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Bernasconi A, Dechir Y, Izzo A, D’Agostino M, Magliulo P, Smeraglia F, de Cesar Netto C, International Weightbearing CT Society, Lintz F. Trends in the Use of Weightbearing Computed Tomography. J Clin Med 2024; 13:5519. [PMID: 39337007 PMCID: PMC11432607 DOI: 10.3390/jcm13185519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Background: This review aimed to critically appraise the most recent orthopedic literature around cone beam weightbearing computed tomography (WBCT), summarizing what evidence has been provided so far and identifying the main research trends in the area. Methods: This scoping review was performed on studies published between January 2013 and December 2023 on the Pubmed database. All studies (both clinical and nonclinical) in which WBCT had been used were critically analyzed to extract the aim (or aims) of the study, and the main findings related to the role of this imaging modality in the diagnostic pathway. Results: Out of 1759 studies, 129 were selected. One hundred five manuscripts (81%) dealt with elective orthopedic conditions. The majority of the analyses (88 studies; 84%) were performed on foot and ankle conditions, while 13 (12%) studies looked at knee pathologies. There was a progressive increase in the number of studies published over the years. Progressive Collapsing Foot Deformity (22 studies; 25%) and Hallux Valgus (19 studies; 21%) were frequent subjects. Twenty-four (19%) manuscripts dealt with traumatic conditions. A particular interest in syndesmotic injuries was documented (12 studies; 60%). Conclusions: In this review, we documented an increasing interest in clinical applications of weightbearing CT in the orthopedic field between 2013 and 2023. The majority of the analyses focused on conditions related to the foot and the ankle; however, we found several works investigating the value of WBCT on other joints (in particular, the knee).
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Affiliation(s)
- Alessio Bernasconi
- Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.I.); (M.D.); (P.M.); (F.S.)
| | - Yanis Dechir
- Department of Orthopaedic and Trauma Surgery, Centre Hospitalier Universitaire (CHU) de Toulouse, 31300 Toulouse, France;
| | - Antonio Izzo
- Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.I.); (M.D.); (P.M.); (F.S.)
| | - Martina D’Agostino
- Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.I.); (M.D.); (P.M.); (F.S.)
| | - Paolo Magliulo
- Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.I.); (M.D.); (P.M.); (F.S.)
| | - Francesco Smeraglia
- Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, 80131 Naples, Italy; (A.I.); (M.D.); (P.M.); (F.S.)
| | | | | | - François Lintz
- Department of Foot and Ankle Surgery, Ramsay Healthcare, Clinique de l’Union, 31240 Saint Jean, France;
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Van den Borre I, Peiffer M, Huysentruyt R, Huyghe M, Vervelghe J, Pizurica A, Audenaert EA, Burssens A. Development and validation of a fully automated tool to quantify 3D foot and ankle alignment using weight-bearing CT. Gait Posture 2024; 113:67-74. [PMID: 38850852 DOI: 10.1016/j.gaitpost.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/08/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
INTRODUCTION Foot and ankle alignment plays a pivotal role in human gait and posture. Traditional assessment methods, relying on 2D standing radiographs, present limitations in capturing the dynamic 3D nature of foot alignment during weight-bearing and are prone to observer error. This study aims to integrate weight-bearing CT (WBCT) imaging and advanced deep learning (DL) techniques to automate and enhance quantification of the 3D foot and ankle alignment. METHODS Thirty-two patients who underwent a WBCT of the foot and ankle were retrospectively included. After training and validation of a 3D nnU-Net model on 45 cases to automate the segmentation into bony models, 35 clinically relevant 3D measurements were automatically computed using a custom-made tool. Automated measurements were assessed for accuracy against manual measurements, while the latter were analyzed for inter-observer reliability. RESULTS DL-segmentation results showed a mean dice coefficient of 0.95 and mean Hausdorff distance of 1.41 mm. A good to excellent reliability and mean prediction error of under 2 degrees was found for all angles except the talonavicular coverage angle and distal metatarsal articular angle. CONCLUSION In summary, this study introduces a fully automated framework for quantifying foot and ankle alignment, showcasing reliability comparable to current clinical practice measurements. This operator-friendly and time-efficient tool holds promise for implementation in clinical settings, benefiting both radiologists and surgeons. Future studies are encouraged to assess the tool's impact on streamlining image assessment workflows in a clinical environment.
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Affiliation(s)
- Ide Van den Borre
- Department of Telecommunications and Information Processing, Group for Artificial Intelligence and Sparse Modelling (GAIM), Ghent University, St-Pietersnieuwstraat 41, Gent, OVL B-9000, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium; Foot and Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, USA
| | - Roel Huysentruyt
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Manu Huyghe
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Jean Vervelghe
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Aleksandra Pizurica
- Department of Telecommunications and Information Processing, Group for Artificial Intelligence and Sparse Modelling (GAIM), Ghent University, St-Pietersnieuwstraat 41, Gent, OVL B-9000, Belgium
| | - Emmanuel A Audenaert
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium
| | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Corneel Heymanslaan 10, Gent, OVL 9000, Belgium.
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Kim J, Kim J, Kim S, Yi Y. Weight-Bearing CT for Diseases around the Ankle Joint. Diagnostics (Basel) 2024; 14:1641. [PMID: 39125518 PMCID: PMC11311840 DOI: 10.3390/diagnostics14151641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/21/2024] [Accepted: 07/27/2024] [Indexed: 08/12/2024] Open
Abstract
Weight-bearing computed tomography (WBCT) enables acquisition of three-dimensional bony structure images in a physiological weight-bearing position, which is fundamental in understanding the pathologic lesions and deformities of the ankle joint. Over the past decade, researchers have focused on validating and developing WBCT measurements, which has significantly enhanced our knowledge of common foot and ankle diseases. Consequently, understanding the application of WBCT in clinical practice is becoming more important to produce improved outcomes in the treatment of disease around the ankle joint. This review will describe an overview of what is currently being evaluated in foot and ankle surgery using WBCT and where the course of research will be heading in the future.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Jaeyoung Kim
- Baylor University Medical Center, Dallas, TX 75246, USA;
| | - Saintpee Kim
- Department of Orthopedic Surgery, Gangbuk Etteum Hospital, Seoul 01170, Republic of Korea;
| | - Young Yi
- Department of Orthopedic Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
- Department of Orthopaedic Surgery and Rehabilitation, Yale School of Medicine, New Haven, CT 06510, USA
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Richter M, Zech S, Naef I, Duerr F, Schilke R. Automatic software-based 3D-angular measurement for weight-bearing CT (WBCT) is valid. Foot Ankle Surg 2024; 30:417-422. [PMID: 38448344 DOI: 10.1016/j.fas.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/17/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The purpose of this study was to compare automatic software-based angular measurement (AM) with validated measurement by hand (MBH) regarding angle values and time spent for Weight-Bearing CT (WBCT) generated datasets. METHODS Five-hundred WBCT scans from different pathologies were included in the study. 1st - 2nd intermetatarsal angle, talo-1st metatarsal angle dorsoplantar and lateral, hindfoot angle, calcaneal pitch angle were measured and compared between MBH and AM. RESULTS The pathologies were ankle osteoarthritis/instability, n = 147 (29%); Haglund deformity/Achillodynia, n = 41 (8%); forefoot deformity, n = 108 (22%); Hallux rigidus, n = 37 (7%); flatfoot, n = 35 (7%); cavus foot, n = 10 (2%); osteoarthritis except ankle, n = 82 (16%). The angles did not differ between MBH and AM (each p > 0.36). The time spent for MBH / AM was 44.5 / 1 s on average per angle (p < .001). CONCLUSIONS AM provided angles which were not different from validated MBH and can be considered as a validated angle measurement method. The time spent was 97% lower for AM than for MBH. LEVELS OF EVIDENCE Level III.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Issam Naef
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Fabian Duerr
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Regina Schilke
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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Li J, Fang M, Van Oevelen A, Peiffer M, Audenaert E, Burssens A. Diagnostic applications and benefits of weightbearing CT in the foot and ankle: A systematic review of clinical studies. Foot Ankle Surg 2024; 30:7-20. [PMID: 37704542 DOI: 10.1016/j.fas.2023.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Foot and ankle weightbearing CT (WBCT) imaging has emerged over the past decade. However, a systematic review of diagnostic applications has not been conducted so far. METHOD A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines after Prospective Register of Systematic Reviews (PROSPERO) registration. Studies analyzing diagnostic applications of WBCT were included. Main exclusion criteria were: cadaveric specimens and simulated WBCT. The Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment. RESULTS A total of 78 studies were eligible for review. Diagnostic applications were identified in following anatomical area's: ankle (n = 14); hindfoot (n = 41); midfoot (n = 4); forefoot (n = 19). Diagnostic applications that could not be used on weightbearing radiographs (WBRX) were reported in 56/78 studies. The mean MINORS was 9.8/24 (range: 8-12). CONCLUSION Diagnostic applications of WBCT were most frequent in the hindfoot, but other areas are on the rise. Post-processing of images was the main benefit compared to WBRX based on a moderate quality of the identified studies.
