MR-Guided Vertebroplasty With Augmented Reality Image Overlay Navigation
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To evaluate the feasibility of magnetic resonance imaging (MRI)-guided vertebroplasty at 1.5 Tesla using augmented reality image overlay navigation.
Materials and Methods
Twenty-five unilateral vertebroplasties [5 of 25 (20 %) thoracic, 20 of 25 (80 %) lumbar] were prospectively planned in 5 human cadavers. A clinical 1.5-Teslan MRI system was used. An augmented reality image overlay navigation system and 3D Slicer visualization software were used for MRI display, planning, and needle navigation. Intermittent MRI was used to monitor placement of the MRI-compatible vertebroplasty needle. Cement injections (3 ml of polymethylmethacrylate) were performed outside the bore. The cement deposits were assessed on intermediate-weighted MR images. Outcome variables included type of vertebral body access, number of required intermittent MRI control steps, location of final needle tip position, cement deposit location, and vertebroplasty time.
All planned procedures (25 of 25, 100 %) were performed. Sixteen of 25 (64 %) transpedicular and 9 of 25 (36 %) parapedicular access routes were used. Six (range 3–9) MRI control steps were required for needle placement. No inadvertent punctures were visualized. Final needle tip position and cement location were adequate in all cases (25 of 25, 100 %) with a target error of the final needle tip position of 6.1 ± 1.9 mm (range 0.3–8.7 mm) and a distance between the planned needle tip position and the center of the cement deposit of 4.3 mm (range 0.8–6.8 mm). Time requirement for one level was 16 (range 11–21) min.
MRI-guided vertebroplasty using image overlay navigation is feasible allowing for accurate vertebral body access and cement deposition in cadaveric thoracic and lumbar vertebral bodies.
KeywordsVertebroplasty Interventional MR imaging MR imaging guidance MR-guided
National Cancer Institute, 1 R01 CA118371-01A2-Image Overlay for MRI-Guided Needle Insertions. Cancer Care Ontario Research Chair in Cancer Imaging (Gabor Fichtinger). NSERC CREATE in Human Mobility (Paweena U-Thainual). Ontario Ministry of Innovation postdoctoral fellowship (Tamas Ungi). Somatex Medical Technologies GmbH, Teltow, Germany, supported this study by providing the MRI-compatible vertebroplasty needles and cement.
Conflict of interest
Jan Fritz, Paweena U-Thaiual, Tamas Ungi, Aaron J. Flammang, Sudhir Kathuria, Gabor Fichtinger, Iulian I. Iordachita, and John A. Carrino received grants from the National Cancer Institute, 1 R01 CA118371-01A2-Image Overlay for MRI-Guided Needle Insertions, as well as nonfinancial support from Somatex Medical Technologies GmbH, Teltow, Germany, during the conduct of the study. Jan Fritz, Gabor Fichtinger, and Sudhir Kathuria received grants and nonfinancial support from Siemens AG outside the submitted work. Paweena U-Thainual received grants from NSERC CREATE in Human Mobility during the conduct of the study. Tamas Ungi received grants and personal fees from Ontario Ministry of Innovation postdoctoral fellowship during the conduct of the study. Gabor Fichtinger received grants from Cancer Care Ontario Research Chair in Cancer Imaging during the conduct of the study. John Carrino received grants from Toshiba and Carestream, as well as personal fees from General Electric, Siemens, and BioClinica, outside the submitted work.
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