Comparison of Angiographic CT and Spiral CT to Assess Cement Distribution after Vertebral Augmentation

Purpose: To compare angiographic computed tomographic (CT) imaging with standard spiral CT imaging for the depiction of extraosseous cement after vertebral augmentation. Materials and Methods: Retrospective analysis of 28 consecutive patients treated with vertebral augmentation for compression fracture was conducted. Intraprocedural angiographic CT and postprocedural spiral CT images were acquired in all patients. Angiographic CT and spiral CT images were evaluated independently by two experienced radiologists. Results: All vertebral augmentation procedures were performed successfully. All observed cement leaks were small, and no patient underwent additional treatment for cement leak. One level was excluded as a result of severe motion artifacts that rendered angiographic CT nondiagnostic. Further analysis was performed in the remaining 27 patients (12 men; mean age, 62 years; age range, 31-87 y) corresponding to 48 vertebral levels. Seventeen patients were treated under general anesthesia (33 levels) and 11 were treated under conscious sedation (15 levels). To detect the presence of extraosseous cement, angiographic CT achieved sensitivity of 0.70 and 0.57 for reader 1 and reader 2, respectively, and specificity of 0.93 and 0.92, respectively. Stratified analyses by anesthesia type showed sensitivity of 0.73 and 0.50, respectively, for conscious sedation versus 0.67 and 0.62, respectively, for general anesthesia. Specificity was 1.00 and 1.00, respectively, versus 0.92 and 0.90, respectively. Conclusions: Cement leaks were detected with a high specificity and a moderate sensitivity with angiographic CT. No difference was found between treatments with general anesthesia versus intravenous conscious sedation.