Rosiak Grzegorz, Lusakowska Anna, Milczarek Krzysztof, Konecki Dariusz, Fraczek Anna, Rowinski Olgierd, Kostera-Pruszczyk Anna
II Department of Radiology, Warsaw Medical University, Banacha 1a, 02-097, Warszawa, Poland.
Department of Neurology, Warsaw Medical University, Banacha 1a, 02-097, Warszawa, Poland.
Neuroradiology. 2021 Apr;63(4):539-545. doi: 10.1007/s00234-021-02643-9. Epub 2021 Jan 29.
Intrathecal injection of nusinersen is an approved treatment of spinal muscular atrophy (SMA). CT-guided injection is a method of nusinersen administration in patients with severe scoliosis, in whom standard lumbar puncture is not feasible. The injections are repeated every 4 months for life, and accumulated radiation doses absorbed by the patient can increase the risk of cancer. In this study, we present the results of CT-guided intrathecal nusinersen injections with an ultra-low radiation dose protocol.
Eighteen patients (15 adults and three children) in whom standard lumbar puncture was not feasible due to severe scoliosis or spinal stabilization were included in this retrospective study. The first 23 injections were performed with a standard radiation dose protocol and the next 42 injections with an ultra-low-dose protocol. The radiation doses, measured as total dose length product (DLP), were acquired and compared between the protocols.
Injections were successful in 100% of patients with both ultra-low-dose and standard protocols. The radiation dose, measured as DLP, was 111.2-1100.7 (Me = 248.1) mGycm for the standard protocol. For the ultra-low-dose protocol, the dose range was 5.0-54.4 (Me = 26.7) mGycm, which was significantly lower than with the standard protocol (p < 0.001, η = 0.67).
Radiation doses can be significantly decreased in the CT-guided injection of nusinersen. The proposed protocol allows for effective CT-guided intrathecal nusinersen administration in patients with SMA and severe scoliosis.
鞘内注射诺西那生钠是脊髓性肌萎缩症（SMA）的一种获批治疗方法。CT引导下注射是在严重脊柱侧弯患者中给予诺西那生钠的一种方法，这些患者无法进行标准腰椎穿刺。注射需每4个月重复进行一次，直至终身，患者累积吸收的辐射剂量会增加患癌风险。在本研究中，我们展示了采用超低辐射剂量方案进行CT引导下鞘内注射诺西那生钠的结果。
本回顾性研究纳入了18例因严重脊柱侧弯或脊柱固定而无法进行标准腰椎穿刺的患者（15例成人和3例儿童）。前23次注射采用标准辐射剂量方案，接下来42次注射采用超低剂量方案。获取以总剂量长度乘积（DLP）衡量的辐射剂量，并在两种方案之间进行比较。
超低剂量方案和标准方案的注射在所有患者中均成功。标准方案以DLP衡量的辐射剂量为111.2 - 1100.7（中位数=248.1）mGycm。超低剂量方案的剂量范围为5.0 - 54.4（中位数=26.7）mGycm，显著低于标准方案（p<0.001，η=0.67）。
在CT引导下注射诺西那生钠时，辐射剂量可显著降低。所提出的方案能够在患有SMA和严重脊柱侧弯的患者中有效地进行CT引导下鞘内注射诺西那生钠。
