Jan Fritz MD, Presenter: Nothing to Disclose

Jörg Henes MD, Abstract Co-Author: Nothing to Disclose

Stephan Clasen MD, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Jonathan Stuart Lewin MD, Abstract Co-Author: Consultant, Interventional Imaging, Inc Founder, Interventional Imaging, Inc

Philippe Lucien Pereira MD, Abstract Co-Author: Nothing to Disclose

To prospectively assess the procedure and outcome of combined diagnostic and interventional MR imaging (MRI) for the sacroiliac joints (SIJ).

20 patients [31 (18-45) years-of-age] with chronic back pain of suspected sacroiliogenic origin were consecutively included. Procedures were performed at an open bore 1.5-T MR scanner (Magnetom Espree, Siemens) with patients in prone position. Diagnostic MRI consisted of a T1W spin echo MR sequence (TR/TE=400/17) and an inversion recovery MR sequence (TIRM,TR/TE=7000/75) by using a body matrix coil. In non-infectious sacroiliitis, 1.2 mL of ropivacaine/triamcinolone acetonide/Gd-DTPA (1/5/0.005) was injected, whereas 1 ml bupivacaine 1%/Gd-DTPA (1/0.005) was injections in all other cases. MR-guided puncture was performed by using a 21G needle (CH Ultra, Somatex, Germany) and a flexible loop coil. MR fluoroscopy(FLASH2D,TR/TE=9.3/3.5) facilitated real time navigated joint puncture. A T1W SE sequence (TR/TE=650/17) with fat saturation documented fluid distribution. Changes in pain intensity were assessed 30 min following injection by use of a visual analog scale. In sacroiliitis, pain intensity and bone marrow edema were assessed at 3-months follow up by use of computer-based quantification.

Diagnostic MRI demonstrated 8 x acute sacroiliitis, 8 x non-speficic degenerative changes and 4 unremarkable SIJ. 20 bilateral injections were preformed, of which 17 proved to be intra-articularly. MR fluoroscopy allowed puncture at a frequency of 1 frame/s with sufficient CNR of needle and fat/muscle/bone (20-42). No complications occurred. Mean duration of the procedures was 48 min (38-118) with exponential shortening (p<0.01) over time identified by regression analysis. Of 12 diagnostic blocks, 6 identified the SIJ as a pain generator. In patients with sacroiliitis, pain decreased by 72% (p<0.05), whereas volume of bone marrow edema decreased by 74% (p<0.05).

Combined diagnostic and interventional MRI of the SIJ can be efficiently used for comprehensive diagnosis and therapy of sacroiliogenic back pain.

Morphologic and functional SIJ evaluation at one session by MRI. Reduction of exposure to ionizing radiation and risk of iodine contrast.

Fritz, J, Henes, J, Clasen, S, Claussen, C, Lewin, J, Pereira, P, Combined Diagnostic and Interventional Magnetic Resonance (MR) Imaging of the Sacroiliac Joints at 1.5-T: A One Stop Shopping Approach Using a Clinical Open Bore Magnet.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5007132.html