MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking

Abstract

The purpose of this study was to evaluate the feasibility of the MRI-guided periradicular nerve root infiltration therapy. Sixty-seven nerve root infiltrations under MRI guidance were done for 61 patients suffering from lumbosacral radicular pain. Informed consent was acquired from all patients. A 0.23-T open-MRI scanner with interventional tools (Outlook Proview, Philips Medical Systems, MR Technologies, Finland) was used. A surface coil was used in all cases. Nerve root infiltration was performed with MRI-compatible 20-G needle (Chiba type MReye, Cook, Bloomington, Ind.; or Manan type, MD Tech, Florida). The evaluation of clinical outcome was achieved with 6 months of clinical follow-up and questionnaire. The effect of nerve root infiltration to the radicular pain was graded: 1=good to excellent, i.e., no pain or not disturbing pain allowing normal physical activity at 3 months from the procedure; 2=temporary, i.e., temporary relief of pain; 3=no relief of pain; and 4=worsening of pain. As an adjunct to MRI-guided positioning of the needle the correct needle localization by the nerve root was confirmed with saline injection to nerve root channel and single-shot fast spin echo (SSFSE) imaging. The MRI guidance allowed adequate needle positioning in all but 1 case (98.5%). This failure was caused by degeneration-induced changes in anatomy. Of patients, 51.5% had good to excellent effect with regard to radicular pain from the procedure, 22.7% had temporary relief, 21.2% had no effect, and in 4.5% the pain worsened. Our results show that MRI guidance is accurate and safe in performing nerve root infiltration at lumbosacral area. The results of radicular pain relief from nerve root infiltration are comparable to CT or fluoroscopy studies on the subject.

Real-time MR fluoroscopy-navigated lumbar facet joint injections: feasibility and technical properties

“…Various spine interventions have been successfully performed at open MR scanners [9][10][11][12]. However, MR fluoroscopy guidance [6,7,10,11] for Electronic supplementary material The online version of this article (doi:10.1007/ s00330-008-0890-4) contains supplementary material, which is available to authorized users. lumbar facet joint injections has not been described in detail.…”

Image-guided spinal injection procedures in open high-field MRI with vertical field orientation: feasibility and technical features

“…After the introduction of MRI systems suitable for MRguided interventions and of special MRI-compatible alloys, several studies on spinal injection therapy were performed in open low-field devices with promising results [13][14][15][16]. This study describes the feasibility of lumbosacral injection therapy in open high-field MRI.…”

“…There are, however, very few studies on MR-guided injection therapies. These were performed in open lowfield devices [13][14][15][16] or, more recently, in a wide-bore high-field MRI system [17,18]. So far, no studies of spinal injection therapy in an open high-field system with vertical field orientation have been described in the literature.…”

MR-gesteuerte Schmerztherapie: Prinzipien und klinische Applikationen

“…Das Risiko allergischer Reaktionen kann so reduziert werden, so wie auch eine potenzielle Irritation der Nervenwurzel durch einen neurotoxischen Effekt des Kontrastmittels selbst [56,57]. Eine grçßere Studie berichtet über 60 von 61 lumbale periradikuläre Wurzelinfiltrationen, die an einem offenen 0,23-T-MRT technisch erfolgreich durchgeführt werden konnten [58]. Eine erfolgreiche Nadelvisualisierung erfolgte mittels einer schnellen Gradienten-Echo-Sequenz (TR/TE/SL/Matrix/FoV = 95 ms/ 7 ms/7 mm/300 300/380 380 mm 2 ).…”

“…Postinterventionell berichteten 51,5 % der Patienten über eine komplette Schmerzreduktion, 34,4 % über eine einbis vierwçchige Schmerzreduktion, 11,4 % berichteten über keine ¾nderung der Symptomatik und bei einem Patienten trat eine temporäre Verschlechterung der Symptomatik auf. Der Literaturvergleich zeigt die MR-gesteuerte Infiltration lumbaler Nervenwurzeln [58,59] Nachteile der interventionellen MRT ! Ein Nachteil der iMRT war bisher die limitierte Verfügbarkeit offener MRT.…”