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Affiliation(s)
- Jing Li
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Mengze Fang
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Aline Van Oevelen
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | - Matthias Peiffer
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Arne Burssens
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium.
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Lintz F, Bernasconi A, Buedts K, Welck M, Ellis S, de Cesar Netto C. Ankle Joint Bone Density Distribution Correlates with Overall 3-Dimensional Foot and Ankle Alignment. J Bone Joint Surg Am 2023; 105:1801-1811. [PMID: 37616414 DOI: 10.2106/jbjs.23.00180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND Altered stress distribution in the lower limb may impact bone mineral density (BMD) in the ankle bones. The purpose of the present study was to evaluate the spatial distribution of BMD with use of weight-bearing cone-beam computed tomography (WBCT). Our hypothesis was that BMD distribution would be even in normal hindfeet, increased medially in varus hindfeet, and increased laterally in valgus hindfeet. METHODS In this study, 27 normally aligned hindfeet were retrospectively compared with 27 valgus and 27 varus-aligned hindfeet. Age (p = 0.967), body mass index (p = 0.669), sex (p = 0.820), and side (p = 0.708) were similar in the 3 groups. Hindfoot alignment was quantified on the basis of WBCT data sets with use of multiple measurements. BMD was calculated with use of the mean Hounsfield unit (HU) value as a surrogate. The HU medial-to-lateral ratio (HUR), calculated from tibial and talar medial and lateral half-volumes, was the primary outcome of the study. RESULTS The 3 groups significantly differed (p < 0.001) in terms of tibial HUR (median, 0.91 [interquartile range (IQR), 0.75 to 0.98] in valgus hindfeet, 1 [IQR, 0.94 to 1.05] in normal hindfeet, and 1.04 [IQR, 0.99 to 1.1] in varus hindfeet) and talar HUR (0.74 [IQR, 0.50 to 0.80] in valgus hindfeet, 0.82 [IQR, 0.76 to 0.87] in normal hindfeet, and 0.92 [IQR, 0.86 to 1.05] in varus hindfeet). Linear regression showed that all hindfoot measurements significantly correlated with tibial and talar HUR (p < 0.001 for all). The mean HU values for normally-aligned hindfeet were 495.2 ± 110 (medial tibia), 495.6 ± 108.1 (lateral tibia), 368.9 ± 80.3 (medial talus), 448.2 ± 90.6 (lateral talus), and 686.7 ± 120.4 (fibula). The mean HU value for each compartment was not significantly different across groups. CONCLUSIONS Hindfoot alignment and medial-to-lateral BMD distribution were correlated. In varus hindfeet, an increased HU medial-to-lateral ratio was consistent with a greater medial bone density in the tibia and talus as compared with the lateral parts of these bones. In valgus hindfeet, a decreased ratio suggested greater bone density in the lateral as compared with the medial parts of both the tibia and the talus. LEVEL OF EVIDENCE Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- François Lintz
- Department of Foot and Ankle Surgery, Clinique de l'Union, Ramsay Healthcare, Saint Jean, France
| | - Alessio Bernasconi
- Trauma and Orthopaedics Unit, Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Matthew Welck
- Royal National Orthopaedic Hospital, London, United Kingdom
| | - Scott Ellis
- The Hospital for Special Surgery, Weill Cornell Medical College, New York, NY
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa
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Mens MA, Bouman CMB, Dobbe JGG, Bus SA, Nieuwdorp M, Maas M, Wellenberg RHH, Streekstra GJ. Metatarsophalangeal and interphalangeal joint angle measurements on weight-bearing CT images. Foot Ankle Surg 2023; 29:538-543. [PMID: 36641368 DOI: 10.1016/j.fas.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND The aim of this study was to present and evaluate methods of measuring toe joint angels using joint-surface based and inertial axes approaches. METHODS Nine scans of one frozen human cadaveric foot were obtained using weight-bearing CT. Two observers independently segmented bones in the forefoot and measured metatarsalphalangeal joint (MTPJ) angles, proximal and distal interphalangeal joint (PIPJ and DIPJ) angles and interphalangeal angles of the hallux (IPJ) using 1) inertial axes, representing the long anatomical axes, of the bones and 2) axes determined using centroids of articular joint surfaces. RESULTS The standard deviations (SD) of the IPJ/PIPJ and DIPJ angles were lower using joint-surface based axes (between 1.5˚ and 4.1˚) than when the inertial axes method was used (between 3.3˚ and 16.4˚), for MTPJ the SD's were similar for both methods (between 0.5˚ and 2.6˚). For the IPJ/PIPJ and DIPJ angles, the width of the 95% CI and the range were also lower using the joint-surface axes method (95% CI: 2.0˚-4.1˚ vs 3.2˚-16.3˚; range: 3.1˚-7.4˚ vs 3.8˚-35.8˚). Intra-class correlation coefficients (ICC) representing inter- and intra-rater reliability were good to excellent regarding the MTPJ and IPJ/PIPJ angles in both techniques (between 0.85 and 0.99). For DIPJ angles, ICC's were good for the inertial axes method (0.78 and 0.79) and moderate for the joint-surface axes method (0.60 and 0.70). CONCLUSION The joint-surface axes method enables reliable and reproducible measurements of MTPJ, IPJ/PIPJ and DIPJ angles. For PIPJ and DIPJ angles this method is preferable over the use of inertial axes.
