Sho Kohyama1, Yasumasa Nishiura2, Yuki Hara3, Takeshi Ogawa4, Akira Ikumi3, Eriko Okano3, Yasukazu Totoki3, Masashi Yamazaki3. 1. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. sho_kohyama_1025@yahoo.co.jp. 2. Tsuchiura Clinical Education and Training Center, Tsukuba University Hospital, Tsuchiura, Japan. 3. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 4. Mito Medical Education and Training Center, Tsukuba University Hospital, Mito, Japan.
Abstract
OBJECTIVES: We developed a novel method to create three-dimensional magnetic resonance imaging-CT (3D MRI-CT) fusion images for detailed lesion evaluation and surgical simulation in capitellar osteochondritis dissecans (COCD). This study aimed to clarify its usefulness. METHODS: We enrolled 12 boys with COCD (mean age, 13.8 years) and preoperatively constructed 3D models of the humerus and articular cartilage from MR images obtained with a 3-T imager. For better visualization of the articular cartilage outline, we applied 7 kg of axial traction to the elbow during MRI. We also constructed a 3D model of the humerus from CT images. 3D MRI-CT fusion images were created using both models. The average distance difference between two corresponding points as per the 3D CT and 3D MRI models of the humerus was evaluated. Using the 3D MRI-CT fusion images, we measured longitudinal and transverse lesion diameters; evaluated articular cartilage fissures and defects, articular surface deformities, and the International Cartilage Repair Society (ICRS) classification; and validated the results using intraoperative findings. RESULTS: The mean average distance difference was 0.75 mm. The 3D MRI-CT fusion images accurately reproduced lesion conditions in every case and correctly predicted the ICRS classification with 100% accuracy. Preoperatively measured longitudinal and transverse lesion diameters were not significantly different from intraoperative measurements (p = 0.79, 0.32 respectively). CONCLUSION: 3D MRI-CT fusion images provide a detailed evaluation of COCD lesion severity by presenting the exact positional relationship between the articular cartilage and subchondral bone. KEY POINTS: • We developed a novel method to create three-dimensional magnetic resonance imaging-computed tomography (3D MRI-CT) fusion images for the evaluation of capitellar osteochondritis dissecans. • 3D MRI-CT fusion images enabled the accurate prediction of lesions and provided a detailed evaluation of lesion severity by presenting the exact positional relationship between the articular cartilage and subchondral bone.
OBJECTIVES: We developed a novel method to create three-dimensional magnetic resonance imaging-CT (3D MRI-CT) fusion images for detailed lesion evaluation and surgical simulation in capitellar osteochondritis dissecans (COCD). This study aimed to clarify its usefulness. METHODS: We enrolled 12 boys with COCD (mean age, 13.8 years) and preoperatively constructed 3D models of the humerus and articular cartilage from MR images obtained with a 3-T imager. For better visualization of the articular cartilage outline, we applied 7 kg of axial traction to the elbow during MRI. We also constructed a 3D model of the humerus from CT images. 3D MRI-CT fusion images were created using both models. The average distance difference between two corresponding points as per the 3D CT and 3D MRI models of the humerus was evaluated. Using the 3D MRI-CT fusion images, we measured longitudinal and transverse lesion diameters; evaluated articular cartilage fissures and defects, articular surface deformities, and the International Cartilage Repair Society (ICRS) classification; and validated the results using intraoperative findings. RESULTS: The mean average distance difference was 0.75 mm. The 3D MRI-CT fusion images accurately reproduced lesion conditions in every case and correctly predicted the ICRS classification with 100% accuracy. Preoperatively measured longitudinal and transverse lesion diameters were not significantly different from intraoperative measurements (p = 0.79, 0.32 respectively). CONCLUSION: 3D MRI-CT fusion images provide a detailed evaluation of COCD lesion severity by presenting the exact positional relationship between the articular cartilage and subchondral bone. KEY POINTS: • We developed a novel method to create three-dimensional magnetic resonance imaging-computed tomography (3D MRI-CT) fusion images for the evaluation of capitellar osteochondritis dissecans. • 3D MRI-CT fusion images enabled the accurate prediction of lesions and provided a detailed evaluation of lesion severity by presenting the exact positional relationship between the articular cartilage and subchondral bone.