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Hille G, Saalfeld S, Serowy S, Tönnies K. Multi-segmental spine image registration supporting image-guided interventions of spinal metastases. Comput Biol Med 2018; 102:16-20. [PMID: 30236968 DOI: 10.1016/j.compbiomed.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/03/2018] [Accepted: 09/08/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Radiofrequency ablation was introduced recently to treat spinal metastases, which are among the most common metastases. These minimally-invasive interventions are most often image-guided by flat-panel CT scans, withholding soft tissue contrast like MR imaging. Image fusion of diagnostic MR and operative CT images could provide important and useful information during interventions. METHOD Diagnostic MR and interventional flat-panel CT scans of 19 patients, who underwent radiofrequency ablations of spinal metastases were obtained. Our presented approach piecewise rigidly registers single vertebrae using normalized gradient fields and embeds them within a fused image. Registration accuracy was determined via Euclidean distances between corresponding landmark pairs of ground truth data. RESULTS Our method resulted in an average registration error of 2.35mm. An optimal image fusion performed by landmark registrations achieved an average registration error of 1.70mm. Additionally, intra- and inter-reader variability was determined, resulting in mean distances of corresponding landmark pairs of 1.05mm (MRI) and 1.03mm (flat-panel CT) for the intra-reader variability and 1.36mm and 1.28mm for the inter-reader variability, respectively. CONCLUSIONS Our multi-segmental approach with normalized gradient fields as image similarity measure can handle spine deformations due to patient positioning and avoid time-consuming manually performed registration. Thus, our method can provide practical and applicable intervention support without significantly delaying the clinical workflow or additional workload.
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Affiliation(s)
- Georg Hille
- Department of Simulation and Graphics, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany.
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
| | - Steffen Serowy
- Department of Neuroradiology, University Hospital of Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Germany
| | - Klaus Tönnies
- Department of Simulation and Graphics, University of Magdeburg, Universitätsplatz 2, 39106, Magdeburg, Germany
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Sohn S, Kim J, Chung CK, Lee NR, Chang UK, Sohn MJ. A Nationwide Study of Stereotactic Radiosurgery in a Newly Diagnosed Spine Metastasis Population. Stereotact Funct Neurosurg 2017; 95:189-196. [DOI: 10.1159/000475764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
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van der Velden JM, Verkooijen HM, Seravalli E, Hes J, Gerlich AS, Kasperts N, Eppinga WSC, Verlaan JJ, van Vulpen M. Comparing conVEntional RadioTherapy with stereotactIC body radiotherapy in patients with spinAL metastases: study protocol for an randomized controlled trial following the cohort multiple randomized controlled trial design. BMC Cancer 2016; 16:909. [PMID: 27871280 PMCID: PMC5117527 DOI: 10.1186/s12885-016-2947-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 11/10/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Standard radiotherapy is the treatment of first choice in patients with symptomatic spinal metastases, but is only moderately effective. Stereotactic body radiation therapy is increasingly used to treat spinal metastases, without randomized evidence of superiority over standard radiotherapy. The VERTICAL study aims to quantify the effect of stereotactic radiation therapy in patients with metastatic spinal disease. METHODS/DESIGN This study follows the 'cohort multiple Randomized Controlled Trial' design. The VERTICAL study is conducted within the PRESENT cohort. In PRESENT, all patients with bone metastases referred for radiation therapy are enrolled. For each patient, clinical and patient-reported outcomes are captured at baseline and at regular intervals during follow-up. In addition, patients give informed consent to be offered experimental interventions. Within PRESENT, 110 patients are identified as a sub cohort of eligible patients (i.e. patients with unirradiated painful, mechanically stable spinal metastases who are able to undergo stereotactic radiation therapy). After a protocol amendment, also patients with non-spinal bony metastases are eligible. From the sub cohort, a random selection of patients is offered stereotactic radiation therapy (n = 55), which patients may accept or refuse. Only patients accepting stereotactic radiation therapy sign informed consent for the VERTICAL trial. Non-selected patients (n = 55) receive standard radiotherapy, and are not aware of them serving as controls. Primary endpoint is pain response after three months. Data will be analyzed by intention to treat, complemented by instrumental variable analysis in case of substantial refusal of the stereotactic radiation therapy in the intervention arm. DISCUSSION This study is designed to quantify the treatment response after (stereotactic) radiation therapy in patients with symptomatic spinal metastases. This is the first randomized study in palliative care following the cohort multiple Randomized Controlled Trial design. This design addresses common difficulties associated with classic pragmatic randomized controlled trials, such as disappointment bias in patients allocated to the control arm, slow recruitment, and poor generalizability. TRIAL REGISTRATION The Netherlands Trials Register number NL49316.041.14. ClinicalTrials.gov registration number NCT02364115 . Date of trial registration February 1, 2015.
