Section of Interventional Radiology, Division of Diagnostic Radiology, University of Texas, M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Spine (Phila Pa 1976). 2010 May 1;35(10):1095-9. doi: 10.1097/BRS.0b013e3181bc39c6.
Retrospective review.
To report our early clinical experience using C-arm cone beam computed tomography (C-arm CBCT) with fluoroscopic overlay for needle guidance during vertebroplasty.
C-arm CBCT is advanced three-dimensional (3-D) imaging technology that is currently available on state-of-the-art flat panel based angiography systems. The imaging information provided by C-arm CBCT allows for the acquisition and reconstruction of "CT-like" images in flat panel based angiography/interventional suites. As part of the evolution of this technology, enhancements allowing the overlay of cross-sectional imaging information can now be integrated with real time fluoroscopy. We report our early clinical experience with C-arm CBCT with fluoroscopic overlay for needle guidance during vertebroplasty.
This is a retrospective review of 10 consecutive oncology patients who underwent vertebroplasty of 13 vertebral levels using C-arm CBCT with fluoroscopic overlay for needle guidance from November 2007 to December 2008. Procedural data including vertebral level, approach (transpedicular vs. extrapedicular), access (bilateral vs. unilateral) and complications were recorded. Technical success with the overlay technology was assessed based on accuracy which consisted of 4 measured parameters: distance from target to needle tip, distance from planned path to needle tip, distance from midline to needle tip, and distance from the anterior 1/3 of the vertebral body to needle tip. Success within each parameter required that the distance between the needle tip and parameter being evaluated be no more than 5 mm on multiplanar CBCT or fluoroscopy.
Imaging data for 12 vertebral levels was available for review. All vertebral levels were treated using unilateral access and 9 levels were treated with an extrapedicular approach. Technical success rates were 92% for both distance from planned path and distance from midline to final needle tip, 100% when distance from needle tip to the anterior 1/3 border of the vertebral body was measured, and 75% when distance from target to needle tip was measured. There were no major complications. Minor complications consisted of 3 cases (25%) of cement extravasation.
C-arm CBCT with needle path overlay for fluoroscopic guided vertebroplasty is feasible and allows for reliable unilateral therapy of both lumbar and thoracic vertebral bodies. Extrapedicular approaches were performed safely and with good accuracy of reaching the targets.
回顾性研究。
报告我们使用 C 臂锥形束 CT（C 臂 CBCT）结合透视叠加引导椎体成形术中穿刺针的早期临床经验。
C 臂 CBCT 是一种先进的三维（3-D）成像技术，目前已应用于最先进的平板式血管造影系统。C 臂 CBCT 提供的成像信息允许在平板式血管造影/介入套件中采集和重建“CT 样”图像。作为这项技术发展的一部分，现在可以将允许叠加横截面成像信息的增强功能与实时透视叠加结合使用。我们报告使用 C 臂 CBCT 结合透视叠加引导椎体成形术中穿刺针的早期临床经验。
这是 2007 年 11 月至 2008 年 12 月期间连续 10 例接受椎体成形术的肿瘤患者的回顾性研究，共涉及 13 个椎体水平。记录了手术数据，包括椎体水平、入路（经皮与经皮外）、入路（双侧与单侧）和并发症。根据准确性评估叠加技术的技术成功率，准确性包括 4 个测量参数：目标到针尖的距离、计划路径到针尖的距离、从中线到针尖的距离和从前 1/3 椎体到针尖的距离。在多平面 CBCT 或透视叠加中，针尖与评估参数之间的距离不超过 5mm 时，认为参数满足要求。
可用于评估的 12 个椎体水平的成像数据。所有椎体水平均采用单侧入路治疗，9 个水平采用经皮外入路治疗。距离计划路径和从中线到最终针尖的技术成功率分别为 92%和 100%，测量针尖到椎体前 1/3 边界的距离时技术成功率为 100%，测量目标到针尖的距离时技术成功率为 75%。没有主要并发症。次要并发症包括 3 例（25%）骨水泥外渗。
C 臂 CBCT 结合透视叠加引导椎体成形术是可行的，可实现腰椎和胸椎椎体单侧可靠治疗。经皮外入路安全且准确地到达目标。
