Paulina Cewe, Mikael Skorpil, Alexander Fletcher-Sandersjöö, Victor Gabriel El-Hajj, Per Grane, Michael Fagerlund, Magnus Kaijser, Adrian Elmi-Terander, Erik Edström
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Intra- and inter-observer variability was evaluated using intraclass correlation coefficients (ICC). Image quality was objectively evaluated by contrast and signal-to-noise measurements (CNR, SNR).</p><h3>Results</h3><p>In image quality, CBCT was the preferred modality in thoracolumbar spine (AUC<sub>VGC</sub> = 0.58, <i>p</i> < 0.001). Conversely, MDCT was preferred in cervical spine (AUC<sub>VGC</sub> = 0.38, <i>p</i> < 0.004). The agreement was good for inter-observer and moderate in intra-observer (ICC 0.76—0.77 vs 0.60—0.71), <i>p</i> < 0.001. SNR and CNR were comparable in thoracolumbar imaging, while MDCT provided superior and more consistent image quality in the cervical spine, <i>p</i> < 0.001.</p><h3>Conclusion</h3><p>In spine surgery, CBCT provides superior image quality for thoracolumbar imaging, while MDCT performs better for cervical imaging. Intraoperative CBCT could potentially replace postoperative MDCT in thoracolumbar spine procedures, while postoperative MDCT remains essential for cervical spine assessment.</p><h3>Key Points</h3>\n<ul>\n <li>\n <p>Subjective assessment demonstrated that CBCT was the preferred modality for thoracolumbar spine imaging, while MDCT was favored for cervical spine imaging.</p>\n </li>\n <li>\n <p>Agreement between readers was good, while individual readings showed moderate consistency in repeated assessments.</p>\n </li>\n <li>\n <p>Objective assessment of image clarity and detail showed both modalities performed equally well in the thoracolumbar spine, while MDCT performed better in the cervical spine.</p>\n </li>\n <li>\n <p>Intraoperative CBCT proves superior to postoperative MDCT for thoracolumbar spine imaging, potentially eliminating redundant scans, and improving workflow. Postoperative MDCT remains essential for cervical spine procedures.</p>\n </li>\n </ul></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06503-w.pdf","citationCount":"0","resultStr":"{\"title\":\"Image quality assessment in spine surgery: a comparison of intraoperative CBCT and postoperative MDCT\",\"authors\":\"Paulina Cewe, Mikael Skorpil, Alexander Fletcher-Sandersjöö, Victor Gabriel El-Hajj, Per Grane, Michael Fagerlund, Magnus Kaijser, Adrian Elmi-Terander, Erik Edström\",\"doi\":\"10.1007/s00701-025-06503-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To evaluate if intraoperative cone-beam CT (CBCT) provides equivalent image quality to postoperative multidetector CT (MDCT) in spine surgery, potentially eliminating unnecessary imaging and cumulative radiation exposure.</p><h3>Methods</h3><p>Twenty-seven patients (16 men, 11 women; median age 39 years) treated with spinal fixation surgery were evaluated using intraoperative CBCT and postoperative MDCT. 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引用次数: 0
摘要
目的评价术中锥形束CT （cone-beam CT， CBCT）是否能提供与术后多层螺旋CT （multidetector CT， MDCT）相当的图像质量，从而潜在地消除不必要的成像和累积辐射暴露。方法27例患者(男16例，女11例；中位年龄39岁)行脊柱固定手术后，采用术中CBCT和术后MDCT进行评估。图像由四名神经放射学家独立评估，利用五步李克特量表和视觉分级特征（VGC）分析。VGC曲线下面积（AUCVGC）量化了不同治疗方式之间的偏好。使用类内相关系数（ICC）评估观察者内部和观察者之间的可变性。通过对比和信噪比（CNR）、信噪比（SNR）客观评价图像质量。结果在图像质量方面，CBCT是胸腰椎的首选方式（AUCVGC = 0.58, p < 0.001）。相反，MDCT更适合颈椎检查（AUCVGC = 0.38, p < 0.004）。观察者之间的一致性良好，观察者内部的一致性中等（ICC 0.76-0.77 vs 0.60-0.71）， p < 0.001。在胸腰椎成像中，信噪比和CNR相当，而MDCT在颈椎成像中提供了更好和更一致的图像质量，p < 0.001。结论在脊柱外科手术中，CBCT对胸腰椎的成像质量较好，而MDCT对颈椎的成像质量较好。在胸腰椎手术中，术中CBCT有可能取代术后MDCT，而术后MDCT对颈椎评估仍然至关重要。主观评价表明，CBCT是胸腰椎影像学的首选方式，而MDCT是颈椎影像学的首选方式。读者之间的一致性很好，而个人阅读在重复评估中显示出适度的一致性。客观评估图像清晰度和细节显示两种方式在胸腰椎表现同样良好，而MDCT在颈椎表现更好。术中CBCT优于术后MDCT用于胸腰椎成像，可能消除冗余扫描，并改善工作流程。术后MDCT对颈椎手术仍是必要的。
Image quality assessment in spine surgery: a comparison of intraoperative CBCT and postoperative MDCT
Objective
To evaluate if intraoperative cone-beam CT (CBCT) provides equivalent image quality to postoperative multidetector CT (MDCT) in spine surgery, potentially eliminating unnecessary imaging and cumulative radiation exposure.
Methods
Twenty-seven patients (16 men, 11 women; median age 39 years) treated with spinal fixation surgery were evaluated using intraoperative CBCT and postoperative MDCT. The images were independently evaluated by four neuroradiologists, utilizing a five-step Likert scale and visual grading characteristics (VGC) analysis. The area under the VGC curve (AUCVGC) quantified preferences between modalities. Intra- and inter-observer variability was evaluated using intraclass correlation coefficients (ICC). Image quality was objectively evaluated by contrast and signal-to-noise measurements (CNR, SNR).
Results
In image quality, CBCT was the preferred modality in thoracolumbar spine (AUCVGC = 0.58, p < 0.001). Conversely, MDCT was preferred in cervical spine (AUCVGC = 0.38, p < 0.004). The agreement was good for inter-observer and moderate in intra-observer (ICC 0.76—0.77 vs 0.60—0.71), p < 0.001. SNR and CNR were comparable in thoracolumbar imaging, while MDCT provided superior and more consistent image quality in the cervical spine, p < 0.001.
Conclusion
In spine surgery, CBCT provides superior image quality for thoracolumbar imaging, while MDCT performs better for cervical imaging. Intraoperative CBCT could potentially replace postoperative MDCT in thoracolumbar spine procedures, while postoperative MDCT remains essential for cervical spine assessment.
Key Points
Subjective assessment demonstrated that CBCT was the preferred modality for thoracolumbar spine imaging, while MDCT was favored for cervical spine imaging.
Agreement between readers was good, while individual readings showed moderate consistency in repeated assessments.
Objective assessment of image clarity and detail showed both modalities performed equally well in the thoracolumbar spine, while MDCT performed better in the cervical spine.
Intraoperative CBCT proves superior to postoperative MDCT for thoracolumbar spine imaging, potentially eliminating redundant scans, and improving workflow. Postoperative MDCT remains essential for cervical spine procedures.
期刊介绍：
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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