Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.290
Peer-review started: February 27, 2014
First decision: April 28, 2014
Revised: August 15, 2014
Accepted: September 4, 2014
Article in press: September 10, 2014
Published online: March 18, 2015
AIM: To summarise and compare currently available evidence regarding accuracy of pre-operative imaging, which is one of the key choices for surgeons contemplating patient-specific instrumentation (PSI) surgery.
METHODS: The MEDLINE and EMBASE medical literature databases were searched, from January 1990 to December 2013, to identify relevant studies. The data from several clinical studies was assimilated to allow appreciation and comparison of the accuracy of each modality. The overall accuracy of each modality was calculated as proportion of outliers > 3% in the coronal plane of both computerised tomography (CT) or magnetic resonance imaging (MRI).
RESULTS: Seven clinical studies matched our inclusion criteria for comparison and were included in our study for statistical analysis. Three of these reported series using MRI and four with CT. Overall percentage of outliers > 3% in patients with CT-based PSI systems was 12.5% vs 16.9% for MRI-based systems. These results were not statistically significant.
CONCLUSION: Although many studies have been undertaken to determine the ideal pre-operative imaging modality, conclusions remain speculative in the absence of long term data. Ultimately, information regarding accuracy of CT and MRI will be the main determining factor. Increased accuracy of pre-operative imaging could result in longer-term savings, and reduced accumulated dose of radiation by eliminating the need for post-operative imaging and revision surgery.
Core tip: At present there is not enough published data to convincingly conclude in favour of computerised tomography (CT) or magnetic resonance imaging for accuracy of pre-operative imaging in patient-specific instrumentation. We recommend CT as a more favourable option at present due to reduced scanning times, increased availability, and relatively cheaper cost.