Artikel
Treatment decision influence on patients with cervical myelopathy – a comparison between virtually calculated low tube voltage monoenergetic datasets on a 3rd generation Dual-Source CT and standard CT
Einfluss von virtuell kalkulierten Datensätzen an einem Dual-source CT der dritten Generation auf die therapeutische Entscheidungsfindung bei Patienten mit cervikaler Myelopathie und einer bestehenden Kontraindikation für eine MRT-Untersuchung
Suche in Medline nach
Autoren
-
Mirko Arp
- Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Neurochirurgische Klinik, Mannheim, Deutschland
-
Daniel Hänggi
- Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Neurochirurgische Klinik, Mannheim, Deutschland
-
Gregory Ehrlich
- Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Neurochirurgische Klinik, Mannheim, Deutschland
-
Jason Perrin
- Universitätsmedizin Mannheim, Medizinische Fakultät, Universität Heidelberg, Neurochirurgische Klinik, Mannheim, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
|---|
Gliederung
Text
Objective: Cervical spinal cord and CSF assessment through computed tomographic (CT) imaging remains difficult due to its low attenuation differences. Therefore, patients with contraindications for MRI depend on the best possible image quality of CT. In contrast to more invasive myelo-CT, dual-energy CT (DECT) allows the specific differentiation of anatomical structures by acquiring two CT datasets with different x-ray spectra. We already showed in a recent study that low 80 keV datasets calculated from DECT increase objective and subjective diagnostic image quality of the spinal cord when compared to standard CT. In this study we evaluated the impact of this improved imaging technique in relationship to treatment decisions.
Methods: We prospectively enrolled 18 patients that presented in our outpatient clinic with cervical spinal stenosis detected in a previous CT due to preexisting MRI contraindications. DECT of the cervical spine on a 3rd generation dual-source CT was performed, low tube voltage monoenergetic datasets at 80 keV were calculated and compared with the previous CT datasets (Figure 1 [Fig. 1]). Two independent observers (X and XX), who were blinded for this study analyzed the two datasets in an unsorted order and assessed the need for operative decompression, the amount of levels for decompression and approach (anterior or posterior).
Results: 18 patients were prospectively included with two CT datasets. In 94,4% of the cases both observers confirmed the indication for surgical decompression. Concerning the total number of segments with indication for decompression, the results showed a decrease of 6,7% (X) and respectively 12,8% (XX) in the DECT datasets. Both neurosurgeons changed the strategy from an anterior to a posterior approach in one different case.
Conclusion: DECT shows subjective higher image quality than standard CT. As an alternative to more invasive imaging modalities and in the absence of MRI, we observed a trend in the decision making towards a less invasive operative strategy. This may be due to a more detailed visualization of the spinal canal and the reduction of artefacts.
