title: Interventional spinal procedures guided and controlled by a 3D rotational angiographic unit.
abstract: OBJECTIVE
  The aim of this paper is to demonstrate the usefulness of 2D multiplanar reformatting images (MPR) obtained from rotational acquisitions with cone-beam computed tomography technology during percutaneous extra-vascular spinal procedures performed in the angiography suite.
  
  
  METHODS
  We used a 3D rotational angiographic unit with a flat panel detector. MPR images were obtained from a rotational acquisition of 8 s (240 images at 30 fps), tube rotation of 180° and after post-processing of 5 s by a local work-station. Multislice CT (MSCT) is the best guidance system for spinal approaches permitting direct tomographic visualization of each spinal structure. Many operators, however, are trained with fluoroscopy, it is less expensive, allows real-time guidance, and in many centers the angiography suite is more frequently available for percutaneous procedures. We present our 6-year experience in fluoroscopy-guided spinal procedures, which were performed under different conditions using MPR images. We illustrate cases of vertebroplasty, epidural injections, selective foraminal nerve root block, facet block, percutaneous treatment of disc herniation and spine biopsy, all performed with the help of MPR images for guidance and control in the event of difficult or anatomically complex access.
  
  
  CONCLUSIONS
  The integrated use of "CT-like" MPR images allows the execution of spinal procedures under fluoroscopy guidance alone in all cases of dorso-lumbar access, with evident limitation of risks and complications, and without need for recourse to MSCT guidance, thus eliminating CT-room time (often bearing high diagnostic charges), and avoiding organizational problems for procedures that need, for example, combined use of a C-arm in the CT room.
authors.affiliation: Department of Bioimaging and Radiological Sciences, Catholic University of Rome, A.Gemelli Hospital, L.go Vito 1, 00168 Rome, Italy. apedicelli@rm.unicatt.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pedicelli
authors.forename: Tommaso
authors.initials: T
authors.lastname: Verdolotti
authors.forename: Angelo
authors.initials: A
authors.lastname: Pompucci
authors.forename: Flora
authors.initials: F
authors.lastname: Desiderio
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Argento
authors.forename: Cesare
authors.initials: C
authors.lastname: Colosimo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
mesh_terms: D000792:Angiography / Q000295:instrumentation*; D001707:Biopsy, Needle / Q000379:methods; D005471:Fluoroscopy; D006801:Humans; D021621:Imaging, Three-Dimensional; D007268:Injections, Epidural / Q000379:methods; D007405:Intervertebral Disc Displacement / Q000628:therapy; D009407:Nerve Block / Q000379:methods; D015641:Radiography, Interventional; D013122:Spinal Diseases / Q000473:pathology / Q000628:therapy*; D013131:Spine / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods