(Saturday, 4/4/2020) [Mountain Time (GMT-6)]
Purpose: This study describes a protocol and outcome for Magnetic Resonance Imaging-guided Focused Ultrasound (MRgFUS) ablation of lumbar facet joints in a patient with an implanted MRI non-conditional pacemaker. MRgFUS is a minimally-invasive thermal treatment modality that utilizes a phased array ultrasound transducer integrated with the MRI scanner and has been successfully used to treat a variety of conditions, as symptomatic uterine fibroids(1-4), essential tremor(5, 6), prostate cancer(7) and facet joint pain(8).
Methods: A risk-benefit analysis by a coordinated multi-disciplinary team prior to this treatment was performed to account for the risks associated with the MRI non-conditional pacemaker in the context of the MRgFUS procedure as per our institutions cardiac implanted electronic device (CIED) /MRI practice guidelines (9). A cardiology nurse and medical physicist were present for the entire procedure. The cardiology nurse continuously monitored the patient’s cardiac function. All MRI was performed in the normal scan mode. The MR physicist assisted the MRI technologist in both, ensuring SAR was limited to 1.5 W/kg by adjusting sequence parameters, and monitoring real-time SAR.
Results: The MRgFUS treatment was completed successfully, during which the patient maintained stable vital signs and cardiac function. There were no changes in pacemaker function or in pacing threshold post treatment. The key to this treatment was the successful integration of existing CIED/MRI practice to this interventional procedure. Specifically, a cardiology pacemaker nurse carried out CIED programming and patient monitoring while the MRI physicist monitored the real-time SAR, related to the CIED; all of which permitted the procedural radiologist to concentrate on the MRgFUS procedure to achieve the desired outcome.
Conclusion: By careful use of our MRI CIED protocol (9, 10), we demonstrated that the MRgFUS ablation treatment of facet joints can be performed, and going forward can be offered to patients with CIEDs on a case-by-case basis.
Funding Support, Disclosures, and Conflict of Interest: MRgFUS use for facet joint treatment is an off-label use in the United States. The authors have no conflict of interest to disclose.
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