Enhanced Precision and Safety in Thermal Ablation: O-Arm Cone Beam Computed Tomography with Magnetic Resonance Imaging Fusion for Spinal Column Tumor Targeting

Abstract

Spinal metastatic tumors are common and often cause debilitating symptoms. Image-guided percutaneous thermal ablation (IPTA) has gained significant recognition in managing spinal column tumors due to its exceptional precision and effectiveness. Conventional guidance modalities, including computed tomography, fluoroscopy, and ultrasound, have been important in targeting spinal column tumors while minimizing harm to adjacent critical structures. This study presents a novel approach utilizing a fusion of cone beam computed tomography with magnetic resonance imaging to guide percutaneous thermal ablation for four patients with secondary spinal column tumors. The visual analog scale (VAS) evaluated the procedure effectiveness during an 18-month follow-up. Percutaneous vertebroplasty was performed in two cases, and a thermostat was used during all procedures. Imaging was performed using the Stealth Station navigation system Spine 8 (SSS8) and a 1.5T MRI machine. The fusion of CBCT with MRI allowed for precise tumor localization and guidance for thermal ablation. Initial results indicate successful tumor ablation and symptom reduction, emphasizing the potential of CBCT-MRI fusion in spinal column tumor management. This innovative approach is promising in optimizing therapy for secondary spinal column tumors. Further studies are necessary to validate its efficacy and applicability.

Keywords: cone beam computed tomography (CBCT); fusion imaging; image-guided procedures; interventional radiology; percutaneous thermal ablation; secondary spinal tumors; thermal ablation techniques.

Figure 1

Intraoperative O-arm scan, the yellow projection line shows the entry point: (A) coronal view; (B) sagittal view; (C) axial view.

Figure 2

O-arm and MRI fused image, using the MRI image primarily, the yellow projection line, which presents the targeted site for electrode placement: (A) coronal view; (B) sagittal view; (C) axial view.

Figure 3

Second intra-operative CBCT scan in the trajectory angled axial view (A), sagittal view (B), and axial view (C). The blue projection line shows the thermostat location, and the red arrow shows the electrode position.

Figure 4

Sagittal view of CT scan (A) and MRI scan (B). The red arrow indicates the tumor and the yellow arrow shows where the tumor should be detectable.

Figure 5

MRI scans before surgery (A), 6 months post-surgery (B), and 12 months post-surgery (C) were examined in both sagittal (A1,B1,C1) and axial sections (A2,B2,C2). The red arrow shows the lesion location.