Department of Radiology, Charité, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Eur Radiol. 2010 Feb;20(2):395-403. doi: 10.1007/s00330-009-1567-3. Epub 2009 Sep 2.
We prospectively evaluated the feasibility and technical features of MR-guided lumbosacral injection procedures in open high-field MRI at 1.0 T.
In a CuSO(4).5H(2)O phantom and five human cadaveric spines, fluoroscopy sequences (proton-density-weighted turbo spin-echo (PDw TSE), T1w TSE, T2w TSE; balanced steady-state free precession (bSSFP), T1w gradient echo (GE), T2w GE) were evaluated using two MRI-compatible 20-G Chiba-type needles. Artefacts were analysed by varying needle orientation to B(0), frequency-encoding direction and slice orientation. Image quality was described using the contrast-to-noise ratio (CNR). Subsequently, a total of 183 MR-guided nerve root (107), facet (53) and sacroiliac joint (23) injections were performed in 53 patients.
In vitro, PDw TSE sequence yielded the best needle-tissue contrasts (CNR = 45, 18, 15, 9, and 8 for needle vs. fat, muscle, root, bone and sclerosis, respectively) and optimal artefact sizes (width and tip shift less than 5 mm). In vivo, PDw TSE sequence was sufficient in all cases. The acquisition time of 2 s facilitated near-real-time MRI guidance. Drug delivery was technically successful in 100% (107/107), 87% (46/53) and 87% (20/23) of nerve root, facet and sacroiliac joint injections, respectively. No major complications occurred. The mean procedure time was 29 min (range 19-67 min).
MR-guided spinal injections in open high-field MRI are feasible and accurate using fast TSE sequence designs.
我们前瞻性地评估了在 1.0 T 开放式高场 MRI 下进行 MR 引导腰骶部注射的可行性和技术特点。
在 CuSO4.5H2O 水模和五具人体尸体脊柱中，使用两种与 MRI 兼容的 20-G 奇巴型针，评估了透视序列（质子密度加权涡轮自旋回波（PDw TSE）、T1w TSE、T2w TSE；平衡稳态自由进动（bSSFP）、T1w 梯度回波（GE）、T2w GE）。通过改变针相对于 B0 的方向、频率编码方向和层面方向来分析伪影。使用对比度噪声比（CNR）描述图像质量。随后，在 53 名患者中总共进行了 183 次 MR 引导的神经根（107 次）、关节突（53 次）和骶髂关节（23 次）注射。
在体外，PDw TSE 序列产生了最佳的针组织对比度（CNR 分别为针与脂肪、肌肉、神经根、骨骼和硬化的 45、18、15、9 和 8）和最佳的伪影大小（宽度和尖端移位小于 5 毫米）。在体内，PDw TSE 序列在所有情况下都足够。2 秒的采集时间促进了近乎实时的 MRI 引导。神经根、关节突和骶髂关节注射的药物输送在技术上均 100%（107/107）、87%（46/53）和 87%（20/23）成功。没有发生重大并发症。平均手术时间为 29 分钟（19-67 分钟）。
在开放式高场 MRI 下使用快速 TSE 序列设计进行 MR 引导的脊柱注射是可行且准确的。
