MR-guided perineural injection of the ganglion impar: technical considerations and feasibility.
MR-guided perineural injection of the ganglion impar: technical considerations and feasibility.
复制标题
MR 引导的神经节 IMP 神经周围注射：技术考虑和可行性。
DOI：
10.1007/s00256-016-2333-7
复制
发表时间：
2016
影响因子：
2.1
通讯作者：
Fritz,Jan
中科院分区：
文献类型：
--
作者：
Marker,DavidR;U-Thainual,Paweena;Ungi,Tamas;Flammang,AaronJ;Fichtinger,Gabor;Iordachita,IulianI;Carrino,JohnA;Fritz,Jan
目的探讨神经周围神经节阻滞注射治疗盆腔疼痛综合征的疗效。然而，对于最优的图像引导，目前还没有达成共识。磁共振成像（MRI）提供了高的软组织对比度和直接可视化和目标神经节的潜力。本研究的目的是评估核磁共振引导下经皮神经周围神经节阻滞注射的可行性。材料与方法在6具人体尸体上进行了6次核磁共振引导下的神经节损伤注射。手术采用临床1.5特斯拉MRI系统，经远外侧臀肌入路。确定神经节不可见性、距骶尾关节的距离、放置针头所需的间歇MRI控制步骤数、预定针尖位置与最终针尖位置之间的目标误差、非目标易损结构的意外穿刺、注射剂分布和手术时间。结果4/6（66%）的病例在MRI上可见神经节阻滞，位于骶尾关节中点的头侧0.8 mm ~尾侧16.3 mm（平均1.2 mm）处。针头放置平均需要3个MRI控制步骤（范围2-6）。平均靶差为2.2±2.1 mm。6/6例（100%）有适当的神经节周围分布和骶尾骨前间隙填充。未发生非目标结构穿刺。手术时间中位数为20分钟（范围12-29分钟）。结论介入性MRI能直观、直接地定位神经节损伤点，便于准确置针和成功进行神经节周围注射，且对患者和工作人员无电离辐射暴露。我们的结果支持临床评价。
ObjectivePerineural ganglion impar injections are used in the management of pelvic pain syndromes; however, there is no consensus regarding the optimal image guidance. Magnetic resonance imaging (MRI) provides high soft tissue contrast and the potential to directly visualize and target the ganglion. The purpose of this study was to assess the feasibility of MR-guided percutaneous perineural ganglion impar injections.Materials and methodsSix MR-guided ganglion impar injections were performed in six human cadavers. Procedures were performed with a clinical 1.5-Tesla MRI system through a far lateral transgluteus approach. Ganglion impar visibility, distance from the sacrococcygeal joint, number of intermittent MRI control steps required to place the needle, target error between the intended and final needle tip location, inadvertent punctures of non-targeted vulnerable structures, injectant distribution, and procedure time were determined.ResultsThe ganglion impar was seen on MRI in 4/6 (66 %) of cases and located 0.8 mm cephalad to 16.3 mm caudad (average 1.2 mm caudad) to the midpoint of the sacrococcygeal joint. Needle placement required an average of three MRI control steps (range, 2–6). The average target error was 2.2 ± 2.1 mm. In 6/6 cases (100 %), there was appropriate periganglionic distribution and filling of the presacrococcygeal space. No punctures of non-targeted structures occurred. The median procedure time was 20 min (range, 12–29 min).ConclusionInterventional MRI can visualize and directly target the ganglion impar for accurate needle placement and successful periganglionic injection with the additional benefit of no ionizing radiation exposure to patient and staff. Our results support clinical evaluation.