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Affiliation(s)
- Joanne M van der Velden
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Helena M Verkooijen
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jochem Hes
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A Sophie Gerlich
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Nicolien Kasperts
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Wietse S C Eppinga
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jorrit-Jan Verlaan
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Toussaint A, Richter A, Mantel F, Flickinger JC, Grills IS, Tyagi N, Sahgal A, Letourneau D, Sheehan JP, Schlesinger DJ, Gerszten PC, Guckenberger M. Variability in spine radiosurgery treatment planning - results of an international multi-institutional study. Radiat Oncol 2016; 11:57. [PMID: 27089966 PMCID: PMC4835862 DOI: 10.1186/s13014-016-0631-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 04/09/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this study was to quantify the variability in spinal radiosurgery (SRS) planning practices between five international institutions, all member of the Elekta Spine Radiosurgery Research Consortium. METHODS Four institutions provided one representative patient case each consisting of the medical history, CT and MR imaging. A step-wise planning approach was used where, after each planning step a consensus was generated that formed the basis for the next planning step. This allowed independent analysis of all planning steps of CT-MR image registration, GTV definition, CTV definition, PTV definition and SRS treatment planning. In addition, each institution generated one additional SRS plan for each case based on intra-institutional image registration and contouring, independent of consensus results. RESULTS Averaged over the four cases, image registration variability ranged between translational 1.1 mm and 2.4 mm and rotational 1.1° and 2.0° in all three directions. GTV delineation variability was 1.5 mm in axial and 1.6 mm in longitudinal direction averaged for the four cases. CTV delineation variability was 0.8 mm in axial and 1.2 mm in longitudinal direction. CTV-to-PTV margins ranged between 0 mm and 2 mm according to institutional protocol. Delineation variability was 1 mm in axial directions for the spinal cord. Average PTV coverage for a single fraction18 Gy prescription was 87 ± 5 %; Dmin to the PTV was 7.5 ± 1.8 Gy averaged over all cases and institutions. Average Dmax to the PRV_SC (spinal cord + 1 mm) was 10.5 ± 1.6 Gy and the average Paddick conformity index was 0.69 ± 0.06. CONCLUSIONS Results of this study reflect the variability in current practice of spine radiosurgery in large and highly experienced academic centers. Despite close methodical agreement in the daily workflow, clinically significant variability in all steps of the treatment planning process was demonstrated. This may translate into differences in patient clinical outcome and highlights the need for consensus and established delineation and planning criteria.
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Affiliation(s)
- André Toussaint
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Anne Richter
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Frederick Mantel
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - John C. Flickinger
- />Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | - Arjun Sahgal
- />Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON Canada
| | | | - Jason P. Sheehan
- />University of Virginia School of Medicine, Charlottesville, VA USA
| | | | - Peter Carlos Gerszten
- />Departments of Neurological Surgery and Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Matthias Guckenberger
- />Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
- />Division of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Hlubek RJ, Theodore N, Chang SW. CT/MRI Fusion for Vascular Mapping and Navigated Resection of a Paraspinal Tumor. World Neurosurg 2016; 89:732.e7-732.e12. [PMID: 26893041 DOI: 10.1016/j.wneu.2016.01.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/20/2016] [Accepted: 01/22/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Computed tomography/magnetic resonance imaging (CT/MRI) fusion is used increasingly in the surgical treatment of cranial pathology. The merging of these complementary modalities provides excellent visualization of the bony anatomy and clear delineation of the soft tissues, including neurovascular structures. To our knowledge, the application of CT/MRI fusion for the surgical management of spinal pathology has not been reported previously. CASE DESCRIPTION A 70-year-old woman presented with a paraspinal tumor that originated from the right psoas muscle and extended into the lumbar neuroforamina, with intricate involvement of the lumbar plexus and retroperitoneal vasculature. CT/MRI fusion was used to map out the vessels surrounding the tumor and for intraoperative navigation during resection of this invasive paraspinal tumor. CONCLUSIONS This case highlights both the feasibility and the advantages of applying CT/MRI fusion technology to the surgical treatment of spinal pathology.
