C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis
C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis
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DOI：
10.1007/s00234-011-0866-y
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发表时间：
2012-03-01
期刊：
影响因子：
2.8
通讯作者：
Taschner, Christian A.
中科院分区：
文献类型：
--
作者：
Leschka, Simon C.;Babic, Drazenko;Taschner, Christian A.
本研究的目的是报告我们在脊柱和骨盆经皮穿刺手术中使用C形臂锥形束计算机断层扫描（带荧光透视覆盖）进行图像引导的早期临床经验。（4名女性和8名男性患者;平均年龄，64岁;范围，47-74岁; SD +/- 7.6岁），因疑似转移（n = 12）、脊椎炎（n = 6），前瞻性纳入2009年3月至2010年11月期间的脓肿（n = 5）或骨肿瘤（n = 1）。在Allura Xper FD 20/20（Philips，Best，the Netherlands）上使用锥形束计算机断层扫描（XperCT）进行手术，C形臂结合荧光透视覆盖进行穿刺引导。基于初始XperCT，使用专用引导软件（XperGuide）定义进入点和靶点。在各种重建平面中可视化针路径，并在必要时进行调整。对于经皮介入，C形臂系统可自动引导进入视图（以靶心方式覆盖进入点和目标点）、进展视图（垂直于进入视图）以及两个附加视图。活检引导装置（Seestar，Radi，Uppsala，Sweden）支持穿刺针导航。通过第二次XperCT采集确认了正确的针定位。技术成功定义为通过计划的针轨迹到达任何靶点，且最终针尖在任何方向上距离计划靶点的距离在5 mm以内。在所有12例患者中，靶区域均可以基于XperCT数据定义。在12例病例中的11例（92%）中，在计划轨迹上成功到达靶点，平均误差为2.8 mm（范围，0.5-9.4 mm; SD，2.4 mm）。没有发生术中或介入后并发症。XperCT引导下的XperGuide系统介入似乎是脊柱和骨盆经皮穿刺介入的安全可靠工具。与CT或透视引导的介入相比，该技术的优势需要在更大规模的比较研究中确定。
The aim of this study is to report our early clinical experience using C-arm cone beam computed tomography with fluoroscopic overlay for image guidance during percutaneous needle procedures of the spine and pelvis.Twelve consecutive patients (four female and eight male patients; mean age, 64 years; range, 47-74 years; SD +/- 7.6 years) who underwent percutaneous biopsy of the spine and pelvis for suspected metastasis (n = 12), spondylodiscitis (n = 6), abscess (n = 5) or bone tumour (n = 1) were prospectively included between March 2009 and November 2010. The procedures were performed on the Allura Xper FD20/20 (Philips, Best, the Netherlands) using cone beam computed tomography (XperCT) with the C-arm combined with fluoroscopic overlay for needle guidance. Based on an initial XperCT, entry and target points were defined using dedicated guidance software (XperGuide). The needle path was visualised in various reconstructed planes and could be adjusted when considered necessary. For percutaneous interventions, the entry view (overlay of entry and target point in the bull's eye fashion), the progression view (perpendicular to the entry view) as well as two additional views could automatically be piloted to with the C-arm system. Needle navigation was supported by a biopsy guidance device (Seestar, Radi, Uppsala, Sweden). Correct needle positioning was confirmed with a second XperCT acquisition. Technical success was defined as any target point reached via the planned needle trajectory with a distance of final needle tip within 5 mm of the planned target point in any direction.In all 12 patients, target areas could be defined based on XperCT data. In 11 of 12 (92%) cases, the target point was successfully reached on the planned trajectory with a mean error of 2.8 mm (range, 0.5-9.4 mm; SD, 2.4 mm). No peri- or post-interventional complications occurred.XperCT-guided interventions with the XperGuide system seem a safe and reliable tool for percutaneous needle interventions of the spine and pelvis. The advantage of the technique when compared to CT- or fluoroscopy-guided interventions needs to be determined in a comparative study of a larger scale.