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MRI-based synthetic CT (sCT) eliminates the radiation exposure associated with the preoperative planning CT, while still providing detailed bony morphology. It may therefore offer a radiation-free method for pedicle screw navigation. Thus, the aim of this study was to compare the accuracy of thoracic and lumbar pedicle screw placement using 3D-printed guides based on conventional CT\n                      <jats:italic>versus<\/jats:italic>\n                      sCT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Full-spine MRI and CT images of four human cadaveric spines were obtained, followed by AI-generation of sCTs, the digital planning of pedicle screws and 3D-printed guide manufacturing. A total of 62\u00a0K-wires were inserted, 30 sCT-based and 32 CT-based. Accuracy was evaluated by superimpose analysis of planned and achieved trajectories, and by the postoperative grading of the cortical breach rate using the Gertzbein-Robbins classification, based on projected screws along the K-wires.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median translational entry-point deviations were 1.0\u00a0mm vertically and 0.5\u00a0mm horizontally for both sCT-based guides and CT-based guides. Angular deviations in the axial plane were 1.0\u02da for sCT and 0.9\u02da for CT. In the sagittal plane these were 1.8\u02da and 2.1\u02da, respectively. No significant differences were observed between sCT and CT. Grading of pedicle\u2019s cortical breach showed no severe malposition for both sCT- and CT-based guides.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>sCT matched the accuracy of conventional CT in providing source data for personalized 3D-printed guides for thoracic and lumbar pedicle screw placement in terms of translational- and angular deviations, and cortical breach rates in this cadaveric study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00586-025-09367-x","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:18:15Z","timestamp":1759418295000},"page":"2058-2066","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["CT vs. MRI-based synthetic CT: accuracy of thoracic and lumbar pedicle screw placement using 3D-printed guides"],"prefix":"10.1007","volume":"35","author":[{"given":"Jules","family":"Cool","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter P. 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