Real-Time MR-Guided Lumbosacral Periradicular Injection Therapy Using a 0.55 T MRI System: A Phantom Study

TL;DR

This study shows that real-time MRI can guide spinal injections as accurately as CT, though it takes longer to plan the procedure.

Contribution

Demonstrates the feasibility of using a 0.55 T MRI system for real-time guidance of periradicular injections in a phantom model.

Findings

MR-guided injections had similar accuracy to CT-guided methods with a median score of 5.

MR-guided puncture time was comparable to CT-guided methods but total procedure time was significantly longer.

All procedures were technically successful across all three guidance systems.

Abstract

Objective: The purpose of this study was to evaluate the accuracy and feasibility of magnetic resonance (MR)-guided periradicular nerve root injection therapy (PRT) using a 0.55 T magnetic resonance imaging (MRI) system with fast dynamic imaging in a phantom. Methods: Five radiologists with varying levels of experience in PRT performed nine randomly assigned PRT procedures: three under MR guidance, three under CT guidance using a fully integrated laser navigation system, and three under conventional CT guidance, all on a specialized phantom of the lumbar spine. The PRTs were assessed by two experienced neuroradiologists with expertise in interventions, using a scale of 1–5, as follows: 5 = excellent to very good, 4 = good, 3 = satisfactory 2 = bad, 1 = very bad. The puncture time and total intervention time were noted. Results: All procedures were technically successful. The subjective evaluation of the PRTs showed similar results with a median of 5 for all three guidance systems. Additionally, there was no significant difference with respect to pure puncture time (the period after needle path determination) among all PRTs (Mean ± SD): MR-guided 178 ± 117 s, CT-guided with laser system 186 ± 73 s, and the conventional CT-guided 218 ± 91 s (p = 0.482). However, the total procedure time including planning images was significantly higher for MR-guided PRT (700 ± 182 s) compared to CT guidance with laser system (366 ± 85 s) and conventional CT guidance (358 ± 150 s; p = 0.012). Conclusions: Real-time MRI-guided lumbosacral periradicular injection therapy utilizing a 0.55 T MRI system is feasible with similar puncture times to CT guidance but consumes more intervention time due to the duration of planning sequences. Limitation: The study utilized a stationary phantom made of homogeneous material, which provides an incomplete representation of real tissue properties and motion complexity applied to human beings.

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