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Affiliation(s)
- Randall J Hlubek
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Steve W Chang
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Sohn S, Chung CK, Sohn MJ, Kim SH, Kim J, Park E. Radiosurgery Compared with External Radiation Therapy as a Primary Treatment in Spine Metastasis from Hepatocellular Carcinoma : A Multicenter, Matched-Pair Study. J Korean Neurosurg Soc 2016; 59:37-43. [PMID: 26885284 PMCID: PMC4754585 DOI: 10.3340/jkns.2016.59.1.37] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/05/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022] Open
Abstract
Objective The aim of this multicenter, matched-pair study was to compare the outcomes of stereotactic radiosurgery (SRS) and conventional external radiation therapy (RT) when used as a primary treatment in spine metastasis from hepatocellular carcinoma (HCC). Methods From 2005 to 2012, 28 patients underwent SRS as the primary treatment in spine metastasis from HCC. Based on sex, age, number of spine metastasis, Child-Pugh classification, interval from original tumor to spine metastasis, and year of treatment, 28 patients who underwent RT were paired. Outcomes of interest were pain relief, progression free survival, toxicities, and further treatment. Results The perioperative visual analog scale (VAS) decrease was larger in SRS group than in RT group, but the difference was not significant (3.7 vs. 2.8, p=0.13). When pain medication was adjusted, the number of patients with complete (n=6 vs.3) or partial (n=12 vs.13) relief was larger in SRS group than in RT group; however, the difference was not significant (p=0.83). There was no significant difference in progression free survival (p=0.48). In SRS group, 32.1% of patients had 1 or more toxicities whereas the percentage in RT group was 63.0%, a significant difference (p=0.04). Six SRS patients and 7 RT patients received further intervention at the treated segment. Conclusion Clinical and radiological outcome were not significantly different between the two treatments. Toxicities, however, were more prevalent in the RT group.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Moon Jun Sohn
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jinhee Kim
- Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - Eunjung Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
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Sohn S, Chung CK, Sohn MJ, Chang UK, Kim SH, Kim J, Park E. Stereotactic radiosurgery compared with external radiation therapy as a primary treatment in spine metastasis from renal cell carcinoma: a multicenter, matched-pair study. J Neurooncol 2014; 119:121-8. [PMID: 24792488 DOI: 10.1007/s11060-014-1455-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
Abstract
The aim of this multicenter, matched- pair study was to compare the outcome of stereotactic radiosurgery (SRS) with that of external radiation therapy (RT) when used as a primary treatment in spine metastasis from renal cell carcinoma (RCC). From 2005 to 2012, 13 patients underwent SRS as a primary treatment in spine metastasis from RCC. Thirteen patients who underwent RT as the primary treatment of RCC spine metastasis were paired with the SRS patients based on age, number of spine metastasis, time interval from original tumor diagnosis to spine metastasis, Eastern Cooperative Oncology Group status, and year of treatment. The primary outcomes of interest were pain relief and progression free survival. Secondary outcomes were treatment toxicities and need for further treatment. The perioperative VAS score decrease was larger in the SRS group than that in the RT group (P = 0.04). More SRS patients had complete or partial pain relief although the difference was not significant. There was a significant difference in progression free survival between the two groups (P = 0.01). The percentage of patients with toxicities was 38.5 % (5/13) in the SRS group and 53.9 % (7/13) in the RT group, but the difference was not significant. There were 2 SRS patients and 3 RT patients who received further intervention at the index segment. This study showed that, when performed as a primary treatment in spine metastasis from RCC, SRS provides relatively better pain relief and better local control than that obtained from RT.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul, 110-744, Korea
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Masucci GL, Yu E, Ma L, Chang EL, Letourneau D, Lo S, Leung E, Chao S, Hyde D, Gorgulho A, Muacevic A, Larson DA, Fehlings MG, Sahgal A. Stereotactic body radiotherapy is an effective treatment in reirradiating spinal metastases: current status and practical considerations for safe practice. Expert Rev Anticancer Ther 2014; 11:1923-33. [DOI: 10.1586/era.11.169] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Miles B, Ayed IB, Law MWK, Garvin G, Fenster A, Shuo Li. Spine Image Fusion Via Graph Cuts. IEEE Trans Biomed Eng 2013; 60:1841-50. [DOI: 10.1109/tbme.2013.2243448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Hueng DY, Tsai CL, Hsu SW, Ma HI. Publication patterns of comparative effectiveness research in spine neurosurgery. Neurosurg Focus 2013; 33:E9. [PMID: 22746241 DOI: 10.3171/2012.5.focus1292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECT The purpose of this study was to investigate publication patterns for comparative effectiveness research (CER) on spine neurosurgery. METHODS The authors searched the PubMed database for the period 1980-2012 using the key words "cost analysis," "utility analysis," "cost-utility," "outcomes research," "practical clinical research," "comparator trial," and "comparative effectiveness research," linked with "effectiveness" and "spine neurosurgery." RESULTS From 1980 through April 9, 2012, neurosurgery CER publications accounted for 1.38% of worldwide CER publications (8657 of 626,330 articles). Spine neurosurgery CER accounted for only 0.02%, with 132 articles. The journal with the greatest number of publications on spine neurosurgery CER was Spine, followed by the Journal of Neurosurgery: Spine. The average annual publication rate for spine neurosurgery CER during this period was 4 articles (132 articles in 33 years), with 68 (51.52%) of the 132 articles being published within the past 5 years and a rising trend beginning in 2008. The top 3 contributing countries were the US, Turkey, and Japan, with 68, 8, and 7 articles, respectively. Only 8 regular articles (6.06%) focused on cost analysis. CONCLUSIONS There is a paucity of publications using CER methodology in spine neurosurgery. Few articles address the issue of cost analysis. The promotion of continuing medical education in CER methodology is warranted. Further investigations to address cost analysis in comparative effectiveness studies of spine neurosurgery are crucial to expand the application of CER in public health.
