Usefulness of cone-beam CT before and after percutaneous vertebroplasty

OBJECTIVE. The usefulness of cone-beam C-arm CT for percutaneous vertebroplasty has not been fully evaluated. The purpose of this study was to assess the feasibility of cone-beam CT for evaluation before and after vertebroplasty. SUBJECTS AND METHODS. This prospective study included 22 consecutive patients (15 women and seven men) with osteoporotic compression fractures (51 vertebrae). Cone-beam CT and 64-MDCT were performed before and after percutaneous vertebroplasty. Multiplanar reformations of the axial, sagittal, and coronal planes were obtained. We evaluated the presence of cortical defects, vacuum phenomena in adjacent disks, and cement leakage, and we calculated the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of cone-beam CT compared with MDCT. RESULTS. All 75 cortical defects in 51 vertebrae seen on MDCT were also observed on cone-beam CT (100% sensitivity and specificity). Vacuum phenomena were detected in 33 of 86 (38.4%) adjacent disk spaces on MDCT and in 29 on cone-beam CT (84.8% sensitivity, 98.1% specificity, and 93.0% accuracy). Cement leakage was noted at 17 disk spaces, 15 paravertebral soft tissues, and 12 veins on MDCT. All cement leakages were correctly identified on cone-beam CT. CONCLUSION. Cone-beam CT is able to correctly evaluate for vertebral fractures and vacuum phenomena in adjacent disks before vertebroplasty and for cement leakage after vertebroplasty.