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DYNA CT Myelography vs MSCT Myelography: time for a change? 2013

Category General Spine Imran Chaudry, MD
Alejandro Spiotta, MD
Nathaniel Brooks, MD
Raymond Turner, DO
David Fiorella, MD
Aquilla Turk, DO
Purpose There have been considerable improvements in C-Arm angiographic flat panel detectors and software reconstruction algorithms that allows for improved spatial resolution as well as osseous and soft tissue differentiation.  Our goal was to compare multislice CT (MSCT) to angiographic CT (DYNA CT) in myelographic imaging, to evaluate the benefits of DYNA CT and its possible clinical applications. Materials & Methods In total, 70 consecutive patients with degenerative spine disease (cervical = 16, thoracic = 3, lumbar = 51) underwent DYNA CT and MSCT Myelography.  DYNA CT myelography was performed on a flat panel Siemens Artis Zee biplane neuroangiography platform with images reconstructed on an independent Leonardo workstation.  MSCT was performed on 16 slice Siemens or GE MSCT scanner with MPR images reconstructed locally.  Four reviewers, two experienced neuroradiologists and two neurosurgeons will review all MSCT and DYNA CT source and MPR images for overall impression, contrast distribution, perceptibility of discs, perceptibility of bines, delineation of spinal canal, delineation of nerve roots, hardware artifact, overall diagnostic applicability.  Images were scored on a 1-5 scale with 1 = very poor, 2 = poor, 3 = moderate, 4 = good and 5 = very good. Results Full data analysis is pending.  To date, both CT and DYNA CT were found to be of diagnostic quality 98% and 95% of the time respectively.  51 (71%) of the DYNA CT’s were found to be of the same or better diagnostic quality while only 18 (26%) were found to be inferior but still of diagnostic quality.  The DYNA CT scored better on perceptibility of bones, spinal canal and nerve roots when compared to MSCT.  DYNA CT exceled at evaluation of nerve root evaluation but was limited by hardware artifact.  We found that DYNA CT is comparable to MSCT and subjectively has better imaging quality in virgin spines but is inferior when orthopedic hardware is present. Conclusion DYNA CT myelography maybe useful in the evaluation of degenerative spine disease in the virgin spine.  Pending software improvements with metal artifact correction software will likely improve these results.  The results will be updated at the time of the meeting. References none