Abstract
We used our novel three-dimensional magnetic resonance imaging-computed tomography fusion images (3D MRI-CT fusion images; MCFIs) for detailed preoperative lesion evaluation and surgical simulation in osteochondritis dissecans (OCD) of the elbow. Herein, we introduce our procedure and report the findings of the assessment of its utility. We enrolled 16 men (mean age: 14.0 years) and performed preoperative MRI using 7 kg axial traction with a 3-Tesla imager and CT. Three-dimensional-MRI models of the humerus and articular cartilage and a 3D-CT model of the humerus were constructed. We created MCFIs using both models. We validated the findings obtained from the MCFIs and intraoperative findings using the following items: articular cartilage fissures and defects, articular surface deformities, vertical and horizontal lesion diameters, the International Cartilage Repair Society (ICRS) classification, and surgical procedures. The MCFIs accurately reproduced the lesions and correctly matched the ICRS classification in 93.5% of cases. Surgery was performed as simulated in all cases. Preoperatively measured lesion diameters exhibited no significant differences compared to the intraoperative measurements. MCFIs were useful in the evaluation of OCD lesions and detailed preoperative surgical simulation through accurate reproduction of 3D structural details of the lesions.
Highlights
Osteochondritis dissecans of the elbow (OCD) is a rare intra-articular osteochondral lesion that is associated with overhead throwing sports [1,2,3,4,5]
We developed and recently reported a method to create 3D magnetic resonance imaging (MRI)-computed tomography (CT) fusion images (MCFIs) of the osteochondritis dissecans (OCD) lesions [28]
We introduce the use of MCFIs as a method of OCD lesion evaluation and surgical simulation for OCD lesions and report the findings of the assessment of the clinical applicability of the computer-aided technique
Summary
Osteochondritis dissecans of the elbow (OCD) is a rare intra-articular osteochondral lesion that is associated with overhead throwing sports [1,2,3,4,5]. The subchondral bone and articular cartilage of the humeral capitellum are affected, and several possible causes, including repetitive microtrauma and genetic factors, are implicated [3,4,6,7]. The stability and size of the lesion are considered important factors impacting lesion severity [6,8,9,10], no single imaging modality can adequately predict lesion severity [11,12,13,14,15,16,17], thereby presenting a challenge to elbow surgeons. A recent study by Pu et al concluded that a combination of radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can most accurately determine OCD lesion stability by compensating for the respective flaws of the individual modalities [18]. MRA alone cannot accurately evaluate the conditions of subchondral bone lesions such as sclerosis
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