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Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit
Alessandro Pedicelli1, Tommaso Verdolotti, Angelo Pompucci
1Department of Bioimaging and Radiological Sciences, Catholic University of Rome, A.Gemelli Hospital, L.go Vito 1, 00168 Rome, Italy. apedicelli@rm.unicatt.it
Skeletal Radiology
|October 4, 2011
Summary
Two-dimensional multiplanar reformatting (MPR) images from rotational cone-beam CT angiography improve fluoroscopy-guided spinal procedures. This technique enhances safety and efficiency, reducing the need for multi-slice CT guidance.
Area of Science:
- Interventional Radiology
- Medical Imaging
- Neurosurgery
Background:
- Fluoroscopy is a common guidance system for spinal procedures due to cost and availability.
- Multislice CT (MSCT) offers superior visualization but can be logistically challenging.
- Percutaneous spinal interventions require precise navigation for safety and efficacy.
Purpose of the Study:
- To evaluate the utility of 2D multiplanar reformatting (MPR) images generated from rotational angiography.
- To demonstrate the effectiveness of MPR images in guiding percutaneous extra-vascular spinal procedures in an angiography suite.
- To assess if MPR images can replace or supplement traditional MSCT guidance.
Main Methods:
- Utilized a 3D rotational angiographic unit with a flat panel detector for image acquisition.
- Acquired MPR images from 8-second rotational scans (240 images at 30 fps) with post-processing.
- Applied MPR image guidance in various fluoroscopy-guided spinal procedures over a 6-year period, including vertebroplasty, epidural injections, nerve blocks, and biopsies.
Main Results:
- MPR images provided "CT-like" visualization, facilitating guidance and control during complex spinal access.
- Procedures were successfully performed using fluoroscopy guidance alone with MPR assistance.
- No need for recourse to MSCT guidance was observed in the studied cases.
Conclusions:
- Integrated use of "CT-like" MPR images enables fluoroscopy-guided spinal procedures without MSCT.
- This approach significantly limits risks and complications associated with spinal interventions.
- Eliminates CT-room time, associated charges, and organizational issues, improving procedural efficiency.
