MR US Fusion Guided Intervention for Pain Syndromes
Christopher Burke

Synopsis

Ultrasound (US) systems equipped with position sensors can acquire three-dimensional spatial data allowing registration with previously acquired magnetic resonance (MR) imaging for fused real-time sonographic imaging. Co-registration and fusion of alignment involves sequential algorithmic transformations minimizing the error between the output and target image. An electromagnetic field generator is used to track transducer orientation to simultaneously map real-time US with corresponding anatomy on pre-acquired MR. The potential utility of this technology in the treatment of various pain syndromes in particular certain joint, tendon and perineural therapies will be described.

Conventional ultrasound (US) systems equipped with position sensors can acquire three-dimensional (3D) spatial data allowing registration with previously acquired magnetic resonance (MR) imaging for fused real-time US imaging. The fusion software requires identification of internal fiducial points that act as localization markers, corresponding to targeted anatomic points in the pre-acquired imaging, the accuracy of which is important to the subsequent real-time registration. Image fusion alignment involves sequential algorithmic transformations minimizing the error between the output and target image. An electromagnetic field generator is used to track transducer orientation to simultaneously map real-time US with corresponding anatomy on pre-acquired MR. This technology allows improved navigation with hand-swept imaging and has demonstrated use in a range of specialties including liver, prostate and breast procedures. With respect to musculoskeletal intervention and specifically pain management, the fusion application may be used to assist in a range of outpatient procedures including technically challenging joint, tendon or perineurial injections possibly allowing for increased accuracy. Examples include sacroiliac joint injection, piriformis injection, pudendal and intercostal nerve perineurial injections as well as certain tendon therapies such as hamstring-origin calcific tendonopathy barbotage. The potential utility of this technology in pain syndromes will be described.

Acknowledgements

No acknowledgement found.

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Figures

Axial Proton Density MR image demonstrating a low signal calcific deposit (*) at the right hamstring origin. IT=Ischial Tuberosity.

Same patient as Figure 1. Real-time MR US fusion image demonstrating needle barbotage of the calcific deposit (*) at the hamstring origin. The patient is positioned prone. The needle is demonstrated (white arrow). IT=Ischial Tuberosity.

Proc. Intl. Soc. Mag. Reson. Med. 25 (2017)