Korean J Radiol.  2012 Dec;13(6):743-751. 10.3348/kjr.2012.13.6.743.

Preliminary Application of High-Definition CT Gemstone Spectral Imaging in Hand and Foot Tendons

• Deng K
• Zhang CQ
• Li W
• Wang JJ
• Wang XY
• Pang T
• Wang GL
• Liu C

• KMID: 1397505
• DOI: http://doi.org/10.3348/kjr.2012.13.6.743

Abstract

OBJECTIVE
To assess the feasibility of visualizing hand and foot tendon anatomy and disorders by Gemstone Spectral Imaging (GSI) high-definition CT (HDCT).
MATERIALS AND METHODS
Thirty-five patients who suffered from hand or foot pain were scanned with GSI mode HDCT and MRI. Spectrum analysis was used to select the monochromatic images that provide the optimal contrast-to-noise ratio (CNR) for tendons. The image quality at the best selected monochromatic level and the conventional polychromatic images were compared. Tendon anatomy and disease were also analyzed at GSI and MRI.
RESULTS
The monochromatic images at about 65 keV (mean 65.09 +/- 2.98) provided the optimal CNR for hand and foot tendons. The image quality at the optimal selected monochromatic level was superior to conventional polychromatic images (p = 0.005, p < 0.05). GSI was useful in visualizing hand and foot tendon anatomy and disorders. There were no statistical differences between GSI and MRI with regard to tendon thickening (chi2 = 0, p > 0.05), compression (chi2 = 0.5, p > 0.05), absence (chi2 = 0, p > 0.05) and rupture (chi2 = 0, p > 0.05). GSI was significantly less sensitive than MRI in displaying tendon adhesion (chi2 = 4.17, p < 0.05), degeneration (chi2 = 4.17, p < 0.05), and tendinous sheath disease (chi2 = 10.08, p < 0.05).
CONCLUSION
GSI with monochromatic images at 65 keV displays clearly the most hand and foot tendon anatomy and disorders with image quality improved, as compared with conventional polychromatic images. It may be used solely or combined with MRI in clinical work, depending on individual patient disease condition.

Keyword

Dual energy CT; Spectral imaging; Magnetic resonance imaging; Tendon

MeSH Terms

Adolescent
Adult
Female
Foot/pathology/*radiography
Hand/pathology/*radiography
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Musculoskeletal Diseases/diagnosis/radiography
*Radiographic Image Enhancement
Tendon Injuries/diagnosis/*radiography
Tendons/pathology/*radiography
Tomography, X-Ray Computed/*methods
Young Adult

Figure

• 

  Fig. 1 Optimal CNR for hand and foot tendons. A. Normal tendon and surrounding muscles as regions of interest. B. According to spectral curve, monochromatic images at about 65 keV were found to provide best CNR. CNR = contrast-to-noise ratio

• 

  Fig. 2 Normal tendons (volume rendering images). A. Normal hand tendons, 1. Musculus flexor digitorum sublimis/profundus tendon, 2. Flexor pollicis longus muscle tendon, 3. Flexor carpi radialis muscle tendon, 4. Musculus flexor carpi ulnaris tendon. B. Normal foot tendons, 1. Extensor pollicis longus muscle tendon, 2. Long extensor muscle digits tendon, 3. Long fibular muscle tendon, 4. Musculus fibularis brevis tendon, 5. Musculus fibularis tertius tendon.

• 

  Fig. 3 Comparison with different imaging modalities. A. Monochramatic images at 65 keV. B. Conventional polychromatic images. Though image noise in former image was larger, edge of tendons was displayed more sharply and image contrast was better (window width/level: 185/55).

• 

  Fig. 4 Tendon adherence after trauma in left hand. A. Gemstone spectral imaging volume rendering images can clearly display whole relationship of adhesive flexor tendon and phalanges (arrow). B. MRI coronal T1WI cannot present whole relationship of tendons and phalanges in two-dimensional image (arrow). T1WI = T1 weighted image

• 

  Fig. 5 Stretching function of thumb is constrained after left external wrist and hand injuries. Absence of extensor pollicis longus tendon, extensor pollicis brevis tendon, extensor carpi radialis longus and brevis were displayed in left hand with gemstone spectral imaging volume rendering image. We could not find any tendon tissues in original area and radialis soft tissues were thickening (arrow). Opposite hand tendons were normal: 1. Extensor pollicis longus tendon, 2. Extensor pollicis brevis tendon, 3. Extensor carpi radialis longus and brevis.

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  Fig. 6 Achilles tendon rupture after trauma. Gemstone spectral imaging volume rendering image showed that superior part of achilles tendon's continuity was broken (arrow). Broken ends of ruptured tendons were contractural and circumambient soft tissues wereswollen.

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  Fig. 7 Compression of tendon. Oblique sagittal MPR of gemstone spectral imaging found mass located in proximal phalanx bottom of little finger. Vicinal flexor tendon was compressed with shape change, but tendon itself was normal (arrow). Enchondroma with tendon compression were comfirmed by operation. MPR = multiplanar reconstryction

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  Fig. 8 Fiftysix year old male patient experienced slight claudication for fifteen years but no pain after surgery for fracture of left lower leg. A. Achilles tendon was not found abnormal in gemstone spectral imaging images. B. In MRI FS PDWI images, high signal in strip can be seen (arrow). Combined with disease history and clinical signs, degenerative changes of achilles tendon were considered.

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