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Study Design Retrospective cohort study Objective Given changes in bone density induced by degenerative disease, general measures of bone health (ie DEXA) are inadequate to evaluate bone density in surgical areas of interest. Regional differences in HU in the cervical spine may influence surgical strategies. The purposes of our study were to determine whether cervical Hounsfield units (HU) vary by level, examine their relationship with age, comorbidities, and alignment, and propose a technique to measure HU in the lateral masses. Methods Two hundred twenty-four patients with degenerative spine pathology with a cervical computed tomography were included (2015-2019). Measurements were performed in each vertebral body (C2-T1; mid-axial, anterior-axial, posterior-axial, mid-coronal, and mid-sagittal) and 2 regions of the lateral masses (C3-C6; mid-cor, mid-sag). To evaluate reliability, 6 observers each measured 355 HU values, inter-relater reliability assessed with intraclass correlation coefficients Correlations of HU with age, BMI, comorbidities, and cervical alignment were evaluated. Results Bone density differed by level, with the lowest HU scores in the lower cervical spine (C6-T1) ( P < .001). No correlations were found between LM HU and age, BMI, CCI, or alignment ( P > .05). Increased kyphosis was weakly correlated with VB HU, while age and CCI showed moderate correlations with VB HU at all levels (P<.001). ICC for HU measurements were good to excellent for the VBs, but poor to moderate for the LMs. Conclusion Bone is least dense in the lower cervical spine. HU scoring is not reliable in the lateral masses. We recommend that a level-specific approach to bone density is considered in surgical planning.

Objective We evaluate the clinical feasibility of a portable, low‐field magnetic resonance imaging (MRI) system for prostate cancer (PCa) biopsy. Methods A retrospective analysis of men who underwent a 12‐core systematic transrectal ultrasound‐guided prostate biopsy (SB) and a low‐field MRI guided transperineal targeted biopsy (MRI‐TB). Comparison of the detection of clinically significant PCa (csPCa) (Gleason Grade [GG] ≥ 2) by SB and low field MRI‐TB, stratified by Prostate Imaging Reporting & Data System (PI‐RADS) score, prostate volume, and prostate serum antigen (PSA) was performed. Results A total of 39 men underwent both the MRI‐TB and SB biopsy. Median (interquartile range [IQR]) age was 69.0 (61.5−73) years, body mass index (BMI) was 28.9 kg/m2 (25.3–34.3), prostate volume was 46.5 cc (32−72.7), and PSA was 9.5 ng/ml (5.5−13.2). The majority (64.4%) of patients had PI‐RADS ≥ 4 lesions and 25% of lesions were anterior on pre‐biopsy MRII. Cancer detection rate (CDR) was greatest when combining SB and MRI‐TB (64.1%). MRI‐TB detected 74.3% (29/39) cancers. Of which, 53.8% (21/39) were csPCa while SB detected 42.5% (17/39) csPCa (p = 0.21). In 32.5% (13/39) of cases, MRI‐TB upstaged the final diagnosis, compared to 15% (6/39) of cases in which SB upstaged the final diagnosis (p = 0.11). Conclusion Low‐field MRI‐TB is clinically feasible. Although future studies on the accuracy of MRI‐TB system are needed, the initial CDR is comparable to those seen with fusion‐based prostate biopsies. A transperineal and targeted approach may be beneficial in patients with higher BMI and anterior lesions.

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