Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands.
Cardiovasc Intervent Radiol. 2013 Aug;36(4):1120-6. doi: 10.1007/s00270-013-0598-y. Epub 2013 Mar 20.
To investigate the accuracy, procedure time, fluoroscopy time, and dose area product (DAP) of needle placement during percutaneous vertebroplasty (PVP) using cone-beam computed tomography (CBCT) guidance versus fluoroscopy.
On 4 spine phantoms with 11 vertebrae (Th7-L5), 4 interventional radiologists (2 experienced with CBCT guidance and two inexperienced) punctured all vertebrae in a bipedicular fashion. Each side was randomization to either CBCT guidance or fluoroscopy. CBCT guidance is a sophisticated needle guidance technique using CBCT, navigation software, and real-time fluoroscopy. The placement of the needle had to be to a specific target point. After the procedure, CBCT was performed to determine the accuracy, procedure time, fluoroscopy time, and DAP. Analysis of the difference between methods and experience level was performed.
Mean accuracy using CBCT guidance (2.61 mm) was significantly better compared with fluoroscopy (5.86 mm) (p < 0.0001). Procedure time was in favor of fluoroscopy (7.39 vs. 10.13 min; p = 0.001). Fluoroscopy time during CBCT guidance was lower, but this difference is not significant (71.3 vs. 95.8 s; p = 0.056). DAP values for CBCT guidance and fluoroscopy were 514 and 174 mGy cm(2), respectively (p < 0.0001). There was a significant difference in favor of experienced CBCT guidance users regarding accuracy for both methods, procedure time of CBCT guidance, and added DAP values for fluoroscopy.
CBCT guidance allows users to perform PVP more accurately at the cost of higher patient dose and longer procedure time. Because procedural complications (e.g., cement leakage) are related to the accuracy of the needle placement, improvements in accuracy are clinically relevant. Training in CBCT guidance is essential to achieve greater accuracy and decrease procedure time/dose values.
研究使用锥形束 CT（CBCT）引导与透视引导经皮椎体后凸成形术（PVP）时，在针的放置准确性、手术时间、透视时间和剂量面积乘积（DAP）方面的差异。
在 4 个脊柱模型（T7-L5）的 11 个椎体上，4 名介入放射科医生（2 名有 CBCT 引导经验，2 名无经验）以双侧入路穿刺所有椎体。每侧随机分为 CBCT 引导或透视引导。CBCT 引导是一种使用 CBCT、导航软件和实时透视的复杂的针引导技术。针尖必须到达特定的目标点。操作完成后，行 CBCT 检查以确定准确性、手术时间、透视时间和 DAP。分析方法和经验水平之间的差异。
使用 CBCT 引导的平均准确性（2.61mm）明显优于透视引导（5.86mm）（p<0.0001）。手术时间有利于透视引导（7.39 与 10.13 分钟；p=0.001）。透视引导下的透视时间虽然较低，但差异无统计学意义（71.3 与 95.8 秒；p=0.056）。CBCT 引导和透视引导的 DAP 值分别为 514 和 174mGy cm(2)（p<0.0001）。在两种方法的准确性、CBCT 引导的手术时间和透视的附加 DAP 值方面，有经验的 CBCT 引导使用者都有明显的优势。
CBCT 引导可提高 PVP 的准确性，但患者剂量和手术时间增加。由于手术并发症（如水泥渗漏）与针尖放置的准确性有关，因此准确性的提高在临床上具有重要意义。进行 CBCT 引导的培训对于获得更高的准确性和降低手术时间/剂量值至关重要。
