evaluated lunate motion during wrist flexion, extension, radial, and ulnar deviation.
Lunate motion in the symptomatic wrist was compared to that of an asymptomatic control subject.

Findings:

The symptomatic lunate exhibited smooth motion initially, followed by a distinct cessation and then a resumption of motion.
In contrast, the asymptomatic lunate displayed smooth, continuous motion throughout all evaluated movements.

Implications:

The observed lunate motion pattern suggests a triggering phenomenon, previously unrecognized radiographically in midcarpal instability.
This finding may enhance the radiographic diagnosis of midcarpal instability and explain the "clunking" sensation.
4D CT provides a dynamic assessment of carpal bone motion, aiding in the understanding of wrist instability mechanisms.