Freehand Real-time MRI-guided lumbar spinal injection procedures at 1.5 T

Feasibility, accuracy, and safety

Jan Fritz, Christoph Thomas, Stephan Clasen, Claus D. Claussen, Jonathan S. Lewin, Phillipe L. Pereira

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purpose of this study was to test the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. MATERIALS AND METHODS. A retrospective analysis was made of spinal injection procedures performed over an 18-month period. Forty-nine procedures were performed on 37 patients (23 women, 14 men; mean age, 36 years; range, 18-48 years). A rapid FLASH 2D MRI sequence (TR/TE, 9.3/3.5; slice thickness, 5 mm; acquisition time, 1 second) was used for real-time needle placement with freehand technique. Data assessed were type of procedure, qualitative and quantitative image quality, dimensions of needle artifact, rate of successful drug delivery, rate of vascular uptake, time requirements, and occurrence of complications. RESULTS. Among the 49 procedures, 22 (45%) were nerve root injections, 18 (37%) were facet joint injections, and nine (18%) were epidural injections. The quality of real-time FLASH 2D MR images was sufficient in all cases. Contrast-to-noise ratios were sufficiently high for good delineation of relevant structures. The needle artifact made was remarkably constant with an average overestimation of length of 1.0 ± 0.2 [SD] mm. Drug delivery was successful in all selective nerve root injections and epidural injections. The rate of successful drug delivery was 89% (16 of 18) for facet joint injections. No complete intravascular injections occurred. The mean table time was 36 minutes (range, 23-75 minutes). The mean realtime MRI time was 38 seconds (range, 12-185 seconds). No major complications occurred. CONCLUSION. We accept the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. We note that real-time MRI guidance has the additional advantage of a complete absence of patient and operator exposure to ionizing radiation.

Original languageEnglish (US)
JournalAmerican Journal of Roentgenology
Volume192
Issue number4
DOIs
StatePublished - Apr 2009

Fingerprint

Spinal Injections
Safety
Injections
Needles
Epidural Injections
Zygapophyseal Joint
Artifacts
Pharmaceutical Preparations
Ionizing Radiation
Blood Vessels
Noise

Keywords

  • Epidural injection
  • Facet joint injection
  • Interventional MRI
  • Nerve root injection
  • Spinal injection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Freehand Real-time MRI-guided lumbar spinal injection procedures at 1.5 T : Feasibility, accuracy, and safety. / Fritz, Jan; Thomas, Christoph; Clasen, Stephan; Claussen, Claus D.; Lewin, Jonathan S.; Pereira, Phillipe L.

In: American Journal of Roentgenology, Vol. 192, No. 4, 04.2009.

Research output: Contribution to journalArticle

Fritz, Jan ; Thomas, Christoph ; Clasen, Stephan ; Claussen, Claus D. ; Lewin, Jonathan S. ; Pereira, Phillipe L. / Freehand Real-time MRI-guided lumbar spinal injection procedures at 1.5 T : Feasibility, accuracy, and safety. In: American Journal of Roentgenology. 2009 ; Vol. 192, No. 4.
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abstract = "OBJECTIVE. The purpose of this study was to test the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. MATERIALS AND METHODS. A retrospective analysis was made of spinal injection procedures performed over an 18-month period. Forty-nine procedures were performed on 37 patients (23 women, 14 men; mean age, 36 years; range, 18-48 years). A rapid FLASH 2D MRI sequence (TR/TE, 9.3/3.5; slice thickness, 5 mm; acquisition time, 1 second) was used for real-time needle placement with freehand technique. Data assessed were type of procedure, qualitative and quantitative image quality, dimensions of needle artifact, rate of successful drug delivery, rate of vascular uptake, time requirements, and occurrence of complications. RESULTS. Among the 49 procedures, 22 (45{\%}) were nerve root injections, 18 (37{\%}) were facet joint injections, and nine (18{\%}) were epidural injections. The quality of real-time FLASH 2D MR images was sufficient in all cases. Contrast-to-noise ratios were sufficiently high for good delineation of relevant structures. The needle artifact made was remarkably constant with an average overestimation of length of 1.0 ± 0.2 [SD] mm. Drug delivery was successful in all selective nerve root injections and epidural injections. The rate of successful drug delivery was 89{\%} (16 of 18) for facet joint injections. No complete intravascular injections occurred. The mean table time was 36 minutes (range, 23-75 minutes). The mean realtime MRI time was 38 seconds (range, 12-185 seconds). No major complications occurred. CONCLUSION. We accept the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. We note that real-time MRI guidance has the additional advantage of a complete absence of patient and operator exposure to ionizing radiation.",
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AU - Lewin, Jonathan S.