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Affiliation(s)
- M A Mens
- Amsterdam UMC, location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands.
| | - C M B Bouman
- Amsterdam UMC, location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - J G G Dobbe
- Amsterdam UMC, location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health - Restoration and Development, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, the Netherlands
| | - S A Bus
- Amsterdam UMC, location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands
| | - M Nieuwdorp
- Amsterdam UMC, location University of Amsterdam, Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Diabetes and Metabolism, Amsterdam, the Netherlands
| | - M Maas
- Amsterdam UMC, location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health - Restoration and Development, Amsterdam, the Netherlands
| | - R H H Wellenberg
- Amsterdam UMC, location University of Amsterdam, Radiology and Nuclear Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health - Restoration and Development, Amsterdam, the Netherlands
| | - G J Streekstra
- Amsterdam UMC, location University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health - Restoration and Development, Amsterdam, the Netherlands
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de Carvalho KAM, Mallavarapu V, Ehret A, Dibbern K, Lee HY, Barbachan Mansur NS, Laleveé M, de Cesar Netto C. The Use of Advanced Semiautomated Bone Segmentation in Hallux Rigidus. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221137597. [PMCID: PMC9716603 DOI: 10.1177/24730114221137597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Weightbearing computed tomography (WBCT) measurements allow evaluation of several anatomical points for a correct clinical-radiographic diagnosis of pathologies, such as hallux rigidus (HR). In addition, a new semiautomatic segmentation software obtains automated 3D measurements from WBCT scan data sets, minimizing errors in reading angular measurements. The study’s objective was (1) to evaluate the reliability of WBCT semiautomatic imaging measures in HR, (2) to evaluate correlation and agreement between manual and semiautomatic measures in the setting of HR, and (3) to compare semiautomatic measurements between pathologic (HR) and standard control groups. Methods: A retrospective study of HR patients was performed including 20 feet with HR. WBCT manual and semiautomatic 3D measurements were performed using the following parameters: (1) first metatarsal-proximal phalanx angle (1stMPP), (2) hallux valgus angle (HVA), (3) first to second intermetatarsal angle (IMA), (4) hallux interphalangeal angle (IPA), (5) first metatarsal length (1stML), (6) second metatarsal length (2ndML), (7) first metatarsal declination angle (1stMD), (8) second metatarsal declination angles (2ndMD), and (9) metatarsus primus elevatus (MPE). The differences between pathologic and control cases were assessed with a Wilcoxon test. Results: Interobserver and intraobserver agreement for manual vs semiautomatic WBCT measurements demonstrated excellent reliability. According to the Pearson coefficient, there was a strong positive linear correlation between both methods for the following parameters evaluated: HVA (ρ = 0.96), IMA (ρ = 0.86), IPA (ρ = 0.89), 1stML (ρ = 0.96), 2ndML (ρ = 0.91), 1stMD (ρ = 0.86), 2ndMD (ρ = 0.95), and MPE (ρ = 0.87). Comparison between the pathologic group with HR and the control (standard) group allowed for the differentiating of the pathologic (HR) from the non-pathologic conditions for MPE (p < 0.05). Conclusion: Semiautomatic measurements are reproducible and comparable to measurements performed manually, showing excellent interobserver and intraobserver agreement. The software used differentiated pathologic from nonpathologic conditions when submitted to semiautomatic MPE measurements. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
| | - Vineel Mallavarapu
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Kepler Alencar Mendes de Carvalho, MD, Department of Orthopaedics and Rehabilitation, Carver College of Medicine, University of Iowa, 200 Hawkins Dr, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA.
| | - Hee Young Lee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Orthopedics and Traumatology, Federal University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Matthieu Laleveé
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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