1.Comparison between pig lumbar zypapophyseal joint cartilage acquired from multiple magnetic resonance image sequences and gross specimens.
Hongli LIAO ; Wenming YU ; Wei WANG ; Yunjie LIAO
Journal of Central South University(Medical Sciences) 2010;35(10):1064-1072
OBJECTIVE:
To evaluate the capability and limitation of magnetic resonance image(MRI)for Lumbar zygapophyseal joint cartilage through comparing pig lumbar zygapophyseal joint cartilage acquired from multiple MRI sequences of a 1.5 Tesla MR and gross specimens.
METHODS:
Six fresh lumbar spines from adult pigs were sagittaly scanned by Siemens 1.5 Tesla MR. The scan sequences included fast spin echo T1-weighted imaging (FSE T1WI), fast spin echo T2-weighted imaging (FSE T2 weighted T2WI), fat saturation proton density-weighted imaging (FS PDWI), 3-dimensional fast low angle shot imaging (3D-FLASH), and water excitation 3-dimensional fast low angle shot imaging (WE 3D-FLASH). Each scan sequence acquired images from the same layer. The signal-noise ratio (SNR) for articular cartilage, contrast-noise ratio (CNR) for cartilage versus bone cortex, cartilage versus bone marrow, and cartilage versus saline were calculated. Right after the scanning, the lumbar spines were snap-frozen, incised sagittally along the midline lumbar zypapophyseal joints, and photographed to compare the gross specimens with corresponding MRIs. The thickness of sagittal midline center of 6 pairs of lumbar(L₃/L₄) zypapophyseal joint cartilage was measured by vernier caliper. The thickness of the back ventral articular cartilage was added and then compared with corresponding MR images.
RESULTS:
3D-FLASH (FA 20°) and WE 3D-FLASH (FA 20°) sequences had significant advantages compared with other sequences in imaging lumbar zypapophyseal joint cartilage, and were mostly close to the real thickness.(1) Comparison of the 4 flip angle (FA 10°, FA 20°, FA 30°, and FA 40°) 3D-FLASH sequences:The highest cartilage SNR and best CNR of cartilage versus bone cortex were both found in the 3D-FLASH(FA 20°) sequence, which was significantly different from the other three 3D-FLASH sequences.The satisfactory CNR of cartilage versus bone marrow, cartilage versus saline were found more in the 3D-FLASH(FA 20°) sequence. (2) Comparison of the 4 flip angle(FA 10°, FA 20°, FA 30°, and FA 40°) WE 3D-FLASH sequences: the highest cartilage SNR,best CNR of cartilage versus bone cortex,and best CNR of cartilage versus bone marrow were found in the WE 3D-FLASH (FA 20°) sequence, which was significantly different from the other three 3D-FLASH sequences. The CNR of cartilage versus saline was found more satisfactory in the WE 3D-FLASH (FA 20°) sequence. (3) The highest cartilage SNR and best CNR of cartilage versus bone cortex were both found in the 3D-FLASH (FA 20°) sequence, which was significantly different from those in the PDWI, FSE T1WI,and FSE T2WI sequences (P<0.05), but with no significance (P>0.05) in the WE 3D-FLASH (FA 20°) sequence. The highest CNR of cartilage versus bone marrow was seen in WE 3D-FLASH (FA 20°) sequence. It was statistically significant compared with that in FS PDWI,FSE T1WI, and T2WI sequences respectively, but the difference was not significant compared with 3D-FLASH (FA 20°) sequence (P>0.05). Both the FS PDWI and T2WI sequences displayed ideal CNR of cartilage versus saline, with no significant difference (P>0.05). The lower SNR of cartilage versus saline was shown in 3D-FLASH (FA 20°) and WE 3D-FLASH (FA 20°) sequence, and the difference was not significant (P>0.05). However, they were significantly different compared with FS PDWI and T2WI sequences (P<0.05). (4) WE 3D-FLASH (FA 20°) and 3D-FLASH (FA 20°) sequences were relatively better than the FS PDWI when comparing the thickness of articular cartilage, which was significantly different from the FS PDWI sequence (P<0.05).
CONCLUSION
The 3D-FLASH sequence and derived WE 3D-FLASH sequence have better definition of cartilage images and are mostly close to the real thickness, which possibly are the optimal scanning sequences for lumbar zypapophyseal joint articular cartilage MR imaging.
