Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA.
Eur Radiol. 2013 Jan;23(1):235-45. doi: 10.1007/s00330-012-2569-0. Epub 2012 Jul 15.
To prospectively assess the technical performance of an augmented reality system for MR-guided spinal injection procedures.
The augmented reality system was used with a clinical 1.5-T MRI system. A total of 187 lumbosacral spinal injection procedures (epidural injection, spinal nerve root injection, facet joint injection, medial branch block, discography) were performed in 12 human cadavers. Needle paths were planned with the Perk Station module of 3D Slicer software on high-resolution MR images. Needles were placed under augmented reality MRI navigation. MRI was used to confirm needle locations. T1-weighted fat-suppressed MRI was used to visualise the injectant. Outcome variables assessed were needle adjustment rate, inadvertent puncture of non-targeted structures, successful injection rate and procedure time.
Needle access was achieved in 176/187 (94.1 %) targets, whereas 11/187 (5.9 %) were inaccessible. Six of 11 (54.5 %) L5-S1 disks were inaccessible, because of an axial obliquity of 30˚ (27˚-34˚); 5/11 (45.5 %) facet joints were inaccessible because of osteoarthritis or fusion. All accessible targets (176/187, 94.1 %) were successfully injected, requiring 47/176 (26.7 %) needle adjustments. There were no inadvertent punctures of vulnerable structures. Median procedure time was 10.2 min (5-19 min).
Image overlay navigated MR-guided spinal injections were technically accurate. Disks with an obliquity ≥27˚ may be inaccessible.
前瞻性评估增强现实系统在 MRI 引导下脊柱注射中的技术性能。
增强现实系统与临床 1.5T MRI 系统一起使用。在 12 具人体尸体上共进行了 187 例腰骶部脊柱注射（硬膜外注射、脊神经根注射、关节突关节注射、内侧支阻滞、椎间盘造影）。在 3D Slicer 软件的 Perk Station 模块上使用高分辨率 MRI 图像规划针道。将针放置在增强现实 MRI 导航下。使用 MRI 确认针的位置。使用 T1 加权脂肪抑制 MRI 可视化注射剂。评估的结果变量包括针调整率、意外穿刺非目标结构、注射成功率和手术时间。
187 个目标中有 176 个（94.1%）可以进入，而 11 个（5.9%）无法进入。由于轴向倾斜度为 30°（27°-34°），无法进入 6 个（54.5%）L5-S1 椎间盘；由于骨关节炎或融合，无法进入 5 个（45.5%）关节突关节。所有可进入的目标（176/187，94.1%）均成功注射，需要 47/176（26.7%）的针调整。没有对脆弱结构的意外穿刺。中位数手术时间为 10.2 分钟（5-19 分钟）。
图像叠加导航的 MRI 引导下脊柱注射技术准确。倾斜度≥27°的椎间盘可能无法进入。
