scholarly journals Intraoperative cone beam computed tomography is as reliable as conventional computed tomography for identification of pedicle screw breach in thoracolumbar spine surgery

2020 ◽  
Author(s):  
Gustav Burström ◽  
Paulina Cewe ◽  
Anastasios Charalampidis ◽  
Rami Nachabe ◽  
Michael Söderman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pedicle Screw ◽  
Negative Predictive Value ◽  
Spine Surgery ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Cone Beam ◽  
Spinal Fixation

Abstract Objectives To test the hypothesis that intraoperative cone beam computed tomography (CBCT) using the Allura augmented reality surgical navigation (ARSN) system in a dedicated hybrid operating room (OR) matches computed tomography (CT) for identification of pedicle screw breach during spine surgery. Methods Twenty patients treated with spinal fixation surgery (260 screws) underwent intraoperative CBCT as well as conventional postoperative CT scans (median 12 months after surgery) to identify and grade the degree of pedicle screw breach on both scan types, according to the Gertzbein grading scale. Blinded assessments were performed by three independent spine surgeons and the CT served as the standard of reference. Screws graded as Gertzbein 0 or 1 were considered clinically accurate while grades 2 or 3 were considered inaccurate. Sensitivity, specificity, and negative predictive value were the primary metrics of diagnostic performance. Results For this patient group, the negative predictive value of an intraoperative CBCT to rule out pedicle screw breach was 99.6% (CI 97.75–99.99%). Among 10 screws graded as inaccurate on CT, 9 were graded as such on the CBCT, giving a sensitivity of 90.0% (CI 55.5–99.75%). Among the 250 screws graded as accurate on CT, 244 were graded as such on the CBCT, giving a specificity of 97.6% (CI 94.85–99.11%). Conclusions CBCT, performed intraoperatively with the Allura ARSN system, is comparable and non-inferior to a conventional postoperative CT scan for ruling out misplaced pedicle screws in spinal deformity cases, eliminating the need for a postoperative CT. Key Points • Intraoperative cone beam computed tomography (CT) using the Allura ARSN is comparable with conventional CT for ruling out pedicle screw breaches after spinal fixation surgery. • Intraoperative cone beam computed tomography can be used to assess need for revisions of pedicle screws making routine postoperative CT scans unnecessary. • Using cone beam computed tomography, the specificity was 97.6% and the sensitivity was 90% for detecting pedicle screw breaches and the negative predictive value for ruling out a pedicle screw breach was 99.6%.

scholarly journals In vivo detection of external apical root resorption induced by apical periodontitis using periapical radiography and cone-beam computed tomography

2021 ◽  
Author(s):  
Stephanie Diaz Huamán ◽  
Maya Fernanda Manfrin Arnez ◽  
Fernanda Maria Machado Pereira Cabral de Oliveira ◽  
Andiara De Rossi ◽  
Léa Assed Bezerra Silva ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Root Resorption ◽  
Calculated Data ◽  
Cone Beam ◽  
Predictive Values ◽  
Apical Root Resorption ◽  
External Apical Root Resorption ◽  
Sensitivity Specificity

Abstract Objectives: To investigate sensitivity, specificity, predictive values and accuracy of periapical radiography (PR) and Cone beam computed tomography (CBCT) for detection of external apical root resorption (EARR).Materials and Methods: Dog’s teeth with experimentally induced root resorption underwent or not root canal treatment (n = 62 roots). True positives (TP), false positives (FP), true negatives (TN) and false negatives (FN) in PR and CBCT diagnoses were determined using histopathologic findings as gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (TP + TN) in the diagnosis of EARR were calculated. Data was compared using chi-squared test (⍺= 0.05).Results: We found that PR detected EARR in 35% of roots and CBCT, in 47%. EARR was microscopically diagnosed in 50% (p = 0.03 comparison between PR and microscopy; p = 0.67 comparison between CBCT and microscopy). Overall, CBCT produced more accurate diagnoses than PR (0.93 for CBCT versus 0.70 for PR; p = 0.008). Interestingly, when data was stratified into small and large resorptions, PR and CBCT allowed identification of large resorption in 100% of the cases and showed the same accuracy. However, for small resorptions, PR showed an accuracy of 0.83, whereas CBCT showed an accuracy of 0.96 (p = 0.003).Conclusions: We demonstrated that CBCT showed higher accuracy to detect EARR. These findings shed light on the use of CBCT for detection of initial root resorption.Clinical relevance: Early identification of resorption allows a prompt treatment and reduces the risk of dental structure loss.

scholarly journals Performance of Bioceramic-based Root Filling Material with Artifact Reduction Properties in the Detection of Vertical Root Fractures Using Cone-beam Computed Tomography

