title: In vivo feasibility of real-time MR-US fusion imaging lumbar facet joint injections.
abstract: OBJECTIVE
  Traditionally, facet joint injections (FJI) are performed under fluoroscopic or computed tomography (CT) guidance, mainly due to the deep anatomical location and the presence of bony landmarks. Fusion imaging technology, which couples the ultrasound scan with the corresponding CT or magnetic resonance (MR) image obtained from the diagnostic examination and reformatted in real time according to the ultrasound scanning plane, allows to combine the panoramic view and the elevated anatomical detail of MR or CT with the ease of use of ultrasound without patient exposure to ionizing radiation.
  
  
  METHODS
  Thirty eight patients (24 females; mean age ± SD: 64 ± 9 years) received MR fusion-assisted ultrasound-guided FJI of 1 ml of a mixture of local anaesthetic and corticosteroid using a ultrasound machine (Logiq E9, GE Healthcare) equipped with a GPS-enhanced fusion imaging technology which couples real-time B-mode images with those of the previous recent diagnostic MR examination. Low-dose CT needle positioning confirmation was performed in the first 28 patients. Patients' pain was recorded using a visual analogue scale (VAS), at baseline and at 2, 4 and 8 weeks.
  
  
  RESULTS
  All fusion imaging-guided injections were performed successfully. Out of 112, 96 FJI had optimal intra-articular needle positioning (accuracy: 85.7%). Patients VAS significantly decreases after the procedure with no differences among who received CT needle positioning control and who did not receive it. No major complications were observed.
  
  
  CONCLUSIONS
  Ultrasound needle guidance with MR fusion assistance allows for safe and effective injection of degenerative facet joint disease.
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sartoris
authors.affiliation: S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy.
authors.forename: Davide
authors.identifier: 0000-0001-5569-3359
authors.initials: D
authors.lastname: Orlandi
authors.affiliation: Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.|Scuola di dottorato in Neuroscienze, Università degli Studi di Genova, Genoa, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Corazza
authors.affiliation: Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Arcidiacono
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy.
authors.forename: Silvia Perugin
authors.initials: SP
authors.lastname: Bernardi
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli studi di Genova, Genoa, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Schiaffino
authors.affiliation: S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Turtulici
authors.affiliation: S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caruso
authors.affiliation: S.C. Diagnostica per Immagini, Radiologia, Ospedale Evangelico Internazionale, Corso Solferino 2A, 16100 Genoa, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Silvestri
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D059350:Chronic Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D064847:Multimodal Imaging / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging*
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008619:Mepivacaine; D008775:Methylprednisolone
keywords: Facet joint; Fusion imaging; Injection; Magnetic resonance; Ultrasound