Advertisement

CardioVascular and Interventional Radiology

, Volume 36, Issue 3, pp 748–755 | Cite as

Saline as the Sole Contrast Agent for Successful MRI-guided Epidural Injections

  • Martin DeliEmail author
  • Jan Fritz
  • Serban Mateiescu
  • Martin Busch
  • John A. Carrino
  • Jan Becker
  • Marietta Garmer
  • Dietrich Grönemeyer
Clinical Investigation

Abstract

Purpose

To assess the performance of sterile saline solution as the sole contrast agent for percutaneous magnetic resonance imaging (MRI)-guided epidural injections at 1.5 T.

Methods

A retrospective analysis of two different techniques of MRI-guided epidural injections was performed with either gadolinium-enhanced saline solution or sterile saline solution for documentation of the epidural location of the needle tip. T1-weighted spoiled gradient echo (FLASH) images or T2-weighted single-shot turbo spin echo (HASTE) images visualized the test injectants. Methods were compared by technical success rate, image quality, table time, and rate of complications.

Results

105 MRI-guided epidural injections (12 of 105 with gadolinium-enhanced saline solution and 93 of 105 with sterile saline solution) were performed successfully and without complications. Visualization of sterile saline solution and gadolinium-enhanced saline solution was sufficient, good, or excellent in all 105 interventions. For either test injectant, quantitative image analysis demonstrated comparable high contrast-to-noise ratios of test injectants to adjacent body substances with reliable statistical significance levels (p < 0.001). The mean table time was 22 ± 9 min in the gadolinium-enhanced saline solution group and 22 ± 8 min in the saline solution group (p = 0.75).

Conclusion

Sterile saline is suitable as the sole contrast agent for successful and safe percutaneous MRI-guided epidural drug delivery at 1.5 T.

Keywords

MRI/MRA Nonvascular interventions Pain Spine/nervous system 

Notes

Acknowledgments

We thank Silke Lange for her support in the statistical data analysis and Aliki Papathanassiou for her support as a second rater in the interrater reliability test of the qualitative assessment.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Riew KD, Yin Y, Gilula L et al (2000) The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am 82:1589–1593PubMedGoogle Scholar
  2. 2.
    Groenemeyer DHW, Seibel RMM (1990) Interventional computed tomography. Blackwell, OxfordGoogle Scholar
  3. 3.
    Richards RJ, George J, Metelko M et al (2010) Spine computed tomography doses and cancer induction. Spine 35:1–4CrossRefGoogle Scholar
  4. 4.
    Groenemeyer D, Seibel RM, Kaufmann L (1990) Interventional procedures in low field magnetic resonance imaging. Diagn Imaging 11:32–36Google Scholar
  5. 5.
    Lufkin R, Teresi L, Hanafee W (1987) New needle for MR-guided aspiration cytology of the head and neck. AJR Am J Roentgenol 149:380–382PubMedCrossRefGoogle Scholar
  6. 6.
    Mueller PR, Stark DD, Simeone JF et al (1986) MR-guided aspiration biopsy: needle design and clinical trials. Radiology 161:605–609PubMedGoogle Scholar
  7. 7.
    Busch M, Bornstedt A, Wendt M et al (1998) Fast “real time” imaging with different k-space update strategies for interventional procedures. J Magn Reson Imaging 8:944–954PubMedCrossRefGoogle Scholar
  8. 8.
    Yutzy SR, Duerk JL (2008) Pulse sequences and system interfaces for interventional and real-time MRI. J Magn Reson Imaging 27:267–275PubMedCrossRefGoogle Scholar
  9. 9.
    Smith KA, Carrino J (2008) MRI-guided interventions of the musculoskeletal system. J Magn Reson Imaging 27:339–346PubMedCrossRefGoogle Scholar
  10. 10.
    Lewin JS, Duerk JL, Jain VR et al (1996) Needle localization in MR-guided biopsy and aspiration: effects of field strength, sequence design, and magnetic field orientation. AJR Am J Roentgenol 166:1337–1345PubMedCrossRefGoogle Scholar
  11. 11.
    Jerosch J, Groenemeyer D, Deli M et al (2000) Precision and comparison of CT-, MRI- and DL-controlled interventions exemplified by lumbar facet infiltration—an experimental study. Biomed Tech 45:228–237CrossRefGoogle Scholar
  12. 12.
    Fritz J, Thomas C, Clasen S et al (2009) Freehand real-time MRI-guided lumbar spinal injection procedures at 1.5 T: feasibility, accuracy, and safety. AJR Am J Roentgenol 192:W161–W167PubMedCrossRefGoogle Scholar
  13. 13.
    Fritz J, Tzaribachev N, Thomas C et al (2011) Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis. Eur Radiol 21:1050–1057PubMedCrossRefGoogle Scholar
  14. 14.
    Fritz J, Clasen S, Boss A et al (2008) Real-time MR fluoroscopy-navigated lumbar facet joint injections: feasibility and technical properties. Eur Radiol 18:1513–1518PubMedCrossRefGoogle Scholar
  15. 15.
    Fritz J, Thomas C, Tzaribachev N et al (2009) MRI-guided injection procedures of the temporomandibular joints in children and adults: technique, accuracy, and safety. AJR Am J Roentgenol 193:1148–1154PubMedCrossRefGoogle Scholar
  16. 16.
    Salonen OL (1990) Case of anaphylaxis and four cases of allergic reaction following Gd-DTPA administration. J Comput Assist Tomogr 14:912–913PubMedCrossRefGoogle Scholar
  17. 17.
    Graves MJ, Wakely S, Bearcroft PW et al (2008) MR-guided direct arthrography of the hip. J Magn Reson Imaging 28:462–465PubMedCrossRefGoogle Scholar
  18. 18.
    Petersilge CA, Lewin JS, Duerk JL et al (1997) MR arthrography of the shoulder: rethinking traditional imaging procedures to meet the technical requirements of MR imaging guidance. AJR Am J Roentgenol 169:1453–1457PubMedCrossRefGoogle Scholar
  19. 19.
    Streitparth F, Walter T, Wonneberger U et al (2010) Image-guided spinal injection procedures in open high-field MRI with vertical field orientation: feasibility and technical features. Eur Radiol 20:395–403PubMedCrossRefGoogle Scholar
  20. 20.
    Fritz J, Henes JC, Thomas C et al (2008) Diagnostic and interventional MRI of the sacroiliac joints using a 1.5-T open-bore magnet: a one-stop-shopping approach. AJR Am J Roentgenol 191:1717–1724PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Martin Deli
    • 1
    Email author
  • Jan Fritz
    • 2
  • Serban Mateiescu
    • 1
  • Martin Busch
    • 1
  • John A. Carrino
    • 2
  • Jan Becker
    • 1
  • Marietta Garmer
    • 1
  • Dietrich Grönemeyer
    • 1
  1. 1.Department of Radiology and Microtherapy, Groenemeyer Institute for Microtherapy (GIMT)University of Witten/HerdeckeBochumGermany
  2. 2.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations