Magnetic Resonance-Guided Musculoskeletal Interventional Radiology

John A. Carrino; Roberto Blanco

doi:10.1055/s-2006-939033

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2006; 10(2): 159-174
DOI: 10.1055/s-2006-939033

Magnetic Resonance-Guided Musculoskeletal Interventional Radiology

John A. Carrino¹ , Roberto Blanco¹ ^, ²

¹Division of Musculoskeletal Radiology, Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Department of Radiology, Boston, Massachusetts
²Oulu University Hospital, Department of Radiology, Oulu, Finland

Abstract

ABSTRACT

As an imaging modality, magnetic resonance (MR) guidance has great potential to direct diagnostic and therapeutic procedures performed in the musculoskeletal region and influence patient management. MR-guided interventional procedures involving bone, soft tissue, intervertebral discs, and joints are safe and sufficiently effective for use in clinical practice. This article discusses and illustrates the procedural characteristics and techniques when performing MR-guided musculoskeletal interventions. Biopsy procedures are similar to other modalities for bone and soft tissue lesions. MR guidance is advantageous if the lesion is not visible by other modalities and for regions adjacent to hardware and implants, subselective targeting, intra-articular locations, and periarticular cyst aspiration. MR guidance has also been used for a host of spine injections and pain management procedures such as sacroiliac joint injections, discography, transforaminal epidural injection, selective nerve block, sympathetic block, celiac plexus block, and facet joint cryotherapy neurotomies. Future directions of clinical applications include tumor ablation and multimodality procedure suites. MR-guided musculoskeletal procedures will continue to be a growth area particularly for the diagnosis and treatment of bone and soft tissue neoplasia.

KEYWORDS

Musculoskeletal procedures - interventional radiology - magnetic resonance imaging - biopsy - spine injections - tumor ablation

