{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:11:56Z","timestamp":1785337916958,"version":"3.55.0"},"reference-count":22,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tomography"],"abstract":"<jats:p>Background: Although magnetic resonance imaging (MRI) provides excellent soft-tissue contrast for most spinal evaluations, computed tomography (CT) is still always required for preoperative planning to assess osseous anatomy and determine surgical device size, increasing the radiation exposure and workflow complexity. CT-like images enable visualization of precise bone morphology without ionizing radiation. In addition, these images often provide CT myelography-like contrasts, allowing the simultaneous depiction of the spinal canal area (SCA). This study aimed to evaluate whether CT-like images provide measurement accuracy equivalent to conventional CT and MRI for pedicle screw planning and spinal canal area assessment. Methods: We retrospectively analyzed paired lumbar CT and MRI datasets obtained within \u22641 month in 51 patients. Pedicle width and length were measured on CT and CT-like images, whereas SCA was measured on T2 weighed-images and CT-like images. A total of 224 vertebrae were analyzed. Annotated images were independently evaluated by two readers in a randomized order. Inter-modality agreement was assessed using intraclass correlation coefficients (ICCs) and a Bland\u2013Altman analysis. Results: CT-like images demonstrated an excellent agreement with CT for pedicle measurements (ICCs: 0.968\u20130.985 for width; 0.922\u20130.966 for length). Mean differences were \u22640.1 mm for pedicle width and approximately 1 mm for pedicle length, which are unlikely to affect screw selection. The agreement with T2WI for SCA was good to excellent (ICCs: 0.766\u20130.945). Conclusions: CT-like images provide comparable performance for quantitative pedicle assessment and show high agreement for SCA evaluation, supporting comprehensive preoperative assessment with a single MRI examination.<\/jats:p>","DOI":"10.3390\/tomography12030040","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:30:32Z","timestamp":1773671432000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnostic Performance of CT-like Images for Lumbar Pedicle Screw Planning and Spinal Canal Area Measurement: A Comparative Study with Conventional CT and MRI"],"prefix":"10.3390","volume":"12","author":[{"given":"Akira","family":"Ogihara","sequence":"first","affiliation":[{"name":"Department of Radiology, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7196-1413","authenticated-orcid":false,"given":"Takeshi","family":"Fukuda","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1682-2749","authenticated-orcid":false,"given":"Shunsuke","family":"Katsumi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5573-6299","authenticated-orcid":false,"given":"Hiroya","family":"Ojiri","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Jikei University School of Medicine, Minato-ku, Tokyo 105-8461, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.wneu.2012.03.011","article-title":"Worldwide survey on the use of navigation in spine surgery","volume":"79","author":"Lam","year":"2013","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1002\/jmri.28067","article-title":"Magnetic Resonance Imaging Versus Computed Tomography for Three-Dimensional Bone Imaging of Musculoskeletal Pathologies: A Review","volume":"56","author":"Florkow","year":"2022","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1007\/s11604-023-01449-4","article-title":"Magnetic resonance bone imaging: Applications to vertebral lesions","volume":"41","author":"Tsuchiya","year":"2023","journal-title":"Jpn. J. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E13","DOI":"10.3171\/2020.10.FOCUS20801","article-title":"Magnetic resonance imaging-based synthetic computed tomography of the lumbar spine for surgical planning: A clinical proof-of-concept","volume":"50","author":"Staartjes","year":"2021","journal-title":"Neurosurg. Focus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"671","DOI":"10.14444\/7098","article-title":"Comparison of Preoperative Pedicle Screw Measurement Between Computed Tomography and Magnet Resonance Imaging","volume":"14","author":"Omar","year":"2020","journal-title":"Int. J. Spine Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e369","DOI":"10.1016\/j.wneu.2021.05.108","article-title":"Impact of Screw Diameter on Pedicle Screw Fatigue Strength-A Biomechanical Evaluation","volume":"152","author":"Viezens","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"566","DOI":"10.31616\/asj.2020.0353","article-title":"Impact of Screw Diameter and