Volume-rendered Three-dimensional Spiral CT: Musculoskeletal Applications

Abstract

Spiral computed tomography (CT) is a powerful modality for evaluation of the musculoskeletal system, particularly when coupled with real-time, volume-rendering reconstruction techniques. Including volume-rendered spiral CT in routine musculoskeletal imaging protocols can change management in a significant number of cases. In cases of trauma, subtle fractures--particularly those oriented in the axial plane--are better seen on volume-rendered images. Complex injuries can be better demonstrated with volume-rendered images, and complicated spatial information about the relative positions of fracture fragments can be easily demonstrated to the orthopedic surgeons. The use of intravenously administered contrast material allows simultaneous evaluation of osseous and vascular structures within the affected area. Evaluation of suspected infectious or neoplastic disease is also aided by including volume-rendered imaging in the musculoskeletal spiral CT examination. The extent of disease can be thoroughly evaluated with volume-rendered images, and therapeutic planning--be it surgical or medical--is aided by the anatomic information available from volume-rendered images. Postoperative studies in patients with orthopedic hardware also benefit from volume-rendered imaging. Volume rendering eliminates most streak artifact and produces high-quality images on which the relationships among hardware, bones, and bone fragments are well demonstrated.

Advances in Imaging of Vertebral and Spinal Cord Injury

“…MRI will generally be successful, based on characteristic morphologic and signal criteria, in differentiating these compressive abnormalities (18). CT is a useful adjunct, certainly, in delineating bony detail (Figure 5a and b) and is important in preoperative planning (4,19,20). Preexisting spondylosis and spinal stenosis will accentuate the vulnerability of the cord to extrinsic compression ( Figure 6), and the severity of cord compression has an adverse correlation with prognosis, independent from intrinsic cord injury (21)(22)(23).…”

Three-Dimensional Volume Rendering Imaging in Detection of Bone Fractures

“…3D VR techniques can eliminate the disadvantage of both techniques, low contrast resolution and spatial resolution, X-ray and CT, respectively. On the other hand, the combination of advantages of both techniques can be possible (3)(4)(5)(6)(7)(8). 3D VR technique might change the treatment by showing displacement way in complex fractures.…”

“…3D volume rendering images has proved valuable in diagnosis of subtle abnormalities and in planning patient therapy. In a substantial number of cases, management is altered because of findings seen only on the 3D images or better demonstrated on these images: subtle fractures, complex injuries, and pathologic conditions masked by metallic streak artefact (1)(2)(3). In this study, we aimed to detect the contrubition of 3D VR images on diagnosis of bone fractures.…”

Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis

“…4 While MRI scans are considered a good alternative to radiographs, 5 frequently post-operative assessments of fracture healing need to be performed in the presence of metal hardware, 6 which produces significant artefacts on MRI and could prove challenging to interpret. In such cases, MDCT is regarded as an appropriate diagnostic modality in the assessment of fracture healing following initial assessment by plain radiograph (modality of choice), 7 where volume rendering mitigates the deleterious effects of streak artefacts 8 that are associated with the presence of metal hardware. 4,9 Recently, we designed, developed and tested the feasibility of a dedicated high-resolution three-dimensional (3D) extremity cone-beam CT (CBCT) scanner for musculoskeletal imaging that has the ability to obtain weightbearing scan acquisition.…”