Image quality assessment in spine surgery: a comparison of intraoperative CBCT and postoperative MDCT

To evaluate if intraoperative cone-beam CT (CBCT) provides equivalent image quality to postoperative multidetector CT (MDCT) in spine surgery, potentially eliminating unnecessary imaging and cumulative radiation exposure.

Twenty-seven patients (16 men, 11 women; median age 39 years) treated with spinal fixation surgery were evaluated using intraoperative CBCT and postoperative MDCT. The images were independently evaluated by four neuroradiologists, utilizing a five-step Likert scale and visual grading characteristics (VGC) analysis. The area under the VGC curve (AUC_VGC) quantified preferences between modalities. Intra- and inter-observer variability was evaluated using intraclass correlation coefficients (ICC). Image quality was objectively evaluated by contrast and signal-to-noise measurements (CNR, SNR).

In image quality, CBCT was the preferred modality in thoracolumbar spine (AUC_VGC = 0.58, p < 0.001). Conversely, MDCT was preferred in cervical spine (AUC_VGC = 0.38, p < 0.004). The agreement was good for inter-observer and moderate in intra-observer (ICC 0.76-0.77 vs 0.60-0.71), p < 0.001. SNR and CNR were comparable in thoracolumbar imaging, while MDCT provided superior and more consistent image quality in the cervical spine, p < 0.001.

In spine surgery, CBCT provides superior image quality for thoracolumbar imaging, while MDCT performs better for cervical imaging. Intraoperative CBCT could potentially replace postoperative MDCT in thoracolumbar spine procedures, while postoperative MDCT remains essential for cervical spine assessment.

Subjective assessment demonstrated that CBCT was the preferred modality for thoracolumbar spine imaging, while MDCT was favored for cervical spine imaging. Agreement between readers was good, while individual readings showed moderate consistency in repeated assessments. Objective assessment of image clarity and detail showed both modalities performed equally well in the thoracolumbar spine, while MDCT performed better in the cervical spine. Intraoperative CBCT proves superior to postoperative MDCT for thoracolumbar spine imaging, potentially eliminating redundant scans, and improving workflow. Postoperative MDCT remains essential for cervical spine procedures.