Background: Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for
near real time 3-D volume imaging guidance of percutaneous interventional procedures. In
combination with digital flat panel detectors, CBCT has high spatial resolution with isotropic
voxel size, allowing for high resolution image reconstruction in any plane, including 3D rotational
reconstructions. CBCT combines the advantages of conventional CT imaging guidance with
the improved spatial resolution, patient positioning, and access of fluoroscopy.
Objective: The aim of this study is to demonstrate the advantages of CBCT over conventional
CT and biplane fluoroscopy for imaging guidance of minimally invasive spinal and paraspinal
interventional procedures.
Methods: Five patients referred to the department of interventional neuroradiology for
percutaneous spinal or paraspinal interventional procedures were intraoperatively evaluated
with CBCT to assist in guidance of instrumentation placement. Procedures included transoral
cervical vertebral biopsy, percutaneous thoracic vertebral biopsy, vertebroplasty, pelvic
paraspinal/epidural abscess drainage, and paraspinal fiducial marker placement for treatment
of osteoid osteoma.
Results: All procedures were successfully performed with satisfactory diagnostic yield or
therapeutic effect without procedure-related complications.
Conclusion: Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for
3D volume imaging guidance of interventional procedures of the spine with the capability
to produce near real time high resolution image reconstructions in any plane. Compared to
conventional CT and biplane fluoroscopy, CBCT offers improved anatomic visualization allowing
high accuracy instrumentation placement, improving procedure results and minimizing risk of
complications.
Key words: Vertebroplasty, kyphoplasty, biopsy, computed tomography, CT, fluoroscopy, Carm, percutaneous, interventional radiology, imaging guidance
Volume imaging using a combined cone beam CT-DTS approach