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MR-Guided Percutaneous Intradiscal Thermotherapy (MRgPIT): Evaluation of a New Technique for the Treatment of Degenerative Disc Disease in Cadaveric Lumbar Spine

  • T. LeidenbergerEmail author
  • A. Winkel
  • C. Philipp
  • J. Rump
  • M. De Bucourt
  • G. Böning
  • U. Teichgräber
  • F. Streitparth
Laboratory Investigation
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Abstract

Purpose

Evaluation of MR feasibility and real-time control of an innovative thermoablative applicator for intradiscal thermotherapy and histological analysis of laser annuloplasty in human ex vivo intervertebral discs.

Materials and Methods

We evaluated a new MR-compatible applicator system for MR-guided percutaneous intradiscal thermotherapy (MRgPIT) in an open 1.0-T MRI-system. Needle artefacts and contrast-to-noise ratios (CNR) of six interactive sequences (PD-, T1-, T2w TSE, T1-, T2w GRE, bSSFP) with varying echo-times (TE) and needle orientations to the main magnetic field (B0) were analysed. Additionally, five laser protocols (Nd: YAG Laser, 2–6 W) were assessed in 50 ex vivo human intervertebral discs with subsequent histological evaluation.

Results

In vitro, we found optimal needle artefacts of 1.5–5 mm for the PDw TSE sequence in all angles of the applicator system to B0. A TE of 20 ms yielded the best CNR. Ex vivo, ablating with 5 W induced histological denaturation of collagen at the dorsal annulus, correlating with a rise in temperature to at least 60 °C. The MRgPIT procedure was feasible with an average intervention time of 17.1 ± 5.7 min.

Conclusion

Real-time MR-guided positioning of the MRgPIT-applicator in cadaveric intervertebral disc is feasible and precise using fast TSE sequence designs. Laser-induced denaturation of collagen in the dorsal annulus fibrosus proved to be accurate.

Keywords

Interventional MRI Artefacts Laser Back pain Intervertebral disc 

Abbreviations

Acq. Matrix

Acquisition matrix

B0

Main magnetic field

bSSFP

Balanced steady state free precession

CNR

Contrast-to-noise ratio

FA

Flip angel

FOV

Field of view

G

Gauge

GRE

Gradient echo

Hz

Hertz

IDET

Intradiscal electrothermal therapy

IC I

Inner cannula I

IC II

Inner cannula II

LBP

Low back pain

min

Minute

mm

Millimeter

MRgPIT

MR-guided percutaneous intradiscal thermotherapy

NOS

Number of scans

NSA

Number of signal averages

OC

Outer cannula

oMRT

Open MRI

PD

Proton density

PLDD

Percutaneous laser discus decompression

ROI

Region of interest

s

Second

SD

Standard deviation

SE

Spin echo

SNR

Signal to noise ratio

T1

Longitudinal relaxation time

T2

Transverse relaxation time

T

Tesla

TA

Time of acquisition

TE

Echo time

TR

Time of repetition

TSE

Turbo spin echo

W

Watt

Weff

Effective power output in watt

Notes

Authors’ Contributions

TL contributed to design and conduction of experimental work, development of MRgPIT-applicator, writing of the manuscript. AW contributed to development of MRgPIT-applicator. CP contributed to design and conduction of experimental work with regards to laser applications. JR contributed to design and conduction of experimental work with regards to artefacts. MB contributed to advisory function. GB contributed to advisory function. UT contributed to study design, advisory function, development of MRgPIT-applicator. FS contributed to study design, design and conduction of experimental work, development of MRgPIT-applicator, advisory function, revision of manuscript.

Funding

This work was supported in part by grants from the Technologiestiftung Berlin - Zukunftsfonds Berlin (TSB) and the EUs European Fund for Regional Development (Grant 10132816/10134231).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in this study involving human ex vivo participants were in accordance with the ethical standards of our ethics committee (ethics committee Charité – Universitätsmedizin Berlin, reference numbers EA1/071/09, EA1/301/12) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent for Publication

Not applicable.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.R&D Interventional InstrumentsInvivo CorporationGainesvilleUSA
  3. 3.Center for Laser MedicineEvangelical Elisabeth ClinicBerlinGermany
  4. 4.Biotronik SE & Co KGBerlinGermany
  5. 5.Department of RadiologyCharité, Humboldt-UniversityBerlinGermany
  6. 6.Department of RadiologyFriedrich-Schiller-UniversityJenaGermany
  7. 7.Department of RadiologyLudwig Maximilian UniversityMunichGermany

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