Improving real-time ultrasound spine imaging with a large-aperture array

Ultrasound offers a safe, low-cost alternative to computed tomography (CT) and magnetic resonance imaging for spinal diagnostics and intervention by enabling real-time imaging. However, the complex structure of the spine and acoustic shadowing from bones present challenges for ultrasonography. This study addresses these limitations using an 8.8-centimeter 384-element large-aperture array and full aperture-based imaging protocols. Volumetric scanning across multiple vertebrae was accomplished in 5 seconds using ultrafast, diverging wave acquisition. In seven healthy volunteers, the large-aperture array and diverging wave transmission improved resolution, contrast, and visualization of the spinal canal, venous plexuses, and facet joints compared with conventional probes. A comparison between the coregistered CT and ultrasound scan confirmed the imaging accuracy. A simulated lumbar puncture demonstrated needle tip visualization throughout the trajectory into the spinal canal. The results suggest that large-aperture arrays, coupled with diverging wave imaging sequences, are a valuable tool for spine imaging and image-guided intervention.