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In vivo feasibility of real-time MR–US fusion imaging lumbar facet joint injections

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Abstract

Objectives

Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation.

Methods

Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients’ pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks.

Results

All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intra-articular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed.

Conclusions

Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease.

Sommario

Obiettivi

Tradizionalmente, le iniezioni delle faccette articolari (FJI) sono state eseguite sotto guida fluoroscopica o tomografia computerizzata (TC), principalmente a causa della posizione anatomica profonda e la presenza di reperi ossei. L’imaging di fusione permette di accoppiare le immagine ecografiche con quelle TC o di risonanza magnetica (RM) corrispondenti, ottenute da un precedente esame diagnostico e riformattate in tempo reale in base al piano di scansione ecografico. Questa tecnica permette di coniugare la visione panoramica e l’elevato dettaglio anatomico della RM o TC con la praticità della guida ecografica senza ulteriore esposizione del paziente a radiazioni ionizzanti.

Metodi

Trentotto pazienti (24 femmine, età media ± DS: 64 ± 9 anni) hanno ricevuto FJI guidata da fusione ecografia-RM di 1 ml di una miscela di anestetico locale e corticosteroide utilizzando una apparecchiatura ecografica (Logiq E9, GE Healthcare) dotata di tecnologia fusion. Nei primi 28 pazienti il posizionamento dell’ago è stato confermato mediante esame TC a bassa dose. Il dolore dei pazienti è stato registrato utilizzando una scala analogica visiva (VAS), al tempo 0 e dopo 2, 4 e 8 settimane.

Risultati

Tutte le iniezioni fusion guidate sono state eseguite con successo. In 96 su 112 iniezioni è stato raggiunto lo spazio intra-articolare (precisione: 85,7%). La VAS è diminuita significativamente dopo la procedura in tutti i pazienti, senza differenze tra chi ha ricevuto il controllo CT del posizionamento degli aghi e chi non lo ha ricevuto. Non sono state osservate complicanze maggiori.

Conclusioni

L’iniezione fusion ecografia-RM guidata delle faccette articolari artrosiche rappresenta una opzione terapeutica sicura ed efficace.

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Authors and Affiliations

  1. Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy

    Riccardo Sartoris, Alice Arcidiacono, Silvia Perugin Bernardi & Simone Schiaffino

  2. S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100, Genoa, Italy

    Davide Orlandi, Giovanni Turtulici, Pietro Caruso & Enzo Silvestri

  3. Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Angelo Corazza & Luca Maria Sconfienza

  4. Scuola di dottorato in Neuroscienze, Università degli Studi di Genova, Genoa, Italy

    Angelo Corazza

  5. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy

    Luca Maria Sconfienza

Authors
  1. Riccardo Sartoris
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  2. Davide Orlandi
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  3. Angelo Corazza
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  4. Luca Maria Sconfienza
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  5. Alice Arcidiacono
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  7. Simone Schiaffino
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  8. Giovanni Turtulici
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  9. Pietro Caruso
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  10. Enzo Silvestri
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Corresponding author

Correspondence to Davide Orlandi.

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Conflict of interest

The authors have no conflict of interest to disclose.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. The present study was approved by the Institutional review board.

Informed consent

Informed patients’ consent was obtained for the present study.

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Sartoris, R., Orlandi, D., Corazza, A. et al. In vivo feasibility of real-time MR–US fusion imaging lumbar facet joint injections. J Ultrasound 20, 23–31 (2017). https://doi.org/10.1007/s40477-016-0233-2

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  • DOI: https://doi.org/10.1007/s40477-016-0233-2

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