MR Imaging-guided Lumbosacral Spinal Injection Procedures

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Abstract

Magnetic resonance (MR)-guided spinal injection procedures describe techniques for percutaneous drug delivery procedures in which MR imaging is used for visualization of the anatomic target, for accurate image-guided needle placement, monitoring of the injectant, and for visualization of the distribution and unintended spread of the injectant to adjacent spinal structures. Initially performed with open low-field MR imaging systems, the recent introduction of clinical wide-bore MR imaging systems has contributed to increased availability and improved practicability of MR-guided spine injections. Field strength of 1.5 T, modern coil technology, and parallel imaging techniques afford increased MR signal, which can be utilized for faster temporal resolution, higher spatial resolution, improved contrast resolution, and combinations thereof. The unparalleled contrast resolution of MR imaging provides the interventionalist with osseous and soft-tissue detail for excellent visualization of spinal targets and injectants. Because interventional MR imaging obviates patients and staff exposure to ionizing radiation, it exemplarily complies with the practice mandate to maintain exposures to ionizing radiation as low as reasonably achievable (ALARA principle) and complements x-ray fluoroscopy and computed tomography guidance. In this article, we review pertinent principles of MR imaging-guided spine injections and illustrate MR guidance techniques for lumbosacral spinal injection procedures, including sacroiliac joint injections, facet joint injections, median branch blocks, perineural and transforaminal injections, interlaminar epidural injections, sympathetic injections, and celiac plexus injections.

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