Guidance Modalities Research Articles

Enhanced Precision and Safety in Thermal Ablation: O-Arm Cone Beam Computed Tomography with Magnetic Resonance Imaging Fusion for Spinal Column Tumor Targeting.

Spinal metastatic tumors are common and often cause debilitating symptoms. Image-guided percutaneous thermal ablation (IPTA) has gained significant recognition in managing spinal column tumors due to its exceptional precision and effectiveness. Conventional guidance modalities, including computed tomography, fluoroscopy, and ultrasound, have been important in targeting spinal column tumors while minimizing harm to adjacent critical structures. This study presents a novel approach utilizing a fusion of cone beam computed tomography with magnetic resonance imaging to guide percutaneous thermal ablation for four patients with secondary spinal column tumors. The visual analog scale (VAS) evaluated the procedure effectiveness during an 18-month follow-up. Percutaneous vertebroplasty was performed in two cases, and a thermostat was used during all procedures. Imaging was performed using the Stealth Station navigation system Spine 8 (SSS8) and a 1.5T MRI machine. The fusion of CBCT with MRI allowed for precise tumor localization and guidance for thermal ablation. Initial results indicate successful tumor ablation and symptom reduction, emphasizing the potential of CBCT-MRI fusion in spinal column tumor management. This innovative approach is promising in optimizing therapy for secondary spinal column tumors. Further studies are necessary to validate its efficacy and applicability.

Multimodal Image Synthesis and Editing: A Survey and Taxonomy.

As information exists in various modalities in real world, effective interaction and fusion among multimodal information plays a key role for the creation and perception of multimodal data in computer vision and deep learning research. With superb power in modeling the interaction among multimodal information, multimodal image synthesis and editing has become a hot research topic in recent years. Instead of providing explicit guidance for network training, multimodal guidance offers intuitive and flexible means for image synthesis and editing. On the other hand, this field is also facing several challenges in alignment of multimodal features, synthesis of high-resolution images, faithful evaluation metrics, etc. In this survey, we comprehensively contextualize the advance of the recent multimodal image synthesis and editing and formulate taxonomies according to data modalities and model types. We start with an introduction to different guidance modalities in image synthesis and editing, and then describe multimodal image synthesis and editing approaches extensively according to their model types. After that, we describe benchmark datasets and evaluation metrics as well as corresponding experimental results. Finally, we provide insights about the current research challenges and possible directions for future research. A project associated with this survey is available at https://github.com/fnzhan/MISE.

Imaging in interventional oncology, the better you see, the better you treat.

Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up.

Comparing Performance and Preference of Visually Impaired Individuals in Object Localization: Tactile, Verbal, and Sonification Cueing Modalities

Audio guidance is a common means of helping visually impaired individuals to navigate, thereby increasing their independence. However, the differences between different guidance modalities for locating objects in 3D space have yet to be investigated. The aim of this study was to compare the time, the hand’s path length, and the satisfaction levels of visually impaired individuals using three automatic cueing modalities: pitch sonification, verbal, and vibration. We recruited 30 visually impaired individuals (11 women, average age 39.6 ± 15.0), who were asked to locate a small cube, guided by one of three cueing modalities: sonification (a continuous beep that increases in frequency as the hand approaches the cube), verbal prompting (“right”, “forward”, etc.), and vibration (via five motors, attached to different locations on the hand). The three cueing modalities were automatically activated by computerized motion capture systems. The subjects separately answered satisfaction questions for each cueing modality. The main finding was that the time to find the cube was longer using the sonification cueing (p = 0.016). There were no significant differences in the hand path length or the subjects’ satisfaction. It can be concluded that verbal guidance may be the most effective for guiding people with visual impairment to locate an object in a 3D space.

Magnetic Resonance-guided Procedures: Consensus on Rationale, Techniques, and Outcomes

