Keywords:
Inflammation, Education and training, Arthritides, Puncture, Equipment, Computer Applications-Virtual imaging, Ultrasound, MR, CT, Ultrasound physics, Musculoskeletal spine, Interventional non-vascular
Authors:
P. Caruso, E. Massone, S. Perugin Bernardi, G. Turtulici, D. Orlandi, E. Silvestri; Genoa/IT
DOI:
10.1594/essr2017/P-0204
Background
Traditionally,
interventional procedures around the spine,
such as facet joint injections,
nerve root blocks and sacroiliac joint injections,
in a low back pain condition,
were performed under fluoroscopy or CT guidance (fig.
1),
that are considered the gold standard to achieve accurate guidance of the needle but expose the patient to a significant radiation dose,
even considering the possibility to repeat the therapeutic treatment over time.
Ultrasound suffers from poor visualization of the target due to its deep location,
frequent presence of bone spurs,
and greater difficulty of interpretation by physicians who are not familiar with spine ultrasound anatomy (fig.
2).
MRI guidance (fig.
3) has the advantage of guiding injection without radiation,
but the procedure is cumbersome and time consuming,
also requiring the use of expensive MR-compatible needles.
Fusion imaging technology,
coupling real-time ultrasound (US) with the corresponding computed tomography (CT) or magnetic resonance (MR) image obtained from a previous diagnostic examination and reformatted in real time according to the ultrasound scanning plane.
This allows combining the panoramic view and elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to additional ionizing radiations.