Assessment of 3D Lumbosacral Vascular Anatomy for OLIF51 by Non-Enhanced MRI and CT Medical Image Fusion Technique.

Masakazu Nagamatsu,Taro Yamauchi,Yoshihiro Fujiwara,Shinsuke Moriue,Masato Tanaka,Sameer Ruparel,Masato Tanaka,Yoshiyuki Takeshita,Shinya Arataki,Koji Uotani,Rika Takamoto

doi:10.3390/diagnostics11101744

Abstract

Study design: Prospective study. Objective: Medical image fusion can provide information from multiple modalities in a single image. The present study aimed to determine whether three-dimensional (3D) lumbosacral vascular anatomy could be adequately portrayed using a non-enhanced CT–MRI medical image fusion technique. Summary of Background Data: Lateral lumbar interbody fusion has gained popularity for the surgical treatment of adult spinal deformity (ASD). Oblique lumbar interbody fusion at L5–S1 (OLIF51) is receiving considerable attention as a method of creating good L5–S1 lordosis. Access in OLIF51 requires evaluation of the vascular anatomy in the lumbosacral region. Conventional imaging modalities need a contrast medium to describe the vascular anatomy. Methods: Participants comprised 15 patients with ASD or degenerative lumbar disease who underwent corrective surgery at our hospital between January 2020 and June 2021. A 3D vascular image with bony structures was obtained by fusing results from MRI and CT. We processed the merged image and measured the distance between left and right common iliac arteries and veins at two levels: the lower end of the L5 vertebral body (Window A) and the upper end of the S1 vertebral body (Window B). Results: The mean sizes of Window A and Window B were 29.7 ± 10.7 mm and 36.9 ± 10.3 mm, respectively. The mean distance from the bifurcation to the lower end of the L5 vertebra was 23.7 ± 10.9 mm. Coronal deviation of the bifurcation was, from center to left, 12.6 ± 12.3 mm, and the distance from the center of the L5 vertebral body to the bifurcation was 0.79 ± 7.3 mm. Only one case showed a median sacral vein (6.7%). Clinically, we performed OLIF51 in 12 of the 15 cases (80%). Conclusion: Evaluating 3D lumbosacral vascular anatomy using a non-enhanced MRI and CT medical image fusion technique is very useful for OLIF51, particularly for patients in whom the use of contrast medium is contraindicated.

Highlights

Adult spinal deformity (ASD) is caused by spinal malalignment. This condition affects a large number of patients, resulting in symptoms such as severe low back pain, neurological dysfunction, reflex esophagitis, cosmetic disorders, and mental disorders [1,2]
Excellent results have been reported for ASD surgery [3,4]
We report hereinherein a novel technique to provide a vide a three-dimensional vascular image containing bony information, created using three-dimensional (3D) vascular image containing bony information, created using vasvascular images from magnetic resonance imaging (MRI)

Summary

Introduction

Adult spinal deformity (ASD) is caused by spinal malalignment. This condition affects a large number of patients, resulting in symptoms such as severe low back pain, neurological dysfunction, reflex esophagitis, cosmetic disorders, and mental disorders [1,2].Excellent results have been reported for ASD surgery [3,4]. Adult spinal deformity (ASD) is caused by spinal malalignment. This condition affects a large number of patients, resulting in symptoms such as severe low back pain, neurological dysfunction, reflex esophagitis, cosmetic disorders, and mental disorders [1,2]. Lateral lumbar interbody fusion (LLIF) has gained popularity for the surgical treatment of ASD. A small vascular window at the L5–S1 level is a contraindication for OLIF51 [7]. Imaging modalities, such as angiography, MRI, and contrast-enhanced computed tomography (CT), are utilized to evaluate the vascular

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Discussion

Conclusion