Skip to main content
SpringerLink
Log in

Use of ultrasound–magnetic resonance image fusion to guide sacroiliac joint injections: a preliminary assessment

  • Original Article
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Background

The sacroiliac joint is one of the sources of chronic lower back pain. Intra-articular injections of anesthetic drugs and/or steroids are currently used in these cases for diagnostic and therapeutic purposes. However, given the anatomic and functional complexity of the joint, imaging guidance is mandatory during such procedures. In this context, the technique of fusing images obtained with two different modalities can often overcome the limitations and enhance the advantages of single-modality guidance.

Aim

The aim of this study was to evaluate the technique of ultrasound (US)–magnetic resonance (MR) image fusion to guide intra-articular injections of drugs into the sacroiliac joint.

Materials and methods

We evaluated seven sacroiliac joints in six patients with sacroiliac pain syndrome (four females, two males; mean age 59 years; range 46–76 years). Five were candidates for radiofrequency thermolysis, and a therapeutic nerve block was performed in the sixth. Using the volume navigation system, we fused three-dimensional MR images with simultaneously acquired real-time ultrasound images and used them to guide the intra-articular injections.

Results

In all patients, spatial accuracy was considered excellent, with definition of registration errors of less than 3 mm. The diagnostic blocks produced positive results in all patients with 80 % reductions in pain (measured with a Numerical Rating Scale, NRS) relative to baseline. The patient who underwent the therapeutic nerve block experienced complete resolution of symptoms that has been maintained over time. There were no complications.

Conclusions

US–MR imaging fusion guidance of sacroiliac joint injections is feasible and effective, in accordance with the data in the literature. The use of the MR for three-dimensional imaging eliminates the risk of radiation exposure.

Riassunto

Background

il dolore sacro-iliaco è una delle cause di dolore lombare cronico. L’infiltrazione intra-articolare di farmaci anestetici e/o steroidi, costituisce uno strumento correntemente utilizzato a scopo diagnostico e terapeutico. Tuttavia, la complessità anatomo-funzionale dell’articolazione impone l’utilizzo della guida imaging all’infiltrazione. La fusion imaging si pone in questo contesto come strumento che risolve i limiti delle singole metodiche e ne amplifica i vantaggi.

Scopo

l’obiettivo del nostro lavoro è valutare la fusion imaging come strumento per la guida della somministrazione farmacologica intra-articolare dell’articolazione sacro-iliaca, utilizzando la co-registrazione di immagini ecografiche e di risonanza magnetica.

Materiali e Metodi

sono state valutate 7 articolazioni sacro-iliache in 6 pazienti (4 femmine, 2 maschi; età media 59 anni; range 46–76 anni) con sindrome dolorosa sacro-iliaca; 5 candidati al trattamento di termolesione, 1 sottoposto a blocco terapeutico. L'iniezione intra-articolare è stata condotta con la guida della fusion imaging ottenuta con i dati tridimensionali RM visualizzati in maniera simultanea alle immagini real-time ecografiche mediante l'utilizzo di un “volume navigation system”.

Risultati

l’accuratezza spaziale è stata considerata ottimale in tutti i pazienti, con definizione di valori di errore di registrazione inferiori ai 3 mm. Il blocco diagnostico è risultato positivo in tutti i pazienti con riduzione del dolore (misurato con scala Numerical Rating Scale, NRS) dell’80 % rispetto al basale. Il paziente sottoposto a trattamento terapeutico ha mostrato una completa risoluzione della sintomatologia, mantenuta nel tempo. Non si è verificata nessuna complicanza.

Conclusioni

la guida fusion nell’infiltrazione delle articolazioni sacro-iliache si è confermata attuabile ed efficace in linea con i dati presenti in letteratura. L’utilizzo della RM come imaging tridimensionale ha il vantaggio di annullare il rischio di esposizione radiante.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Manchikanti L, Boswell MV, Singh V, Benyamin RM, Fellows B, Abdi S, Buenaventura RM, Conn A, Datta S, Derby R, Falco FJ, Erhart S, Diwan S, Hayek SM, Helm S, Parr AT, Schultz DM, Smith HS, Wolfer LR, Hirsch JA, ASIPP-IPM (2009) Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 12(4):699–802