Full Text

References

REFERENCES

1 Salomonowitz E. MR imaging-guided biopsy and therapeutic intervention in a closed-configuration magnet: single-center series of 361 punctures. AJR Am J Roentgenol. 2001; 177 159-163
2 Mankin H J, Lange T A, Spanier S S. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am. 1982; 64 1121-1127
3 Fraser-Hill M A, Renfrew D L, Hilsenrath P E. Percutaneous needle biopsy of musculoskeletal lesions. 2. Cost-effectiveness. AJR Am J Roentgenol. 1992; 158 813-818
4 Neuerburg J, Adam G, Bucker A et al.. A new MR-(and CT-) compatible bone biopsy system: first clinical results [in German]. Rofo. 1998; 169 515-520
5 Blanco Sequeiros R, Klemola R, Ojala R et al.. MRI-guided trephine biopsy and fine-needle aspiration in the diagnosis of bone lesions in low-field (0.23 T) MRI system using optical instrument tracking. Eur Radiol. 2002; 12 830-835
6 Adam G, Bucker A, Nolte-Ernsting C, Tacke J, Gunther R W. Interventional MR imaging: percutaneous abdominal and skeletal biopsies and drainages of the abdomen. Eur Radiol. 1999; 9 1471-1478
7 Duerk J L, Lewin J S, Wendt M, Petersilge C. Remember true FISP? A high SNR, near 1-second imaging method for T2-like contrast in interventional MRI at. 2 T. J Magn Reson Imaging. 1998; 8 203-208
8 Parkkola R K, Mattila K T, Heikkila J T et al.. Dynamic contrast-enhanced MR imaging and MR-guided bone biopsy on a 0.23 T open imager. Skeletal Radiol. 2001; 30 620-624
9 Butts K, Pauly J M, Daniel B L, Kee S, Norbash A M. Management of biopsy needle artifacts: techniques for RF-refocused MRI. J Magn Reson Imaging. 1999; 9 586-595
10 Lewin J S, Petersilge C A, Hatem S F et al.. Interactive MR imaging-guided biopsy and aspiration with a modified clinical C-arm system. AJR Am J Roentgenol. 1998; 170 1593-1601
11 Parkkola R K, Mattila K T, Heikkila J T et al.. Dynamic contrast-enhanced MR imaging and MR-guided bone biopsy on a 0.23 T open imager. Skeletal Radiol. 2001; 30 620-624
12 Adam G, Neuerburg J, Bucker A et al.. Interventional magnetic resonance. Initial clinical experience with a 1.5-tesla magnetic resonance system combined with c-arm fluoroscopy. Invest Radiol. 1997; 32 191-197
13 Neuerburg J, Adam G, Bucker A et al.. MRI-guided biopsy of bone in a hybrid system. J Magn Reson Imaging. 1998; 8 85-90
14 Koenig C W, Duda S H, Truebenbach J et al.. MR-guided biopsy of musculoskeletal lesions in a low-field system. J Magn Reson Imaging. 2001; 13 761-768
15 Ojala R, Sequeiros R B, Klemola R et al.. MR-guided bone biopsy: preliminary report of a new guiding method. J Magn Reson Imaging. 2002; 15 82-86
16 Ojala R, Sequeiros R B, Klemola R et al.. MRI-guided trephine biopsy and fine-needle aspiration in the diagnosis of bone lesions in low-field (0.23 T) MRI system using optical instrument tracking. Eur Radiol. 2002; 12 830-835
17 Genant J W, Vandevenne J E, Bergman A G et al.. Interventional musculoskeletal procedures performed by using MR imaging guidance with a vertically open MR unit: assessment of techniques and applicability. Radiology. 2002; 223 127-136
18 Khurana B, Carrino J A, Winalski C S, Silverman S G, Jolesz F A. MR-Guided Musculoskeletal Interventions: A Valuable Tool in Certain Contexts. International Society for Magnetic Resonance in Medicine 10th Scientific Meeting and Exhibition; May 20-24, 2002 Honolulu, Hawai'i.
19 Sequeiros R B, Klemola R, Ojala R, Jyrkinen L, Vaara T, Tervonen O. Percutaneous MR-guided discography in a low-field system using optical instrument tracking: a feasibility study. J Magn Reson Imaging. 2003; 17 214-219
20 Sequeiros R B, Ojala R O, Klemola R, Vaara T J, Jyrkinen L, Tervonen O A. MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking. Eur Radiol. 2002; 12 1331-1337
21 Sze D Y, Mackey S C. MR guidance of sympathetic nerve blockade: measurement of vasomotor response initial experience in seven patients. Radiology. 2002; 223 574-580
22 Hol P K, Kvarstein G, Viken O, Smedby O, Tonnessen T I. MRI-guided celiac plexus block. J Magn Reson Imaging. 2000; 12 562-564
23 Ojala R, Klemola R, Karppinen J, Sequeiros R B, Tervonen O. Sacro-iliac joint arthrography in low back pain: feasibility of MRI guidance. Eur J Radiol. 2001; 40 236-239