Magnetic resonance (MR) image guidance has demonstrated significant potential in the field of interventional radiology in several applications. This article covers the main points of MR-guided hepatic tumor ablation as a representative of MR-guided procedures. Patient selection and appropriate equipment utilization are essential for successful MR-guided tumor ablation. Intra-procedural planning imaging enables the visualization of the tumor and surrounding anatomical structures in most cases without application of contrast agent, ensuring optimal planning of the applicator tract. MRI enables real-time, multiplanar imaging, thus simultaneous observation of the applicator and target tumor is possible during targeting with adaptable slice angulations in case of challenging tumor positions. Typical ablation zone appearance during therapy monitoring with MRI enables save assessment of the therapy result, resulting in a high primary efficacy rate. Recent advancements in ablation probes have shortened treatment times, while technical strategies address applicator visibility issues. MR-imaging immediately after the procedure is used to rule out complications and to assess technical success. Especially in smaller neoplasms, MRI-guided liver ablation demonstrates positive outcomes in terms of technical success rates, as well as promising survival and recurrence rates. Additionally, percutaneous biopsy under MR guidance offers an alternative to classic guidance modalities, providing high soft tissue contrast and thereby increasing the reliability of lesion detection, particularly in cases involving smaller lesions. Despite these advantages, use of MR-guidance in clinical routine is still limited to few indications and centers, due to by high costs, extended duration, and the need for specialized expertise. In conclusion, MRI-guided interventions could benefit from ongoing advancements in hardware, software and devices. Such progress has the potential to expand diagnostic and treatment options in the field of interventional radiology.

Robot-assisted percutaneous pedicle screw placement accuracy compared with alternative guidance in lateral single-position surgery: a systematic review and meta-analysis.

While single-position surgery (SPS) eliminates the need for patient repositioning, the placement of screws in the unconventional lateral position poses unique challenges related to asymmetry relative to the surgical table. Use of robotic guidance or intraoperative navigation can help to overcome this. The aim of this study was to compare the relative accuracies offered by these various navigation modalities for pedicle screws placed in lateral SPS. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed/Medline, Embase, and Cochrane Library databases were queried for studies reporting pedicle screw placement accuracy using fluoroscopic, CT-navigated, O-arm, or robotic guidance in lateral SPS, and a systematic review and meta-analysis was performed. Included studies all compared evaluated screw placement accuracy in lateral SPS using a single navigation method. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system; risk of bias was assessed using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. The primary outcome, rate of pedicle screw breach, was analyzed using random-effects meta-analysis. Eleven studies were included comprising 548 patients who underwent the placement of instrumentation with 2488 screws. For the fluoroscopic, CT-navigated, O-arm, and robotic guidance cohorts, there were 3, 2, 3, and 3 studies, respectively. Breach rates by modality were as follows: fluoroscopic guidance (6.6%), CT navigation (4.7%), O-arm (3.9%), and robotic guidance (3.9%). Random-effects meta-analysis showed a significant difference between studies, with an overall breach rate of 4.9% (95% CI 3.1%-7.5%; p < 0.001); however, testing for subgroup differences failed to show a significant difference between guidance modalities (QM = 0.69, df = 3; p = 0.88). Heterogeneity between studies was significant (I2 = 79.0%, τ2 = 0.41, χ2 = 47.65, df = 10; p < 0.001). Robotic guidance of screws is noninferior to alternative guidance modalities in lateral SPS; however, additional prospective studies directly comparing different guidance types are merited.

Comparison of Six Different Percutaneous Coronary Intervention Guidance Modalities.

Background: New randomized trials and modalities in guiding percutaneous coronary intervention (PCI) have become available. Objective: We aimed to compare the clinical outcomes of coronary angiography (CAG), intravascular ultrasound (IVUS), optical coherence tomography (OCT), fractional flow reserve (FFR), instantaneous wave-free ratio (iFR), and optical frequency domain imaging (OFDI)-guided PCI. Methods: A network meta-analysis was performed to compare different PCI guidance modalities. The clinical outcomes included major adverse cardiovascular events (MACE), all-cause death, myocardial infarction (MI), and target vessel/lesion revascularization (TVR/TLR). Odds ratio (OR) and corresponding 95% credible interval (CrI) were calculated. Results: Thirty-six randomized trials, including 19,042 patients, were included. In comparison with CAG, IVUS significantly reduced MACE (OR: 0.71; 95% CrI: 0.57 to 0.86) and TVR/TLR (OR: 0.53; 95% CrI: 0.43 to 0.66). MACE (OR: 1.44; 95% CrI: 1.02 to 2.08) and TVR/TLR (OR: 1.87; 95% CrI: 1.04 to 3.71) were significantly increased in the FFR group, compared with IVUS group. There were no significant differences in MACE or TVR/TLR among the left guidance modality comparisons. Differences in all-cause death or MI were not observed in any comparisons. Conclusions: IVUS could reduce MACE and TVR/TLR, compared with CAG or FFR. Therefore, IVUS may be the optimal modality in guiding PCI.

The role of guidance in delivering cardiac resynchronization therapy: A systematic review and network meta-analysis

Positioning the left ventricular lead at the optimal myocardial segment has been proposed to improve cardiac resynchronization therapy (CRT) response. We performed a systematic review and network meta-analysis evaluating echocardiographic and clinical response delivered with different guidance modalities compared to conventional fluoroscopic positioning. Randomized trials with ≥6 months follow-up comparing any combination of imaging, electrical, hemodynamic, or fluoroscopic guidance were included. Imaging modalities were split whether one modality was used: cardiac magnetic resonance (CMR), speckle-tracking echocardiography (STE), single-photon emission computed tomography, cardiac computed tomography (CT), or a combination of these, defined as "multimodality imaging." Twelve studies were included (n = 1864). Pair-wise meta-analysis resulted in significant odds of reduction in left ventricular end-systolic volume (LVESV) >15% (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.05-2.13, P = .025) and absolute reduction in LVESV (standardized mean difference [SMD] -0.25, 95% CI -0.43 to -0.08, P = .005) with guidance. CMR (OR 55.3, 95% CI 4.7-656.9, P = .002), electrical (OR 17.0, 95% CI 2.9-100, P = .002), multimodality imaging (OR 4.47, 95% CI 1.36-14.7, P = .014), and hemodynamic guidance (OR 1.29-28.0, P = .02) were significant in reducing LVESV >15%. Only STE demonstrated a significant reduction in absolute LVESV (SMD -0.38, 95% CI -0.68 to -0.09, P = .011]. CMR had the highest probability of improving clinical response (OR 17.9, 95% CI 5.14-62.5, P < .001). Overall, guidance improves CRT outcomes. STE and multimodality imaging provided the most reliable evidence of efficacy. Wide CIs observed for results of CMR guidance suggest more powered studies are required before a clear ranking is possible.

Robotics in spine surgery: systematic review of literature.

Over 4.83 million spine surgery procedures are performed annually around the world. With the considerable caseload and the precision needed to achieve optimal spinal instrumentation, technical progress has helped to improve the technique's safety and accuracy with the development of peri-operative assistance tools. Contrary to other surgical applications already part of the standard of care, the development of robotics in spine surgery is still a novelty and is not widely available nor used. Robotics, especially when coupled with other guidance modalities such as navigation, seems to be a promising tool in our quest for accuracy, improving patient outcomes and reducing surgical complications. Robotics in spine surgery may also be for the surgeon a way to progress in terms of ergonomics, but also to respond to a growing concern among surgical teams to reduce radiation exposure. We present in this recent systematic review of the literature realized according to the PRISMA guidelines the place of robotics in spine surgery, reviewing the comparison to standard techniques, the current and future indications, the learning curve, the impact on radiation exposure, and the cost-effectiveness. Seventy-six relevant original studies were identified and analyzed for the review. Robotics has proved to be a safe help for spine surgery, both for the patient with a decrease of operating time and increase in pedicular screw accuracy, and for the surgical team with a decrease of radiation exposure. Medico-economic studies demonstrated that despite a high buying cost, the purchase of a robot dedicated for spine surgery is cost-effective resulting in lesser revision, lower infection, reduced length of stay, and shorter surgical procedure.

Clinical Outcomes Following Hemodynamic Parameter or Intravascular Imaging-Guided Percutaneous Coronary Intervention in the Era of Drug-Eluting Stents: An Updated Systematic Review and Bayesian Network Meta-Analysis of 28 Randomized Trials and 11,860 Patients

BackgroundCoronary angiography (CAG) is the standard imaging modality for guiding percutaneous coronary interventions (PCI). Intracoronary imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), and hemodynamic parameter like fractional flow reserve (FFR) can overcome some limitations of CAG.ObjectiveWe sought to explore the clinical outcomes of different PCI guidance modalities in the era of drug-eluting stent (DES).MethodsA network meta-analysis of 28 randomized trials and 11,860 patients undergoing different modalities-guided PCI in the era of DES was performed. Odds ratio (OR) with 95% credible interval (CrI) were calculated.ResultsIn comparison with CAG, IVUS was associated with a significant reduction in major adverse cardiovascular events (MACE, OR: 0.60; 95% CrI: 0.46–0.79), cardiovascular death (OR: 0.46; 95% CrI: 0.20–0.94), target vessel/lesion revascularization (TVR/TLR, OR: 0.55; 95% CrI: 0.41–0.74), and a trend toward decreased risk of stent thrombosis (OR: 0.44; 95% CrI: 0.17 to 1.00). FFR/quantitative flow ratio (QFR) could significantly reduce stroke compared with CAG, IVUS, and OCT/optical frequency domain imaging (OFDI). However, myocardial infarction (MI), all-cause death, stent thrombosis, and any revascularization presented similar risks for different PCI guidance modalities.ConclusionIn the era of DES, IVUS led to lower risks of MACE than CAG, which was mainly due to lower risks of cardiovascular death and TVR/TLR. A trend toward decreased risk of stent thrombosis was also observed with IVUS. Hemodynamic parameter (FFR/QFR)-guided PCI could significantly reduce the stroke risk compared with CAG, IVUS, and OCT/OFDI.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021291442].

AB205. SOH22ABS234. Patient positions and ultrasound guided chronic pain interventions

Background: Image guidance is commonly used in chronic pain intervention procedures. Guidance modalities include fluoroscopy, CT, magnetic resonance imaging (MRI) and ultrasound. Ultrasound guidance is growing in popularity due to absence of radiation, absence of dye injections, decreased cost and spectrum of utility. Another potential benefit is more comfortable patient positioning, reduction in stress for patients regarding positioning and intervention and reduced procedure time. This benefit of ultrasound-guided injections for single and multi-source have not been studied. The aim of this study was to examine these potential benefits of ultrasound guided chronic pain relief procedures.

Total Generate: Cycle in Cycle Generative Adversarial Networks for Generating Human Faces, Hands, Bodies, and Natural Scenes

We propose a novel and unified Cycle In Cycle Generative Adversarial Network (C2GAN) for generating human faces, hands, bodies, and natural scenes. Our proposed C2GAN is a cross-modal model exploring a joint exploitation of the input image data and guidance data in an interactive manner. C2GAN contains two different generators, i.e., an image-generation generator and a guidance-generation generator. Both generators are mutually connected and trained in an end-to-end fashion and explicitly form three cycled subnets, i.e., one image generation cycle and two guidance generation cycles. Each cycle aims at reconstructing the input domain and simultaneously produces a useful output involved in the generation of another cycle. In this way, the cycles constrain each other implicitly providing complementary information from both image and guidance modalities and bringing an extra supervision gradient across the cycles, facilitating a more robust optimization of the whole model. Extensive experimental results on four guided image-to-image translation subtasks, i.e., person image generation, facial expression generation, hand gesture-to-gesture translation, and cross-view image translation, demonstrate that the proposed C2GAN is effective in generating more realistic images compared with state-of-the-art models.

Image guidance used for large joint and bursa injections; a survey study

ABSTRACT Objectives To determine the current rates of use of available image guidance modalities for large joint and bursal injections, in addition to their relationships to physician demographics. Methods An electronic survey was sent to 3,400 members of the American Medical Society for Sports Medicine (AMSSM), examining types of guidance used for each large joint and bursal injection. Results A total of 674 sports medicine physicians responded to the survey. Intra-articular hip and glenohumeral joint injections were more commonly performed with ultrasound guidance, while palpation-guidance was more common with all other injections. Physicians who specialized in Physical Medicine & Rehabilitation (PM&R) were more likely to use ultrasound for trochanteric bursa (p = 0.007, OR = 4.16 [1.46–11.8]), while internal medicine-, pediatrics-, and family medicine-trained physicians were more likely to use palpation guidance for at least one joint (p < 0.05). Physicians with fewer years of experience were more likely to use ultrasound for glenohumeral joint injections (p ≤ 0.002 for all age groups with less than 20 years of experience, ORs ranging from 6.3 to 9.2). Conclusion Palpation-guidance is the most common technique used for large joint and bursal injections, other than for glenohumeral and hip joint injections. PM&R-trained physicians and those with less experience tend to use ultrasound more frequently.

Ultrasound-guided versus traditional surgical resection of supratentorial gliomas in a limited-resources neurosurgical setting

BackgroundIntraoperative ultrasonography (IOUS) represents a cheap and safe alternative to the more expensive intraoperative guidance modalities. In this study, we investigate the impact of introducing IOUS in the surgical management of supratentorial gliomas and compare its use objectively to unguided surgery.MethodsWe conducted a prospective cohort study comparing two groups of patients with supratentorial gliomas amenable to gross total resection. One group was operated using intraoperative ultrasound guidance while the other group was operated using a more traditional approach with no intraoperative image guidance. The main outcomes assessed were the extent of tumor resection (EOR) based on early postoperative MRI, the postoperative Karnofsky performance score (KPS), and the rate of complications.ResultsThere were 17 patients in the ultrasound group and 13 in the control group. EOR was significantly better in the IOUS group. Gross total (GTR) and near-total (NTR) resection were achieved in 29% and 24% respectively in the IOUS group, while 0% and 8% respectively in the control group. The mean volumetric EOR was 83% and 66% in the IOUS and the control groups respectively. Ultrasound was able to detect residual tumor after surgeon perceived GTR in 76% of cases. Postoperative KPS was significantly better in the IOUS group.ConclusionIOUS guidance is superior to non-guided surgery in terms of EOR. Higher tumor resection confers a survival benefit according to previously published literature. This is particularly useful in a limited-resource setting, where neuronavigation and intraoperative MRI are not available.