AU - Pereira, Phillipe L.

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N2 - OBJECTIVE. The purpose of this study was to test the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. MATERIALS AND METHODS. A retrospective analysis was made of spinal injection procedures performed over an 18-month period. Forty-nine procedures were performed on 37 patients (23 women, 14 men; mean age, 36 years; range, 18-48 years). A rapid FLASH 2D MRI sequence (TR/TE, 9.3/3.5; slice thickness, 5 mm; acquisition time, 1 second) was used for real-time needle placement with freehand technique. Data assessed were type of procedure, qualitative and quantitative image quality, dimensions of needle artifact, rate of successful drug delivery, rate of vascular uptake, time requirements, and occurrence of complications. RESULTS. Among the 49 procedures, 22 (45%) were nerve root injections, 18 (37%) were facet joint injections, and nine (18%) were epidural injections. The quality of real-time FLASH 2D MR images was sufficient in all cases. Contrast-to-noise ratios were sufficiently high for good delineation of relevant structures. The needle artifact made was remarkably constant with an average overestimation of length of 1.0 ± 0.2 [SD] mm. Drug delivery was successful in all selective nerve root injections and epidural injections. The rate of successful drug delivery was 89% (16 of 18) for facet joint injections. No complete intravascular injections occurred. The mean table time was 36 minutes (range, 23-75 minutes). The mean realtime MRI time was 38 seconds (range, 12-185 seconds). No major complications occurred. CONCLUSION. We accept the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. We note that real-time MRI guidance has the additional advantage of a complete absence of patient and operator exposure to ionizing radiation.

AB - OBJECTIVE. The purpose of this study was to test the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. MATERIALS AND METHODS. A retrospective analysis was made of spinal injection procedures performed over an 18-month period. Forty-nine procedures were performed on 37 patients (23 women, 14 men; mean age, 36 years; range, 18-48 years). A rapid FLASH 2D MRI sequence (TR/TE, 9.3/3.5; slice thickness, 5 mm; acquisition time, 1 second) was used for real-time needle placement with freehand technique. Data assessed were type of procedure, qualitative and quantitative image quality, dimensions of needle artifact, rate of successful drug delivery, rate of vascular uptake, time requirements, and occurrence of complications. RESULTS. Among the 49 procedures, 22 (45%) were nerve root injections, 18 (37%) were facet joint injections, and nine (18%) were epidural injections. The quality of real-time FLASH 2D MR images was sufficient in all cases. Contrast-to-noise ratios were sufficiently high for good delineation of relevant structures. The needle artifact made was remarkably constant with an average overestimation of length of 1.0 ± 0.2 [SD] mm. Drug delivery was successful in all selective nerve root injections and epidural injections. The rate of successful drug delivery was 89% (16 of 18) for facet joint injections. No complete intravascular injections occurred. The mean table time was 36 minutes (range, 23-75 minutes). The mean realtime MRI time was 38 seconds (range, 12-185 seconds). No major complications occurred. CONCLUSION. We accept the hypothesis that freehand real-time MRI-guided lumbar spinal injection procedures are feasible, accurate, and safe when performed with a clinical open-bore 1.5-T MRI system. We note that real-time MRI guidance has the additional advantage of a complete absence of patient and operator exposure to ionizing radiation.

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KW - Facet joint injection

KW - Interventional MRI

KW - Nerve root injection

KW - Spinal injection

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