ISSN 1305-3825 | E-ISSN 1305-3612
Interventional Radiology - Original Article
1.5 Tesla augmented reality navigated interventional magnetic resonance imaging: paravertebral sympathetic plexus injections
1 Russel H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA  
2 Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada  
3 School of Computing, Queen’s University, Kingston, ON, Canada  
4 Siemens Corporate Research, Center for Applied Medical Imaging, Baltimore, MD, USA  
5 Department of Mechanical Engineering and Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, MD, USA  
Diagn Interv Radiol ; : -

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Purpose: The high contrast resolution and absent ionizing radiation of interventional magnetic resonance imaging (MRI) can be advantageous for paravertebral sympathetic nerve plexus injections. We assessed the feasibility and technical performance of MR-guided paravertebral sympathetic injections utilizing augmented reality navigation and 1.5 Tesla MRI scanner.


Methods: A total of 23 bilateral injections of the thoracic (8/23, 35%), lumbar (8/23, 35%) and hypogastric (7/23, 30%) paravertebral sympathetic plexus were prospectively planned in twelve human cadavers using a 1.5-Tesla MRI scanner and augmented reality navigation system. MR-conditional needles were used. Gadolinium-DTPA-enhanced saline was injected. Outcome variables included the number of control MR images, target error of the needle tip, punctures of critical non-target structures, distribution of the injected fluid, and procedure length.


Results: Augmented-reality navigated MR guidance at 1.5 Tesla provided detailed anatomical visualization for successful targeting of the paravertebral space, needle placement, and perineural paravertebral injections in 46/46 (100%) targets. A mean of 2 (1-5) MR images were required to control needle placement. There were 9/46 (20%) changes of the needle trajectory and 6/46 (13%) changes of needle advancement, which were statistically not related to spinal regions (P = 0.728 and 0.86) and cadaver sizes (P = 0.893 and 0.859), respectively. The mean error of the needle tip was 3.9 ± 1.7 mm. There were no punctures of critical non-target structures. The mean procedure length was 33 ± 12 min.


Conclusion: 1.5 Tesla augmented reality-navigated interventional MRI can provide accurate imaging guidance for perineural injections of the thoracic, lumbar, and hypogastric sympathetic plexus.

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