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Affiliation(s)
- Dueng-Yuan Hueng
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Hwang YJ, Sohn MJ, Lee BH, Kim SY, Seo JW, Han YH, Lee JY, Cha SJ, Kim YH. Radiosurgery for metastatic spinal tumors: follow-up MR findings. AJNR Am J Neuroradiol 2011; 33:382-7. [PMID: 22033723 DOI: 10.3174/ajnr.a2760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging is the primary tool for evaluation and monitoring of spinal tumors. We retrospectively analyzed the MR imaging findings before and after SRS for metastatic spinal tumors. MATERIALS AND METHODS We reviewed MR imaging findings on 79 metastatic spinal tumor lesions in 44 patients (29 male and 15 female)who had undergone radiosurgery between November 2003 and April 2008. Posttreatment MR imaging was evaluated retrospectively for 3 aspects: 1) changes in tumor volume; 2) changes in T2 signal intensity;and 3) changes in contrast enhancement patterns. RESULTS With regard to tumor volume on MR images, 32 lesions(40.5%) decreased in volume (group 1), 39 (49.4%) showed no change (group 2), and 8 (10.1%) increased in volume (group 3). T2 signal intensities were unchanged in 4 lesions (type 1), homogeneously increased in 3 (type 2), and changed to a homogeneously dark signal in 4 (type 4). The T2 signal intensity was increased and inter mixed with dark signal intensity (type 3) in 68 lesions. A decrease in contrast enhancement with or without non-enhancing foci was seen in 73 lesions. A persistent homogeneous enhancement pattern was seen in all 4 of the type 1 lesions, in 1 of the 3 type 2 lesions, and in 1 of the 68 type 3 lesions. CONCLUSIONS Main MR imaging features of locally controlled metastatic spinal tumors included no increase in tumor volume, increased T2 signal intensity with intermixed T2 dark signal intensity,and decreased contrast enhancement. Follow-up MR imaging also provided several patterns of tumor recurrence [corrected].
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Affiliation(s)
- Y J Hwang
- Department of Radiology, Inje University Ilsan Paik Hospital, College of Medicine, Goyang-si, Gyenggi-do, Republic of Korea.
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Dahele M, Zindler JD, Sanchez E, Verbakel WF, Kuijer JPA, Slotman BJ, Senan S. Imaging for Stereotactic Spine Radiotherapy: Clinical Considerations. Int J Radiat Oncol Biol Phys 2011; 81:321-30. [PMID: 21664062 DOI: 10.1016/j.ijrobp.2011.04.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 04/03/2011] [Accepted: 04/19/2011] [Indexed: 11/16/2022]
Affiliation(s)
- Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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MR/CT image fusion of the spine after spondylodesis: a feasibility study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:1771-5. [PMID: 20473623 DOI: 10.1007/s00586-010-1430-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 04/22/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
Abstract
The objective of this study is to evaluate feasibility, accuracy and time requirements of MR/CT image fusion of the lumbar spine after spondylodesis. Sagittal MR and CT images derived from standard imaging protocols (sagittal T2-weighted MR/sagittal reformatted multi-planar-reformation of the CT) of the lumbar spine with correct (n = 5) and incorrect (n = 5) implant position were fused by two readers (R1, R2) using OsiriX in two sessions placing one (session 1) or two (session 2) reference point(s) on the dorsal tip(s) of the cranial and caudal endplates from the second lumbar to the first sacral vertebra. R1 was an experienced musculoskeletal radiologist; R2 a spine surgeon, both had received a short training on the software tool. Fusion times and fusion accuracy, defined as the largest deviation between MR and CT in the median sagittal plane on the ventral tip of the cranial end plate of the most cranial vertebra visible on the CT, were measured in both sessions. Correct or incorrect implant position was evaluated upon the fused images for all patients by an experienced senior staff musculoskeletal radiologist. Mean fusion time (session 1/session 2; in seconds) was 100.4/95 (R1) and 104.2/119.8 (R2). Mean fusion deviation (session 1/session 2; in mm) was 1.24/2.20 (R1) and 0.79/1.62 (R2). The correct/incorrect implant position was identified correctly in all cases. In conclusion, MR/CT image fusion of the spine with metallic implants is feasible, fast, accurate and easy to implement in daily routine work.
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