2021 ◽  
Vol 15 (1) ◽  
pp. 170-175
Author(s):  
Ali Bahmani ◽  
Hamed Karkehabadi ◽  
Abbas Shokri ◽  
Maryam Farhadian
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Testing Machine ◽  
Cone Beam ◽  
Filling Material ◽  
Filling Materials ◽  
Gutta Percha ◽  
Significant Difference ◽  
Root Fractures

Introduction: In Cone-beam Computed Tomography (CBCT) images, metallic artifacts by root filling materials reduce the quality of images. It seems that bioceramic sealers produce fewer artifacts than gutta-percha. In this situation, the possibility of VRF detection could increase, and therefore, flap and exploratory surgery would not be needed. The purpose of this study was to evaluate the performance of a bioceramic-based root filling material in the detection of Vertical Root Fractures (VRF) in CBCT imaging. Materials and Methods: This study was conducted at the dental school from March to August 2019, and 100 healthy human mandibular premolar teeth were obtained and randomly divided into two equal groups. The teeth were filled with either AH26 and gutta-percha or bioceramic root filling materials. VRF was induced on half of the decoronated teeth in each group using a Global Testing Machine, and the others were considered control. CBCT imaging was performed by the Cranex 3D machine. Comparisons of the 2 groups were made using the Mann-Whitney test. Results: There was a significant difference between the two groups of bioceramic and gutta-percha in the measured indices, including sensitivity (P=0.017), specificity (P=0.018), positive predictive value (P=0.018), negative predictive value (P=0.018), and accuracy (P=0.011). The Area Under Curve (AUC) also showed a significant difference between the two groups (P=0.011). According to Kappa test results, no significant difference was obtained between the findings of the two observers. Conclusion: Different root filling materials showed a different extent of artifact in CBCT images. Bioceramic root filling material induces fewer artifacts in CBCT images, and the diagnostic value of VRF in CBCT images in the root canals filled with it is greater than those filled with AH26 and gutta-percha.

scholarly journals Computed Tomography of the Chest as a Screening Tool for Low Bone Mineral Density

2021 ◽  
Author(s):  
Alan T Vanier ◽  
Donald Colantonio ◽  
Sameer K Saxena ◽  
Daniel Rodkey ◽  
Scott Wagner
Keyword(s):  
Computed Tomography ◽  
Bone Mineral Density ◽  
Femoral Neck ◽  
Negative Predictive Value ◽  
Thoracic Spine ◽  
Predictive Value ◽  
Screening Tool ◽  
Ct Scans ◽  
Mineral Density ◽  
Dxa Scans

ABSTRACT Introduction Computed tomography (CT) Hounsfield units (HU) recently emerged as a promising screening tool for low bone mineral density (BMD). We hypothesized that CT HU measurements of the thoracic spine would significantly and positively correlate with dual X-ray absorptiometry (DXA) BMD scans of the femoral neck. Materials and methods The study included patients with DXA scans and thoracic CT scans at the Walter Reed National Military Medical Center. One author, blinded to the DXA scans, measured HU from the cancellous bone in T4 vertebrae. Another author statistically compared femoral neck DXA T-scores to the CT HU measurements. Results The study included 145 patients with CT scans and femoral neck DXAs. The osteoporotic and osteopenic groups had a significant difference in HU measurements compared to the normal group within the study (P < .0001 and .002, respectively). A low BMD screening value of 231 HU provided a sensitivity of 90.1% and negative predictive value of 85.7%. Conclusion Thoracic vertebrae HU measurements correlate with a low BMD of the femoral neck as determined by DXA T-scores. A high sensitivity and negative predictive value was achieved with a screening value of 231 HU. Utilization of chest or thoracic spine CT imaging as a screening method provides a quick and available screening tool for assessing low BMD in patients with these scans. Level of Evidence: III (Diagnostic)

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography 

2021 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

scholarly journals Patient-Specific Templates for Pedicle Screw Insertion in Spinal Fixation Surgery

10.29007/kbf7 ◽  
2018 ◽  
Author(s):  
Mahmoud Hafez ◽  
Mohamed Fouda
Keyword(s):  
Pedicle Screw ◽  
3D Model ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Patient Specific ◽  
Scoliosis Surgery ◽  
Spinal Fixation ◽  
Screw Insertion ◽  
Pedicle Screw Insertion ◽  
Surgery Patient

The increased use of pedicle screws in scoliosis creates a challenge for accurate and safe placement ofscrew within the pedicle during the scoliosis surgery. Patient-specific templates (PST) is a novelmethod to guide the surgeons for allocating and detecting the positions and trajectories of pediclescrews in scoliosis surgery. Based on CT-scans and according to certain protocol, this technique willallow the surgeon to construct a 3D model of spine and present the stage and vertebrae which containthe most deformed bone. With preplanned surgery on specific software, we can develop an accurateand safe position of pedicle screws and its trajectories. This method has the ability to customize theplacement and the size of each pedicle screw based on the unique morphology and landmarks of thevertebrae.

