Cewe Paulina, Skorpil Mikael, Fletcher-Sandersjöö Alexander, El-Hajj Victor Gabriel, Grane Per, Fagerlund Michael, Kaijser Magnus, Elmi-Terander Adrian, Edström Erik
Department of Trauma and Musculoskeletal Radiology, ME Trauma Radiology, Karolinska University Hospital, 171 64, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Acta Neurochir (Wien). 2025 Mar 31;167(1):94. doi: 10.1007/s00701-025-06503-w.
To evaluate if intraoperative cone-beam CT (CBCT) provides equivalent image quality to postoperative multidetector CT (MDCT) in spine surgery, potentially eliminating unnecessary imaging and cumulative radiation exposure.
Twenty-seven patients (16 men, 11 women; median age 39 years) treated with spinal fixation surgery were evaluated using intraoperative CBCT and postoperative MDCT. The images were independently evaluated by four neuroradiologists, utilizing a five-step Likert scale and visual grading characteristics (VGC) analysis. The area under the VGC curve (AUC) quantified preferences between modalities. Intra- and inter-observer variability was evaluated using intraclass correlation coefficients (ICC). Image quality was objectively evaluated by contrast and signal-to-noise measurements (CNR, SNR).
In image quality, CBCT was the preferred modality in thoracolumbar spine (AUC = 0.58, p < 0.001). Conversely, MDCT was preferred in cervical spine (AUC = 0.38, p < 0.004). The agreement was good for inter-observer and moderate in intra-observer (ICC 0.76-0.77 vs 0.60-0.71), p < 0.001. SNR and CNR were comparable in thoracolumbar imaging, while MDCT provided superior and more consistent image quality in the cervical spine, p < 0.001.
In spine surgery, CBCT provides superior image quality for thoracolumbar imaging, while MDCT performs better for cervical imaging. Intraoperative CBCT could potentially replace postoperative MDCT in thoracolumbar spine procedures, while postoperative MDCT remains essential for cervical spine assessment.
Subjective assessment demonstrated that CBCT was the preferred modality for thoracolumbar spine imaging, while MDCT was favored for cervical spine imaging. Agreement between readers was good, while individual readings showed moderate consistency in repeated assessments. Objective assessment of image clarity and detail showed both modalities performed equally well in the thoracolumbar spine, while MDCT performed better in the cervical spine. Intraoperative CBCT proves superior to postoperative MDCT for thoracolumbar spine imaging, potentially eliminating redundant scans, and improving workflow. Postoperative MDCT remains essential for cervical spine procedures.
评估术中锥形束CT（CBCT）在脊柱手术中是否能提供与术后多排螺旋CT（MDCT）相当的图像质量，从而有可能消除不必要的影像学检查及累积辐射暴露。
对27例行脊柱固定手术的患者（16例男性，11例女性；中位年龄39岁）进行术中CBCT及术后MDCT评估。图像由4名神经放射科医生独立评估，采用五分量表和视觉分级特征（VGC）分析。VGC曲线下面积（AUC）量化了不同模式之间的偏好。采用组内相关系数（ICC）评估观察者内和观察者间的变异性。通过对比度和信噪比测量（CNR、SNR）客观评估图像质量。
在图像质量方面，CBCT是胸腰椎成像的首选模式（AUC = 0.58，p < 0.001）。相反，MDCT在颈椎成像中更受青睐（AUC = 0.38，p < 0.004）。观察者间一致性良好，观察者内一致性中等（ICC 0.76 - 0.77 vs 0.60 - 0.71），p < 0.001。在胸腰椎成像中，SNR和CNR相当，而MDCT在颈椎提供了更好且更一致的图像质量，p < 0.001。
在脊柱手术中，CBCT在胸腰椎成像方面提供了更好的图像质量，而MDCT在颈椎成像方面表现更佳。术中CBCT有可能在胸腰椎手术中取代术后MDCT，而术后MDCT对颈椎评估仍然至关重要。
主观评估表明，CBCT是胸腰椎成像的首选模式，而MDCT更适合颈椎成像。读者之间的一致性良好，而个体读数在重复评估中显示出中等一致性。对图像清晰度和细节的客观评估表明，两种模式在胸腰椎成像中表现相当，而MDCT在颈椎成像中表现更好。术中CBCT在胸腰椎成像方面优于术后MDCT，有可能消除冗余扫描并改善工作流程。术后MDCT对颈椎手术仍然至关重要。
