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01.06.2015 | Musculoskeletal

Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength

verfasst von: Julian L. Wichmann, Christian Booz, Stefan Wesarg, Ralf W. Bauer, J. Matthias Kerl, Sebastian Fischer, Thomas Lehnert, Thomas J. Vogl, M. Fawad Khan, Konstantinos Kafchitsas

Erschienen in: European Radiology | Ausgabe 6/2015

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Abstract

Objectives

To evaluate quantitative dual-energy computed tomography (DECT) for phantomless analysis of cancellous bone mineral density (BMD) of vertebral pedicles and to assess the correlation with pedicle screw pull-out strength.

Methods

Twenty-nine thoracic and lumbar vertebrae from cadaver specimens were examined with DECT. Using dedicated post-processing software, a pedicle screw vector was mapped (R1, intrapedicular segment of the pedicle vector; R2, intermediate segment; R3, intracorporal segment; global, all segments) and BMD was calculated. To invasively evaluate pedicle stability, pedicle screws were drilled through both pedicles and left pedicle screw pull-out strength was measured. Resulting values were correlated using the paired t test and Pearson’s linear correlation.

Results

Average pedicle screw vector BMD (R1, 0.232 g/cm³; R2, 0.166 g/cm³; R3, 0.173 g/cm³; global, 0.236 g/cm³) showed significant differences between R1–R2 (P < 0.002) and R1–R3 (P < 0.034) segments while comparison of R2–R3 did not reach significance (P > 0.668). Average screw pull-out strength (639.2 N) showed a far stronger correlation with R1 (r = 0.80; P < 0.0001) than global BMD (r = 0.42; P = 0.025), R2 (r = 0.37; P = 0.048) and R3 (r = −0.33; P = 0.078) segments.

Conclusions

Quantitative DECT allows for phantomless BMD assessment of the vertebral pedicle. BMD of the intrapedicular segment shows a significantly stronger correlation with pedicle screw pull-out strength than other segments.

Key points

• Quantitative dual-energy CT enables evaluation of pedicle bone mineral density.

• Intrapedicular segments show significant differences regarding bone mineral density.

• Pedicle screw pull-out strength correlated strongest with R1 values.

• Dual-energy CT may improve preoperative assessment before transpedicular screw fixation.

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Titel: Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength
verfasst von: Julian L. Wichmann
Christian Booz
Stefan Wesarg
Ralf W. Bauer
J. Matthias Kerl
Sebastian Fischer
Thomas Lehnert
Thomas J. Vogl
M. Fawad Khan
Konstantinos Kafchitsas
Publikationsdatum: 01.06.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 6/2015
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3529-7

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Quantitative dual-energy CT for phantomless evaluation of cancellous bone mineral density of the vertebral pedicle: correlation with pedicle screw pull-out strength