MR-Guided Percutaneous Intradiscal Thermotherapy (MRgPIT): Evaluation of a New Technique for the Treatment of Degenerative Disc Disease in Cadaveric Lumbar Spine
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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.
KeywordsInterventional MRI Artefacts Laser Back pain Intervertebral disc
- Acq. Matrix
Main magnetic field
Balanced steady state free precession
Field of view
Intradiscal electrothermal therapy
- IC I
Inner cannula I
- IC II
Inner cannula II
Low back pain
MR-guided percutaneous intradiscal thermotherapy
Number of scans
Number of signal averages
Percutaneous laser discus decompression
Region of interest
Signal to noise ratio
Longitudinal relaxation time
Transverse relaxation time
Time of acquisition
Time of repetition
Turbo spin echo
Effective power output in watt
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.
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
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