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MR-Guided Percutaneous Intradiscal Thermotherapy (MRgPIT): Evaluation of a New Technique for the Treatment of Degenerative Disc Disease in Cadaveric Lumbar Spine

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Abstract

Purpose

Evaluation of MR feasibility and real-time control of an innovative thermoablative applicator for intradiscal thermotherapy and histological analysis of laser annuloplasty in human ex vivo intervertebral discs.

Materials and Methods

We evaluated a new MR-compatible applicator system for MR-guided percutaneous intradiscal thermotherapy (MRgPIT) in an open 1.0-T MRI-system. Needle artefacts and contrast-to-noise ratios (CNR) of six interactive sequences (PD-, T1-, T2w TSE, T1-, T2w GRE, bSSFP) with varying echo-times (TE) and needle orientations to the main magnetic field (B0) were analysed. Additionally, five laser protocols (Nd: YAG Laser, 2–6 W) were assessed in 50 ex vivo human intervertebral discs with subsequent histological evaluation.

Results

In vitro, we found optimal needle artefacts of 1.5–5 mm for the PDw TSE sequence in all angles of the applicator system to B0. A TE of 20 ms yielded the best CNR. Ex vivo, ablating with 5 W induced histological denaturation of collagen at the dorsal annulus, correlating with a rise in temperature to at least 60 °C. The MRgPIT procedure was feasible with an average intervention time of 17.1 ± 5.7 min.

Conclusion

Real-time MR-guided positioning of the MRgPIT-applicator in cadaveric intervertebral disc is feasible and precise using fast TSE sequence designs. Laser-induced denaturation of collagen in the dorsal annulus fibrosus proved to be accurate.

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Availability of Data and Materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Acq. Matrix:

Acquisition matrix

B 0 :

Main magnetic field

bSSFP:

Balanced steady state free precession

CNR:

Contrast-to-noise ratio

FA:

Flip angel

FOV:

Field of view

G:

Gauge

GRE:

Gradient echo

Hz:

Hertz

IDET:

Intradiscal electrothermal therapy

IC I:

Inner cannula I

IC II:

Inner cannula II

LBP:

Low back pain

min:

Minute

mm:

Millimeter

MRgPIT:

MR-guided percutaneous intradiscal thermotherapy

NOS:

Number of scans

NSA:

Number of signal averages

OC:

Outer cannula

oMRT:

Open MRI

PD:

Proton density

PLDD:

Percutaneous laser discus decompression

ROI:

Region of interest

s:

Second

SD:

Standard deviation

SE:

Spin echo

SNR:

Signal to noise ratio

T1:

Longitudinal relaxation time

T2:

Transverse relaxation time

T:

Tesla

TA:

Time of acquisition

TE:

Echo time

TR:

Time of repetition

TSE:

Turbo spin echo

W:

Watt

W eff :

Effective power output in watt

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Funding

This work was supported in part by grants from the Technologiestiftung Berlin - Zukunftsfonds Berlin (TSB) and the EUs European Fund for Regional Development (Grant 10132816/10134231).

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    T. Leidenberger

  2. R&D Interventional Instruments, Invivo Corporation, Gainesville, FL, USA

    A. Winkel

  3. Center for Laser Medicine, Evangelical Elisabeth Clinic, Berlin, Germany

    C. Philipp

  4. Biotronik SE & Co KG, Berlin, Germany

    J. Rump

  5. Department of Radiology, Charité, Humboldt-University, Berlin, Germany

    M. De Bucourt & G. Böning

  6. Department of Radiology, Friedrich-Schiller-University, Jena, Germany

    U. Teichgräber

  7. Department of Radiology, Ludwig Maximilian University, Munich, Germany

    F. Streitparth

Authors
  1. T. Leidenberger
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  2. A. Winkel
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  3. C. Philipp
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  4. J. Rump
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  8. F. Streitparth
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Contributions

TL contributed to design and conduction of experimental work, development of MRgPIT-applicator, writing of the manuscript. AW contributed to development of MRgPIT-applicator. CP contributed to design and conduction of experimental work with regards to laser applications. JR contributed to design and conduction of experimental work with regards to artefacts. MB contributed to advisory function. GB contributed to advisory function. UT contributed to study design, advisory function, development of MRgPIT-applicator. FS contributed to study design, design and conduction of experimental work, development of MRgPIT-applicator, advisory function, revision of manuscript.

Corresponding author

Correspondence to T. Leidenberger.

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The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in this study involving human ex vivo participants were in accordance with the ethical standards of our ethics committee (ethics committee Charité – Universitätsmedizin Berlin, reference numbers EA1/071/09, EA1/301/12) and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Leidenberger, T., Winkel, A., Philipp, C. et al. MR-Guided Percutaneous Intradiscal Thermotherapy (MRgPIT): Evaluation of a New Technique for the Treatment of Degenerative Disc Disease in Cadaveric Lumbar Spine. Cardiovasc Intervent Radiol 43, 505–513 (2020). https://doi.org/10.1007/s00270-019-02382-8

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