C-arm fluoroscopic cone beam CT for guidance of minimally invasive spine interventions.
BACKGROUND
Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for near real time 3-D volume imaging guidance of percutaneous interventional procedures. In combination with digital flat panel detectors, CBCT has high spatial resolution with isotropic voxel size, allowing for high resolution image reconstruction in any plane, including 3D rotational reconstructions. CBCT combines the advantages of conventional CT imaging guidance with the improved spatial resolution, patient positioning, and access of fluoroscopy.


OBJECTIVE
The aim of this study is to demonstrate the advantages of CBCT over conventional CT and biplane fluoroscopy for imaging guidance of minimally invasive spinal and paraspinal interventional procedures.


METHODS
Five patients referred to the department of interventional neuroradiology for percutaneous spinal or paraspinal interventional procedures were intraoperatively evaluated with CBCT to assist in guidance of instrumentation placement. Procedures included transoral cervical vertebral biopsy, percutaneous thoracic vertebral biopsy, vertebroplasty, pelvic paraspinal/epidural abscess drainage, and paraspinal fiducial marker placement for treatment of osteoid osteoma.


RESULTS
All procedures were successfully performed with satisfactory diagnostic yield or therapeutic effect without procedure-related complications.


CONCLUSIONS
Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for 3D volume imaging guidance of interventional procedures of the spine with the capability to produce near real time high resolution image reconstructions in any plane. Compared to conventional CT and biplane fluoroscopy, CBCT offers improved anatomic visualization allowing high accuracy instrumentation placement, improving procedure results and minimizing risk of complications.
Powell
Michael F
MF
Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. mpowell1@bidmc.harvard.edu
DiNobile
Diane
D
Reddy
Arra S
AS
D000368:Aged; D001706:Biopsy / Q000295:instrumentation / Q000379:methods; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D020802:Epidural Abscess / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D010017:Osteoma, Osteoid / Q000000981:diagnostic imaging / Q000532:radiotherapy; D011183:Postoperative Complications / Q000517:prevention & control; D011237:Predictive Value of Tests; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome