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Dynamic wrist imaging using four-dimensional CT: current concepts, clinical applications, and future perspectives.

E P A van der Heijden1,2, T Terng1, M Haenen2

  • 1Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.

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|May 1, 2026
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Summary

Four-dimensional CT (4D CT) uniquely visualizes dynamic carpal instability during wrist motion. This advanced imaging technique aids in diagnosing subtle wrist abnormalities missed by static scans, improving treatment outcomes.

Keywords:
4DCTdynamic CTdynamic instability disordersdynamic wrist disordersfour-dimensional CT

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Area of Science:

  • Orthopedics
  • Radiology
  • Biomechanics

Background:

  • Carpal instability is a dynamic disorder often missed by static imaging (radiography, CT, MRI).
  • Delayed diagnosis can lead to progressive instability and degenerative changes.
  • Conventional imaging lacks the ability to visualize in vivo wrist kinematics during motion.

Purpose of the Study:

  • To introduce and evaluate the utility of four-dimensional CT (4D CT) for dynamic carpal instability assessment.
  • To demonstrate 4D CT's capability in identifying abnormal wrist motion patterns and subluxations.
  • To explore 4D CT's role in clinical applications and preoperative/postoperative assessment.

Main Methods:

  • Acquisition of sequential volumetric datasets during active wrist motion using 4D CT.
  • Dynamic, in vivo visualization and quantitative analysis of wrist kinematics.
  • Comparison with the contralateral wrist for physiological reference.

Main Results:

  • 4D CT enables visualization of abnormal intercarpal coordination and subluxations not detectable with static imaging.
  • Identifies altered carpal kinematics in conditions like Kienböck disease.
  • Provides objective evaluation of wrist motion for surgical planning and assessment.

Conclusions:

  • 4D CT offers functional insights into wrist biomechanics, complementing conventional imaging and arthroscopy.
  • It is valuable for diagnosing dynamic carpal instability when static imaging is inconclusive.
  • Advancements in 4D CT are expected to enhance its clinical applicability and integration into practice.