scholarly journals Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

2020 ◽  
Author(s):  
Satoshi Sumiya ◽  
Kazuyuki Fukushima ◽  
Yoshiro Kurosa ◽  
Takashi Hirai ◽  
Hiroyuki Inose ◽  
...  
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Pedicle Screw ◽  
Odds Ratio ◽  
Pedicle Screws ◽  
Cone Beam ◽  
Clinical Factors ◽  
Factors Associated ◽  
Pull Out ◽  
History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.Conclusions Our findings suggest that age, number of fused segments, the presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

Stimulus-evoked electromyography testing of percutaneous pedicle screws for the detection of pedicle breaches: a clinical study of 409 screws in 93 patients

2010 ◽  
Vol 13 (5) ◽  
pp. 600-605 ◽  
Author(s):  
Michael Y. Wang ◽  
Guillermo Pineiro ◽  
Praveen V. Mummaneni
Keyword(s):  
Pedicle Screw ◽  
Predictive Value ◽  
Intraoperative Imaging ◽  
Pedicle Screws ◽  
Ct Scans ◽  
Screw Placement ◽  
Low Grade ◽  
Percutaneous Pedicle Screw ◽  
Evoked Electromyography ◽  
Lumbar Spinal

Object Percutaneous pedicle screws have recently become popularized for lumbar spinal fixation. However, successful anatomical hardware placement is highly dependent on intraoperative imaging. In traditional open surgery, stimulus-evoked electromyography (EMG) responses can be useful for detecting pedicle screw breaches. The use of insulated sleeves for percutaneous screws has allowed for EMG testing in minimally invasive surgery; however, no reports on the reliability of this testing modality have been published. Methods A total of 409 lumbar percutaneous pedicle screws were placed in 93 patients. Levels of instrumentation included L-1 (in 12 patients), L-2 (in 34), L-3 (in 44), L-4 (in 120), L-5 (in 142), and S-1 (in 57 patients). Intraoperative EMG stimulation thresholds were obtained using insulating sleeves over a metallic tap prior to final screw placement. Data were compared with postoperative fine-cut CT scans to assess pedicle screw placement. Data were collected prospectively and analyzed retrospectively. Results There were 5 pedicle breaches (3 medial and 2 lateral; 3 Grade 1 and 2 Grade 2 breaches) visualized on postoperative CT scans (1.2%). Two of these breaches were symptomatic. In 2 instances, intraoperative thresholds were the sole basis for screw trajectory readjustment, which resulted in proper placement on postoperative imaging. Thirty-five screw trajectories were associated with a threshold of less than 12 mA. However, all breaches were associated with thresholds of greater than 12 mA. Using thresholds below 12 mA as the indicator of a screw breach, this resulted in a sensitivity of 0.0, specificity of 90.3, positive predictive value of 0.0, and negative predictive value of 0.98. Utilizing a threshold of any decreased stimulus (< 20 mA) would have detected 60% of breaches, with a mean threshold of 16.25 mA. Conclusions While these data are limited by the low number of radiographic breaches, it appears that tap stimulation with an insulating sleeve may not be reliable for detecting low-grade radiographically breached pedicles using typical stimulation thresholds (< 12 mA). Imaging-based modalities remain more reliable for assessing percutaneous pedicle screw trajectories until more robust and sensitive electrophysiological testing methods can be devised.

scholarly journals Cone-Beam Computed Tomography to Assess Mandibular Invasion in Oral Squamous Cell Carcinoma

2018 ◽  
Vol 8 (2) ◽  
pp. 18-22
Author(s):  
Md Ariful Islam ◽  
Md Nasir Uddin ◽  
Md Shahjahan Ali ◽  
Md Mahfuz Hossain
Keyword(s):  
Computed Tomography ◽  
Squamous Cell Carcinoma ◽  
Oral Squamous Cell Carcinoma ◽  
Positive Predictive Value ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Cone Beam Computed Tomography ◽  
Predictive Value ◽  
Cone Beam ◽  
Sensitivity Specificity

Background: Oral squamous cell carcinoma which occurs closely to the mandible has a tendency to invade mandible. An accurate preoperative evaluation of mandibular invasion is important for optimum treatment planning. Aim of this study is to determine the accuracy of CBCT in detection of mandibular invasion in oral squamous cell carcinoma. Study design: In this prospective observational study 35 patients of histologically proven squamous cell carcinoma which was close proximity to the mandible were selected. The results of preoperative CBCT scan of mandible were compared with that of post operative histopathology of bone and thus sensitivity, specificity, negative predictive value, positive predictive value were calculated. Results: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CBCT were 96%, 90.90%, 96%, 90.90%, 97.14% respectively (Chi squared with Yates correction equals 21.844 with 1 degrees of freedom, p value < o.oooo1). Conclusion: Cone beam computed tomography is a sensitive test and has an acceptable range of specificity. Update Dent. Coll. j: 2018; 8 (2): 18-22

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