24 Ojala R, Vahala E, Karppinen J et al.. Nerve root infiltration of the first sacral root with MRI guidance. J Magn Reson Imaging. 2000; 12 556-561
25 Weiner B K, Fraser R D. Foraminal injection for lateral lumbar disc herniation. J Bone Joint Surg Br. 1997; 79 804-807
26 Karppinen J, Malmivaara A, Kurunlahti M et al.. Periradicular infiltration for sciatica: a randomized controlled trial. Spine. 2001; 26 1059-1067
27 Sequeiros R B, Ojala R O, Klemola R, Vaara T J, Jyrkinen L, Tervonen O A. MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking. Eur Radiol. 2002; 12 1331-1337
28 Riew K D, Yin Y, Gilula L et al.. The effect of nerve-root injections on the need for operative treatment of lumbar radicular pain. A prospective, randomized, controlled, double-blind study. J Bone Joint Surg Am. 2000; 82 1589-1593
29 Kaplan P A, Dussault R G. Image-guided selective nerve blocks in the spine. Semin Musculoskelet Radiol. 1997; 1 231-240
30 Ojala R, Vahala E, Karppinen J et al.. Nerve root infiltration of the first sacral root with MRI guidance. J Magn Reson Imaging. 2000; 12 556-561
31 Sequeiros R B, Ojala R O, Klemola R, Vaara T J, Jyrkinen L, Tervonen O A. MRI-guided periradicular nerve root infiltration therapy in low-field (0.23-T) MRI system using optical instrument tracking. Eur Radiol. 2002; 12 1331-1337
32 Winalski C S, Robbins M I, Silverman S G, Davies J A. Interactive magnetic resonance image-guided aspiration therapy of a glenoid labral cyst: a case report. J Bone Joint Surg Am. 2001; 83 1237-1242
33 Jolesz F A. Magnetic resonance image-guided focused ultrasound surgery. Cancer J. 2002; 5(suppl 1) S100-112
34 Anzai Y, Lufkin R B, Castro D J et al.. MR imaging guided interstitial Nd-YAG laser phototherapy: dosimetry study of acute tissue damage in an in vivo model. J Magn Reson Imaging. 1991; 1 553-559
35 Le Bihan D, Delannoy J, Levin R L. Temperature mapping with MR imaging of molecular diffusion: application to hyperthermia. Radiology. 1989; 171 853-857
36 Delannoy J, Chen C N, Turner R, Levin R L, Le Bihan D. Noninvasive temperature imaging using diffusion MRI. Magn Reson Med. 1991; 19 333-339
37 Matsumoto R, Mulkern R V, Hushek S G, Jolesz F A. Tissue temperature monitoring for thermal interventional therapy: comparison of T1-weighted MR sequences. J Magn Reson Imaging. 1994; 4 65-70
38 Mulkern R V, Panych L P, McDannold N J, Jolesz F A, Hynynen K. Tissue temperature monitoring with multiple gradient-echo imaging sequences. J Magn Reson Imaging. 1998; 8 493-502
39 Bleier A R, Jolesz F A, Cohen M S et al.. Real-time magnetic resonance imaging of laser heat deposition in tissue. Magn Reson Med. 1991; 21 132-137
40 Cline H E, Hynynen K, Watkins R D et al.. Focused US system for MR imaging-guided tumor ablation. Radiology. 1995; 194 731-737
41 Daum D R, Smith N B, King R, Hynynen K. In vivo demonstration of noninvasive thermal surgery of the liver and kidney using an ultrasonic phased array. Ultrasound Med Biol. 1999; 25 1087-1098
42 McDannold N J, Jolesz F A, Hynynen K H. Determination of the optimal delay between sonications during focused ultrasound surgery in rabbits by using MR imaging to monitor thermal buildup in vivo. Radiology. 1999; 211 419-426
43 Adam G, Neuerburg J, Bucker A et al.. Initial clinical experience with a 1.5-tesla magnetic resonance system combined with C-arm fluoroscopy. Invest Radiol. 1997; 32 191-197
44 Neuerburg J-M, Adam G, Buecker A et al.. MRI-guided biopsy of bone in a hybrid system. J Magn Reson Imaging. 1998; 8 85-90
45 Fahrig R, Butts K, Rowlands J A et al.. A truly hybrid interventional MR/X-ray system: Feasibility demonstration. J Magn Reson Imaging. 2001; 13 294-300
46 Fahrig R, Butts K, Wen Z et al.. Hybrid interventional MR/X-ray system: investigation of in vivo applications. Acad Radiol. 2001; 8 1200-1207
47 Fahrig R, Heit G, Wen Z, Daniel B L, Butts K, Pelc N J. First use of a truly-hybrid X-ray/MR imaging system for guidance of brain biopsy. Acta Neurochir (Wien). 2003; 145 995-997

John A CarrinoM.D. M.P.H.

Assistant Professor of Radiology, Harvard Medical School, Clinical Director, Magnetic Resonance Therapy, Co-Director, Spine, Intervention Service

Brigham and Women's Hospital, Department of Radiology, ASB-1, L1, Room 003A, 75 Francis Street, Boston, MA 02115