Animals
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Cartilage, Articular
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anatomy & histology
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Imaging, Three-Dimensional
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Lumbar Vertebrae
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anatomy & histology
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Magnetic Resonance Imaging
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methods
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Swine
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Zygapophyseal Joint
;
anatomy & histology
2.Evaluation of Dimensions of Kambin’s Triangle to Calculate Maximum Permissible Cannula Diameter for Percutaneous Endoscopic Lumbar Discectomy: A 3-Dimensional Magnetic Resonance Imaging Based Study
Pradyumna Purushottam PAIRAITURKAR ; Onkar Shekhar SUDAME ; Chetan Shashikant POPHALE
Journal of Korean Neurosurgical Society 2019;62(4):414-421
OBJECTIVE: To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin’s safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy.METHODS: Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin’s triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken.RESULTS: The mean root to facet distances at upper end plate level measured on axial sections increased from 3.42±3.01 mm at L12 level to 4.57±2.49 mm at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from 6.07±1.13 mm at L12 level to 12.9±2.83 mm at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin’s triangle increased from 5.67±1.38 mm at L12 level to 9.7±3.82 mm at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin’s triangle also increased from 4.03±1.08 mm at L12 level to 6.11±1 mm at L5S1 level. Only 2% of the 427 bony Kambin’s triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin’s triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view.CONCLUSION: The largest mean diameter of endoscopic cannula passable through “bony” Kambin’s triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through “neural” Kambin’s triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.
Anatomy, Regional
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Catheters
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Diskectomy
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Endoscopy
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Female
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Humans
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Intervertebral Disc
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Lumbosacral Region
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Magnetic Resonance Imaging
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Male
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Zygapophyseal Joint
3.Transverse Process and Needles of Medial Branch Block to Facet Joint as Landmarks for Ultrasound-Guided Selective Nerve Root Block.
Daehee KIM ; Donghyuk CHOI ; Chungyoung KIM ; Jeongseok KIM ; Yongsoo CHOI
Clinics in Orthopedic Surgery 2013;5(1):44-48
BACKGROUND: Selective lumbar nerve root block (SNRB) is generally accepted as an effective treatment method for back pain with sciatica. However, it requires devices producing radioactive materials such as C-arm fluoroscopy. This study evaluated the usefulness of the longitudinal view of transverse process and needles for medial branch block as landmarks under ultrasonography. METHODS: We performed selective nerve root block for 96 nerve roots in 61 patients under the guidance of ultrasound. A curved probe was used to identify the facet joints and transverse processes. Identifying the lumbar nerve roots under the skin surface and ultrasound landmarks, the cephalad and caudal medial branch blocks were undertaken under the transverse view of sonogram first. A needle for nerve root block was inserted between the two transverse processes under longitudinal view, while estimating the depth with the needle for medial branch block. We then injected 1.0 mL of contrast medium and checked the distribution of the nerve root with C-arm fluoroscopy to evaluate the accuracy. The visual analog scale (VAS) was used to access the clinical results. RESULTS: Seven SNRBs were performed for the L2 nerve root, 15 for L3, 49 for L4, and 25 for L5, respectively. Eighty-six SNRBs (89.5%) showed successful positioning of the needles. We failed in the following cases: 1 case for the L2 nerve root; 2 for L3; 3 for L4; and 4 for L5. The failed needles were positioned at wrong leveled segments in 4 cases and inappropriate place in 6 cases. VAS was improved from 7.6 +/- 0.6 to 3.5 +/- 1.3 after the procedure. CONCLUSIONS: For SNRB in lumbar spine, the transverse processes under longitudinal view as the ultrasound landmark and the needles of medial branch block to the facet joint can be a promising guidance.
Adult
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Aged
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Aged, 80 and over
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Chronic Disease
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Female
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Humans
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Low Back Pain/etiology/*therapy
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Lumbar Vertebrae/anatomy & histology/*ultrasonography
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Male
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Middle Aged
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Nerve Block/*methods
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Sciatica/etiology/*therapy
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Spinal Stenosis/complications/*diagnosis
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Zygapophyseal Joint/anatomy & histology/ultrasonography