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3T 磁共振引导下腰椎和骶孔注射的临床疗效。

Clinical outcomes of 3T magnetic resonance imaging-guided lumbar and sacral foraminal injections.

机构信息

Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Division of Radiology, Geneva University Hospitals, Geneva, Switzerland.

出版信息

Neuroradiology. 2023 Dec;65(12):1793-1802. doi: 10.1007/s00234-023-03234-6. Epub 2023 Oct 17.

DOI:10.1007/s00234-023-03234-6
PMID:37848741
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10654205/
Abstract

PURPOSE

This article evaluates the feasibility, safety, and efficacy of MRI-guided lumbar or sacral nerve root infiltration for chronic back pain. We compared the outcomes of our MRI-guided infiltrations with data from CT-guided infiltrations reported in the literature and explored the potential advantages of MRI guidance.

METHOD

Forty-eight MRI-guided nerve root infiltrations were performed using a 3 T MRI machine. The optimal needle path was determined using breathhold T2-weighted sequences, and the needle was advanced under interleaved guidance based on breathhold PD-weighted images. Pain levels were assessed using a numeric rating scale (NRS) before the procedure and up to 5 months after, during follow-up. Procedure success was evaluated by comparing patients' pain levels before and after the infiltration.

RESULTS

The MRI-guided infiltrations yielded pain reduction 1 week after the infiltration in 92% of cases, with an average NRS substantial change of 3.9 points. Pain reduction persisted after 5 months for 51% of procedures. No procedure-related complications occurred. The use of a 22G needle and reconstructed subtraction images from T2 FatSat sequences improved the workflow.

CONCLUSION

Our study showed that MRI-guided nerve root infiltration is a feasible, safe, and effective treatment option for chronic back pain. Precise positioning of the needle tip and accurate distribution of the injected solution contributed to the effectiveness of MRI-guided infiltration, which appeared to be as accurate as CT-guided procedures. Further research is needed to explore the potential benefits of metal artifact reduction sequences to optimize chronic back pain management.

摘要

目的

本文评估了 MRI 引导下腰椎或骶神经根浸润术治疗慢性腰痛的可行性、安全性和疗效。我们将我们的 MRI 引导下浸润术的结果与文献中报告的 CT 引导下浸润术的数据进行了比较，并探讨了 MRI 引导的潜在优势。

方法

使用 3T MRI 机进行了 48 例 MRI 引导下的神经根浸润术。使用屏气 T2 加权序列确定最佳进针路径，根据屏气 PD 加权图像进行交错引导进针。在术前和术后 5 个月的随访期间，使用数字评分量表（NRS）评估疼痛程度。通过比较浸润前后患者的疼痛程度来评估手术成功率。

结果

MRI 引导下的浸润术在 92%的病例中在浸润后 1 周内减轻了疼痛，平均 NRS 显著变化为 3.9 分。51%的病例在 5 个月后仍有疼痛减轻。无手术相关并发症发生。使用 22G 针和 T2 FatSat 序列重建的减影图像改善了工作流程。

结论

我们的研究表明，MRI 引导下神经根浸润术是治疗慢性腰痛的一种可行、安全且有效的治疗选择。针尖的精确定位和注入溶液的准确分布有助于 MRI 引导下浸润术的有效性，其准确性似乎与 CT 引导下的程序相当。需要进一步研究来探讨金属伪影减少序列的潜在益处，以优化慢性腰痛的管理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/f60b07786b91/234_2023_3234_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/2148853086f1/234_2023_3234_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/c15e1e4e2232/234_2023_3234_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/f60b07786b91/234_2023_3234_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/2148853086f1/234_2023_3234_Fig1_HTML.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/c15e1e4e2232/234_2023_3234_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/70cd/10654205/f60b07786b91/234_2023_3234_Fig7_HTML.jpg

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