Keil Fee, Schneider Robert, Polomac Nenad, Zabar Omar, Finger Tobias, Holzgreve Fabian, Czabanka Marcus, Erbe Christina, Groneberg David A, Hattingen Elke, Ohlendorf Daniela, Diaremes Panagiotis
Institute of Neuroradiology, Goethe University Hospital, 60528 Frankfurt, Germany.
Institute of Occupational, Social, Environmental Medicine, Goethe University, 60596 Frankfurt, Germany.
J Clin Med. 2024 Sep 27;13(19):5768. doi: 10.3390/jcm13195768.
Patients with scoliosis often require multiple imaging modalities. The aim of this study was to find out whether primary diagnosis, including surgical planning, could be carried out entirely without computed tomography (CT) scans and whether follow-up could be replaced with alternative methods without the use of X-rays. In order to reduce the radiation exposure in the diagnosis and treatment of severe scoliosis, we expect to replace X-rays with radiation-free or less-intensive radiation examinations. This study protocol is interdisciplinary.
A total of 50 male and female patients (children and adolescents, aged 7-18 years) treated for scoliosis will be analyzed. In addition to routine projection radiographs, preoperative CT, and/or X-ray stereoradiography (EOS) examinations, thin-slice 3D magnetic resonance imaging (MRI) sequences will be retrospectively reformatted during the preoperative MRI examination. A three-dimensional back scan (video-raster stereography) and an intraoral scan will also be obtained. The following questions should be answered at the end of the project: (1) Can MRI examination with additional thin-slice 3D reconstruction answer all relevant questions for preoperative planning instead of CT? (2) Are EOS or whole-spine X-ray examinations in combination with MRI data sufficient for the evaluation of the pedicles and spinal deformity? (3) Does the Cobb angle in the radiograph correlate with the calculations from the back scanner image and can follow-up checks be replaced? (4) Are there any correlations between dental anomalies and scoliosis?
Until now, pediatric patients with scoliosis have been diagnosed, monitored, and treated with numerous independent specialist disciplines, such as pediatricians, orthopedic surgeons, neurosurgeons, and general practitioners with different radiological issues. The aim of this project is to reduce radiation and lower perioperative risks by creating a preoperative and follow-up-related standard protocol in close interdisciplinary and targeted cooperation between all the specialist disciplines involved. In line with the holistic examination approach, the associated accompanying diseases and developmental disorders such as dental and neuronal malformations will also be examined. On the one hand, CT-based questions could be replaced with the reconstruction of thin-slice MRI sequences. In addition, it may be possible to use the three-dimensional back scan as an intermediate diagnostic procedure instead of X-rays in the monitoring of severe scoliosis. Insofar as correlations or causalities between scoliosis and occlusal anomalies, early orthodontic intervention could positively benefit the duration of therapy at a later stage.
脊柱侧弯患者通常需要多种成像方式。本研究的目的是查明能否完全不使用计算机断层扫描（CT）进行包括手术规划在内的初步诊断，以及能否用不使用X射线的替代方法取代随访。为了减少重度脊柱侧弯诊断和治疗中的辐射暴露，我们期望用无辐射或低强度辐射检查取代X射线。本研究方案具有跨学科性质。
将分析总共50例接受脊柱侧弯治疗的男性和女性患者（儿童和青少年，年龄7至18岁）。除了常规投影X线片、术前CT和/或X线立体放射摄影（EOS）检查外，术前MRI检查期间将对薄层三维磁共振成像（MRI）序列进行回顾性重新格式化。还将进行三维背部扫描（视频光栅立体摄影）和口腔内扫描。在项目结束时应回答以下问题：（1）带有额外薄层三维重建的MRI检查能否代替CT回答术前规划的所有相关问题？（2）EOS或全脊柱X线检查与MRI数据相结合是否足以评估椎弓根和脊柱畸形？（3）X线片中的Cobb角与背部扫描仪图像的计算结果是否相关，随访检查能否被取代？（4）牙齿异常与脊柱侧弯之间是否存在关联？
到目前为止，患有脊柱侧弯的儿科患者一直由众多独立的专科进行诊断、监测和治疗，例如儿科医生、骨科医生、神经外科医生以及处理不同放射学问题的全科医生。本项目的目的是通过在所有相关专科之间密切的跨学科和有针对性的合作中创建术前和随访相关的标准方案，来减少辐射并降低围手术期风险。根据整体检查方法，还将检查相关的伴随疾病和发育障碍，如牙齿和神经元畸形。一方面，基于CT的问题可以用薄层MRI序列的重建来代替。此外，在重度脊柱侧弯的监测中，有可能使用三维背部扫描作为中间诊断程序来代替X射线。就脊柱侧弯与咬合异常之间的相关性或因果关系而言，早期正畸干预可能会对后期治疗的持续时间产生积极影响。
