Bone-enhanced 3D ultrasound: a non-ionizing alternative for pediatric scoliosis assessment.

Abstract

Scoliosis affects up to 5% of the population, and early detection is crucial to prevent progression and surgical intervention. X-ray imaging remains the standard for scoliosis assessment, but repeated exposure to ionizing radiation increases cancer risks, particularly in pediatric patients. This study evaluates bone-enhanced 3D ultrasound (BEUS) as a non-ionizing alternative for scoliosis measurement. We conducted a comparative analysis of X-ray and BEUS measurements in 34 pediatric patients. Each participant underwent same-day spinal imaging with both modalities. Scoliosis angles were measured independently by two observers using anatomical landmarks visible in both imaging modalities. Statistical tests assessed agreement between X-ray and BEUS, inter-observer variability, and potential biases. Minimal inter-observer variability was found (intraclass correlation coefficient = 0.98). 93% of BEUS measurements fell within a clinically acceptable ± 5° range of X-ray values. Regression analysis identified age and scoliosis severity as significant predictors of measurement differences (p < 0.05). In particular, error increased with scoliosis severity, with curvatures above 40° showing significant deviation. BEUS is a promising alternative for scoliosis assessment, demonstrating strong reliability for mild to moderate cases while eliminating radiation exposure. BEUS holds potential for routine scoliosis monitoring, reducing reliance on X-rays and minimizing radiation risk in pediatric patients.