• Takaki Inoue, Satoshi Maki, Hajime Yokota, Takeo Furuya, Takafumi Yoda, Koji Matsumoto, Atsushi Yunde, Masataka Miura, Yuki Shiratani, Yuki Nagashima, Juntaro Maruyama, Masahiro Inoue, Yasuhiro Shiga, Kazuhide Inage, Sumihisa Orita, Yoshitada Masuda, Takashi Uno, Masashi Yamazaki, and Seiji Ohtori.
• Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
• World Neurosurg. 2024 Jul 1; 187: e166e173e166-e173.

ObjectiveVertebral artery (VA) injury poses a significant risk in cervical spine surgery, necessitating accurate preoperative assessment. This study aims to introduce and validate a novel approach that combines the Fast field echo that resembles a computed tomography using restricted echo spacing (FRACTURE) sequence with Time of Flight (TOF) Magnetic Resonance Angiography (MRA) for comprehensive evaluation of VA courses in the cervical spine.Materials And MethodsA total of eight healthy volunteers and two patients participated in this study. The FRACTURE sequence provided high-resolution bone images of the cervical spine, while TOF MRA offered non-invasive vascular imaging. Fusion images were created by merging FRACTURE and MRA modalities to simultaneously visualize cervical spine structures and VA courses. Board-certified orthopedic spine surgeons independently evaluated images to assess the visibility of anatomical characteristics of the VA course by Likert-scale.ResultsThe FRACTURE-MRA fusion images effectively depicted the extraosseous course of the VA at the craniovertebral junction, the intraosseous course of the VA at the craniovertebral junction, the VA entrance level to the transverse foramen, and the side-to-side asymmetry of bilateral VAs. Additionally, clinical cases demonstrated the utility of the proposed technique in identifying anomalies and guiding surgical interventions.ConclusionsThe integration of the FRACTURE sequence and TOF MRA presents a promising methodology for the precise evaluation of VA courses in the cervical spine. This approach improves preoperative planning for cervical spine surgery with detailed anatomy and is a valuable alternative to conventional methods without contrast agents.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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