Comparison of low-dose CT with CT/CT fluoroscopy guidance in percutaneous sacral and supra-acetabular cementoplasty

Özet

PURPOSEPercutaneous cementoplasty is a minimally invasive treatment modality for painful osteoporoticand pathologic sacral and supra-acetabular iliac fractures. This study compares the use of lowdose CT guidance with CT/CT fluoroscopy in sacral and supra-acetabular cementoplasty.METHODSA retrospective review of patients who had undergone sacral or supra-acetabular cementoplastywas performed with patients grouped by use of CT/CT fluoroscopy or low-dose CT guidanceduring the procedure. Parameters evaluated included type of fracture, laterality of lesions, painscores, pain medication use, imaging parameters, procedure time, dose-length product, effective dose, cement volume, and complications.RESULTSThere were 17 patients identified who underwent cementoplasty utilizing dual CT/CT fluoroscopy, while 13 patients had their procedures performed with low-dose CT. There was a statisticallysignificant decrease in radiation dose in the low-dose CT group (1481 mGy·cm) compared withthe CT/CT fluoroscopy group (2809 mGy·cm) (P = 0.013). There was a significant decrease in procedure time with low-dose CT for bilateral lesions (P = 0.016). There was no significant differencebetween groups in complication rate (P = 0.999). Clinically nonsignificant cement extravasationoccurred in two patients (10%) in the CT/CT fluoroscopy group and in one patient (8%) in thelow-dose CT group (P = 0.999). There was a significant decrease in pain scores compared withbaseline on the visual analogue scale in both groups at 1 week (low-dose CT P = 0.002, CT/CTfluoroscopy P = 0.008) and 1 month postprocedure (low-dose CT P = 0.014, CT/CT fluoroscopyP = 0.004), but no difference between groups at 1 day (P = 0.196), 1 week (P = 0.368), or 1 month(P = 0.514).CONCLUSIONSacral and supra-acetabular cementoplasties can be performed safely and precisely using lowdose multiple-acquisition CT guidance while providing significant radiation dose reduction withno difference in extravasation rates, postprocedural pain reduction, and complications compared with CT/CT fluoroscopy.