Abstract
The paper reviews the current imaging methods in the diagnosis and monitoring of patients with adolescent idiopathic scoliosis. Radiography is generally used in the initial diagnosis of the condition. Postero-anterior erect full spine radiograph is generally prescribed, and is supplemented by lateral full spine radiograph when indicated. To reduce the radiation hazard, only the area of interest should be exposed, and follow-up radiographs should be taken with as few projections as possible. When available, EOS® stereoradiography should be used. The radiation of the microdose protocol is 45 times less than that of the conventional radiography. Surface topography offers another approach to monitoring changes of curvatures in AIS patients. Recently, 3D ultrasound has been found to be able to measure the Cobb angle accurately. Yet, it is still in the early developmental stages. The inherent intrinsic and external limitations of the imaging system need to be resolved before it can be widely used clinically. For AIS patients with atypical presentation, computed tomography (CT) and/or magnetic resonance imaging (MRI) may be required to assess for any underlying pathology. As CT is associated with a high radiation dose, it is playing a diminishing role in the management of scoliosis, and is replaced by MRI, which is also used for pre-operative planning of scoliosis.The different imaging methods have their limitations. The EOS® stereoradiography is expensive and is not commonly available. The surface topography does not enable measurement of Cobb angle, particularly when the patient is in-brace. The 3D ultrasound scanning has inherent intrinsic technical limitation and cannot be used in all subjects. Radiography, however, enables diagnosis and monitoring of the adolescent idiopathic scoliosis (AIS). It is thus the gold standard in the evaluation and management of scoliosis curves.
Highlights
INTRODUCTIONAdolescent idiopathic scoliosis afflicts 2-3% of the population
Adolescent idiopathic scoliosis afflicts 2-3% of the population. It is generally noticed by parents, friends or detected during a spinal screening utilizing a scoliometer which measures the angle of trunk rotation (ATR)
The radiograph may need to include the hip to determine if the tri-radiate cartilage, which is the Y-shape epiphyseal plate between the ilium, ischium and pubis has fused [7], as closure of the cartilage occurs after the peak height growth velocity phase [8].Weiss and Seibel (2013), are of the opinion that it is not necessary to include the entire pelvis and the hip, as this increases the radiation exposure and does not provide useful information in the management of scoliosis [9]
Summary
Adolescent idiopathic scoliosis afflicts 2-3% of the population. It is generally noticed by parents, friends or detected during a spinal screening utilizing a scoliometer which measures the angle of trunk rotation (ATR). When the ATR is ≥ 5o, the patient is likely to have a lateral spinal curvature in excess of 10o. Different imaging methods are used in the management of idiopathic scoliosis. These include conventional radiography, the low-dose stereoradiography (EOS®), surface topography, 3D ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). Fluoroscopy is generally used intra-operatively and is not discussed in this review paper. These various imaging methods have different indications, advantages and disadvantages.
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