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



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.


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.


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.


Interventional MRI Artefacts Laser Back pain Intervertebral disc 


Acq. Matrix

Acquisition matrix


Main magnetic field


Balanced steady state free precession


Contrast-to-noise ratio


Flip angel


Field of view




Gradient echo




Intradiscal electrothermal therapy


Inner cannula I


Inner cannula II


Low back pain






MR-guided percutaneous intradiscal thermotherapy


Number of scans


Number of signal averages


Outer cannula


Open MRI


Proton density


Percutaneous laser discus decompression


Region of interest




Standard deviation


Spin echo


Signal to noise ratio


Longitudinal relaxation time


Transverse relaxation time




Time of acquisition


Echo time


Time of repetition


Turbo spin echo




Effective power output in watt


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.


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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