    PubMed  Google Scholar 

  2. Hansen HC, McKenzie-Brown AM, Cohen SP, Swicegood JR, Colson JD, Manchikanti L (2007) Sacroiliac joint interventions: a systematic review. Pain Physician 10(1):165–184

    PubMed  Google Scholar 

  3. Rosenberg JMJM, Quint TJ, de Rosayro AM (2000) Computerized tomographic localization of clinically-guided sacroiliac joint injections. Clin J Pain 16(1):18–21

    Article  PubMed  CAS  Google Scholar 

  4. Galiano K, Obwegeser AA, Bale R, Harlander C, Schatzer R, Schocke M, Gruber H (2007) Ultrasound-guided and CT-navigation-assisted periradicular and facet joint injections in the lumbar and cervical spine: a new teaching tool to recognize the sonoanatomic pattern. Reg Anesth Pain Med 32(3):254–257

    PubMed  Google Scholar 

  5. Zacchino M, Allegri M, Canepari M, Minella CE, Bettinelli S, Draghi F, Calliada F (2010) Feasibility of pudendal nerve anesthetic block using fusion imaging technique in chronic pelvic pain. Eur J Pain 4:329–333

    Article  Google Scholar 

  6. Klauser A, De Zordo T, Feuchtner G, Sögner P, Schirmer M, Gruber J, Sepp N, Moriggl B (2008) Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 59(11):1618–1624

    Article  PubMed  Google Scholar 

  7. Dussault RG, Kaplan PA, Anderson MW (2000) Fluoroscopy-guided sacroiliac joint injections. Radiology 214(1):273–277

    PubMed  CAS  Google Scholar 

  8. Fritz J, Henes JC, Thomas C, Clasen S, Fenchel M, Claussen CD, Lewin JS, Pereira PL (2008) Diagnostic and interventional MRI of the sacroiliac joints using a 1.5-T open-bore magnet: a one-stop-shopping approach. AJR Am J Roentgenol 191(6):1717–1724

    Article  PubMed  Google Scholar 

  9. Bollow M, Braun J, Taupitz M, Häberle J, Reibhauer BH, Paris S, Mutze S, Seyrekbasan F, Wolf KJ, Hamm B (1996) CT-guided intraarticular corticosteroid injection into the sacroiliac joints in patients with spondyloarthropathy: indication and follow-up with contrast-enhanced MRI. J Comput Assist Tomogr 20(4):512–521

    Article  PubMed  CAS  Google Scholar 

  10. Pekkafahli MZ, Kiralp MZ, Başekim CC, Silit E, Mutlu H, Oztürk E, Kizilkaya E, Dursun H (2003) Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 22(6):553–559

    PubMed  Google Scholar 

  11. Migliore A, Bizzi E, Massafra U, Vacca F, Martin–Martin LS, Granata M, Tormenta S (2010) A new technical contribution for ultrasound-guided injections of sacro-iliac joints. Eur Rev Med Pharmacol Sci 14(5):465–469

    PubMed  CAS  Google Scholar 

  12. Klauser AS, De Zordo T, Feuchtner GM, Djedovic G, Weiler RB, Faschingbauer R, Schirmer M, Moriggl B (2010) Fusion of real-time US with CT images to guide sacroiliac joint injection in vitro and in vivo. Radiology 256(2):547–553

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

M. Zacchino, J. Almolla, E. Canepari, V. Merico and F. Calliada declare that they have no conflict on interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided (written) informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

Human and animal studies

The study described in this articles did not include any procedures involving humans or animal.

Author information

Authors and Affiliations

  1. IRCCS Foundation, San Matteo Medical Center, Institute of Radiology, University of Pavia, Pavia, Italy

    M. Zacchino, J. Almolla, E. Canepari, V. Merico & F. Calliada

Authors
  1. M. Zacchino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Almolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Canepari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Merico
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F. Calliada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Zacchino.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zacchino, M., Almolla, J., Canepari, E. et al. Use of ultrasound–magnetic resonance image fusion to guide sacroiliac joint injections: a preliminary assessment. J Ultrasound 16, 111–118 (2013). https://doi.org/10.1007/s40477-013-0028-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-013-0028-7

Keywords

Search

Navigation