title: A signal-inducing bone cement for magnetic resonance imaging-guided spinal surgery based on hydroxyapatite and polymethylmethacrylate.
abstract: The aim of this study was to develop a signal-inducing bone cement for magnetic resonance imaging (MRI)-guided cementoplasty of the spine. This MRI cement would allow precise and controlled injection of cement into pathologic lesions of the bone. We mixed conventional polymethylmethacrylate bone cement (PMMA; 5 ml methylmethacrylate and 12 g polymethylmethacrylate) with hydroxyapatite (HA) bone substitute (2-4 ml) and a gadolinium-based contrast agent (CA; 0-60 μl). The contrast-to-noise ratio (CNR) of different CA doses was measured in an open 1.0-Tesla scanner for fast T1W Turbo-Spin-Echo (TSE) and T1W TSE pulse sequences to determine the highest signal. We simulated MRI-guided cementoplasty in cadaveric spines. Compressive strength of the cements was tested. The highest CNR was (1) 87.3 (SD 2.9) in fast T1W TSE for cements with 4 μl CA/ml HA (4 ml) and (2) 60.8 (SD 2.4) in T1W TSE for cements with 1 μl CA/ml HA (4 ml). MRI-guided cementoplasty in cadaveric spine was feasible. Compressive strength decreased with increasing amounts of HA from 46.7 MPa (2 ml HA) to 28.0 MPa (4 ml HA). An MRI-compatible cement based on PMMA, HA, and CA is feasible and clearly visible on MRI images. MRI-guided spinal cementoplasty using this cement would permit direct visualization of the cement, the pathologic process, and the anatomical surroundings.
authors.affiliation: Center for Musculoskeletal Surgery, University Charité, 13353, Berlin, Germany. florian.wichlas@charite.de
authors.forename: Florian
authors.initials: F
authors.lastname: Wichlas
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Seebauer
authors.forename: Rene
authors.initials: R
authors.lastname: Schilling
authors.forename: Jens
authors.initials: J
authors.lastname: Rump
authors.forename: Sascha S
authors.initials: SS
authors.lastname: Chopra
authors.forename: Thula
authors.initials: T
authors.lastname: Walter
authors.forename: Ulf K M
authors.initials: UK
authors.lastname: Teichgräber
authors.forename: Hermann J
authors.initials: HJ
authors.lastname: Bail
mesh_terms: D001843:Bone Cements / Q000494:pharmacology*; D002102:Cadaver; D003287:Contrast Media / Q000494:pharmacology; D017886:Durapatite / Q000494:pharmacology*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007278:Injections, Spinal; D053783:Magnetic Resonance Imaging, Interventional; D008536:Meglumine / Q000494:pharmacology; D009942:Organometallic Compounds / Q000494:pharmacology; D019904:Polymethyl Methacrylate / Q000494:pharmacology*; D013131:Spine / Q000601:surgery*; D013314:Stress, Mechanical
chemical_list: D001843:Bone Cements; D003287:Contrast Media; D009942:Organometallic Compounds; D008536:Meglumine; D019904:Polymethyl Methacrylate; D017886:Durapatite; C072417:gadoterate meglumine