- Spine Cryoablation: Pain Palliation and Local Tumor Control for Vertebral Metastases
This is a retrospective study of imaging-guided spine cryoablation that was performed on 31 vertebral metastases in 14 patients. The lesions were refractory to conventional chemoradiation therapy or analgesics and were ablated to achieve pain palliation and local tumor control. The procedures were performed with the patient under conscious sedation (13 patients) or general anesthesia in 1 case. Postcryoablation MR imaging and PET/CT imaging were available for all patients. Spinal nerve and soft-tissue thermal protection techniques were implemented in all ablations (epidural or neuroforaminal carbon dioxide or warmed 5% dextrose). There were statistically significant decreases in the median numeric pain rating scale score and analgesic usage at 1-week, 1-month, and 3-month time points. Local tumor control was achieved in 96.7% (30/31) of tumors.
- Bone-Subtracted Spinal CT Angiography Using Nonrigid Registration for Better Visualization of Arterial Feeders in Spinal Arteriovenous Fistulas
CTA images of the arterial and late arterial phases were used to obtain warped images of the late arterial phase by nonrigid registration that was adjusted to the arterial phase images. R-CTA images were then obtained by subtracting the warped images from the arterial phase images. R-CTA had a higher accuracy compared with conventional spinal CTA (80% versus 47%). The authors conclude that subtracted CTA imaging using nonrigid registration detects feeders of spinal arteriovenous fistulas more accurately and quickly than conventional CTA.
- CT Metal Artifact Reduction in the Spine: Can an Iterative Reconstruction Technique Improve Visualization?
CT images were reconstructed by using weighted filtered back-projection and iterative metal artifact reduction. Two neuroradiologists evaluated images in the region of spinal hardware and assigned a score for the visualization of critical anatomic structures by using soft-tissue and bone windows. Using bone windows, they measured the length of the most pronounced linear artifacts. Visualization of critical soft-tissue anatomic structures was significantly improved by using iterative metal artifact reduction, but there was not a significant improvement in visualization of critical osseous structures. Routine generation of these iterative reconstructed images in addition to routine weighted filtered back-projection is recommended.
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