C-Arm Cone Beam Computed Tomography Needle Path Overlay for Fluoroscopic Guided Vertebroplasty

Study Design. Retrospective review. Objective. To report our early clinical experience using C-arm cone beam computed tomography (C-arm CBCT) with fluoroscopic overlay for needle guidance during vertebroplasty. Summary of Background Data. 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. Methods. 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. Results. 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. Conclusion. 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.

[1]  Hesham Morsi,et al.  Angiographic CT in cerebrovascular stenting. , 2005, AJNR. American journal of neuroradiology.

[2]  Aravind Arepally,et al.  Adjunctive use of C-arm CT may eliminate technical failure in adrenal vein sampling. , 2007, Journal of vascular and interventional radiology : JVIR.

[3]  D. Kallmes,et al.  Unilateral transpedicular percutaneous vertebroplasty: initial experience. , 2002, Radiology.

[4]  A. Berenstein,et al.  The utility of DynaCT in neuroendovascular procedures. , 2006, AJNR. American journal of neuroradiology.

[5]  Drazenko Babic,et al.  Live 3D guidance in the interventional radiology suite. , 2007, AJR. American journal of roentgenology.

[6]  Sang-Ho Lee,et al.  Unipedicular Vertebroplasty for Osteoporotic Compression Fracture Using an Individualized Needle Insertion Angle , 2007, The Clinical journal of pain.

[7]  Marie-Odile Berger,et al.  Model of a Vascular C-Arm for 3D Augmented Fluoroscopy in Interventional Radiology , 2005, MICCAI.

[8]  Y.S. Chung,et al.  Extrapedicular approach of percutaneous vertebroplasty in the treatment of upper and mid‐thoracic vertebral compression fracture , 2005, Acta radiologica.

[9]  Thomas Albrecht,et al.  Contrast-Enhanced Abdominal Angiographic CT for Intra-abdominal Tumor Embolization: A New Tool for Vessel and Soft Tissue Visualization , 2007, CardioVascular and Interventional Radiology.

[10]  Marcus Pfister,et al.  C-arm Cone Beam Computed Tomographic Needle Path Overlay for Fluoroscopic-Guided Placement of Translumbar Central Venous Catheters , 2009, CardioVascular and Interventional Radiology.

[11]  Ravi Murthy,et al.  Impact of C-arm CT on hepatic arterial interventions for hepatic malignancies. , 2007, Journal of vascular and interventional radiology : JVIR.

[12]  Andrew C Larson,et al.  Effect of C-arm angiographic CT on transcatheter arterial chemoembolization of liver tumors. , 2007, Journal of vascular and interventional radiology : JVIR.

[14]  David F Kallmes,et al.  Vertebroplasty in the mid- and upper thoracic spine. , 2002, AJNR. American journal of neuroradiology.

[15]  Michael Söderman,et al.  3D roadmap in neuroangiography: technique and clinical interest , 2005, Neuroradiology.