Length on Pedicle Screw Fixation Strength in Osteoporotic Vertebrae: A Finite Element Analysis","volume":"15","author":"Matsukawa","year":"2021","journal-title":"Asian Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"936","DOI":"10.31616\/asj.2018.0276","article-title":"The Optimal Screw Length of Lumbar Pedicle Screws during Minimally Invasive Surgery Fixation: A Computed Tomography-Guided Evaluation of 771 Screws","volume":"13","author":"Chua","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"132","DOI":"10.14444\/6018","article-title":"Currently Adopted Criteria for Pedicle Screw Diameter Selection","volume":"13","author":"Solitro","year":"2019","journal-title":"Int. J. Spine Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4103\/isj.isj_4_24","article-title":"A Narrative Review on Pedicle Screw Instrumentation in the Lumbar Spine","volume":"8","author":"Anil","year":"2025","journal-title":"Indian Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1016\/j.spinee.2022.01.006","article-title":"Comparison of differences and random errors in pedicle diameter measurements between MRI and CT: Observational study of 315 pedicles in Lenke type 1 adolescent idiopathic scoliosis patients","volume":"22","author":"Hatakenaka","year":"2022","journal-title":"Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1148\/radiol.12111930","article-title":"Radiologic criteria for the diagnosis of spinal stenosis: Results of a Delphi survey","volume":"264","author":"Mamisch","year":"2012","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1097\/BRS.0b013e3181d359bd","article-title":"Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images","volume":"35","author":"Schizas","year":"2010","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3109\/17453674.2011.566150","article-title":"Correlation between disability and MRI findings in lumbar spinal stenosis: A prospective study of 109 patients operated on by decompression","volume":"82","author":"Sigmundsson","year":"2011","journal-title":"Acta Orthop."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1097\/BRS.0b013e318060a5f5","article-title":"The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis","volume":"32","author":"Ogikubo","year":"2007","journal-title":"Spine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"403","DOI":"10.3171\/2010.3.SPINE09657","article-title":"A retrospective analysis of pedicle screws in contact with the great vessels","volume":"13","author":"Foxx","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3171\/2008.10.SPI08383","article-title":"Placement of thoracolumbar pedicle screws using three-dimensional image guidance: Experience in a large patient cohort","volume":"10","author":"Nottmeier","year":"2009","journal-title":"J. Neurosurg. Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E133","DOI":"10.1097\/BSD.0000000000000178","article-title":"Biomechanical evaluation of the pedicle screw insertion depth effect on screw stability under cyclic loading and subsequent pullout","volume":"28","author":"Karami","year":"2015","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Zhang, L., Tian, N., Yang, J., Ni, W., and Jin, L. (2020). Risk of pedicle and spinous process violation during cortical bone trajectory screw placement in the lumbar spine. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03535-4"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s00276-021-02707-8","article-title":"Thoracic and lumbar spine pedicle morphology in Japanese patients","volume":"43","author":"Morita","year":"2021","journal-title":"Surg. Radiol. Anat."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1302\/0301-620X.92B8.24237","article-title":"The biomechanics of pedicle screw-based instrumentation","volume":"92","author":"Cho","year":"2010","journal-title":"J. Bone Jt. Surg. Br. Vol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/s00586-008-0646-5","article-title":"Degenerative lumbar spinal stenosis: Correlation with Oswestry Disability Index and MR imaging","volume":"17","author":"Sirvanci","year":"2008","journal-title":"Eur. Spine J."}],"container-title":["Tomography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2379-139X\/12\/3\/40\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:57:47Z","timestamp":1773673067000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2379-139X\/12\/3\/40"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,16]]},"references-count":22,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["tomography12030040"],"URL":"https:\/\/doi.org\/10.3390\/tomography12030040","relation":{},"ISSN":["2379-139X"],"issn-type":[{"value":"2379-139X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,16]]}}}