Post-processing of quantitative 4D-CT for initial evaluation of scapholunate Instability: Assessment of simplified approaches to data analysis.

OBJECTIVES: To evaluate the diagnostic performance of simplified post-processing approaches for quantitative wrist 4D-CT in the assessment of scapholunate instability (SLI). METHODS: A prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard. RESULTS: The SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93-0.96) compared to the standard approach (ICC values 0.65-0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes). CONCLUSION: Simpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.

Lethal head ballistic trauma with a «nonlethal¼ projectile: A case report and review of the literature.

Forensic investigations of cranioencephalic ballistic trauma involve several aspects, including the study of terminal ballistics. This includes the analysis of projectiles and the damage they cause. Although some projectiles are considered "non-lethal", serious injuries and deaths secondary to the use of this type of ammunition have been reported. We report the case of a 37-year-old man who died from ballistic head trauma after the use of "Gomm Cogne" ammunition. A post-mortem computed tomography (CT) showed a right temporal bone defect and seven foreign bodies. Three of these were located in the encephalic parenchyma, which showed diffuse hemorrhagic changes. External examination indicated that this was a contact entry wound and confirmed encephalic involvement. This case illustrates the potential lethality of this type of ammunition with CT and autopsy with similar features to single projectile firearm injuries.