Computed Tomography Bronchus Sign and the Diagnostic Yield of Guided Bronchoscopy for Peripheral Pulmonary Lesions. A Systematic Review and Meta-Analysis.

Indeterminate peripheral pulmonary lesions (PPLs) often require tissue diagnosis. If nonsurgical biopsy techniques are considered, deciding between bronchoscopic transbronchial versus computed tomography-guided transthoracic biopsy can be difficult. The former has a low diagnostic yield with a low complication risk, whereas the latter has a better diagnostic yield but a higher complication rate. Investigators have looked at various lesion characteristics that can predict the diagnostic yield of guided bronchoscopic biopsies. Although consensus exists that larger size and proximity to the hilum increase the diagnostic yield, there is ongoing debate about the association between computed tomography bronchus sign (air-filled bronchus in close proximity of the lesion as seen on computed tomography imaging) and the diagnostic yield of guided bronchoscopic modalities. To perform a meta-analysis and systematic review, determining the association between computed tomography bronchus sign and the diagnostic yield of guided bronchoscopy for PPLs. MEDLINE, Embase, Scopus, and Google Scholar were searched in January 2018 for guided bronchoscopy studies that had assessed the impact of computed tomography bronchus sign on the diagnostic yield. The quality of included studies was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 tool. Meta-analysis was performed using MedCalc (version 18). Odds ratios were used to compare yield of lesions with and without bronchus sign. Random effects model was used when significant heterogeneity was observed (I2 > 40%). For 2,199 lesions with computed tomography bronchus sign, the overall weighted diagnostic yield was 74.1% (95% confidence interval, 68.3-79.5%). For 971 lesions without computed tomography bronchus sign, the overall weighted diagnostic yield was 49.6% (95% confidence interval, 39.6-59.5%). The odds ratio for successfully diagnosing a lesion with computed tomography bronchus sign was 3.4 (95% confidence interval, 2.4-5.0). Possible sources of heterogeneity in the meta-analysis included differences in study designs, guidance modalities, and cancer prevalence. The odds ratio for successfully diagnosing a lesion with computed tomography bronchus sign was relatively lower for prospective studies. PPLs with computed tomography bronchus sign are more likely to be diagnosed with guided bronchoscopy than the lesions without computed tomography bronchus sign. Clinicians should consider this, along with the lesion size and distance from the hilum, when contemplating guided bronchoscopy for PPLs.

Aspiration and Injection Techniques of the Lower Extremity.

Orthopaedic surgeons frequently use aspirations and injections to both diagnose and treat disorders of the lower extremity. Comprehensive knowledge of regional anatomy, procedural indications, and appropriate techniques are essential. Clinicians must be well versed in a range of musculoskeletal aspiration and injection techniques, including patient positioning, equipment needs, injectable solutions, aspirate analysis, and potential complications. Safe and effective aspiration and injection techniques for the lower extremity, including the hip, knee, foot, and ankle, are reviewed. Image guidance modalities include fluoroscopy, ultrasonography, CT, and MRI.

Just Breathe

Motivated by the idea that slow breathing practices could transform the automobile commute from a depleting, mindless activity into a calming, mindful experience, we introduce the first guided slow breathing intervention for drivers. We describe a controlled in-lab experiment (N=24) that contrasts the effectiveness and impact of haptic and voice guidance modalities at slowing drivers' breathing pace, which is a known modulator of stress. The experiment was conducted in two simulated driving environments (city, highway) while driving in one of two driving modes (autonomous, manual). Results show that both haptic and voice guidance systems can reduce drivers' breathing rate and provide a sustained post-intervention effect without affecting driving safety. Subjectively, most participants (19/24) preferred the haptic stimuli as they found it more natural to follow, less distracting, and easier to engage and disengage from, compared to the voice stimuli. Finally, while most participants found guided breathing to be a positive experience, a few participants in the autonomous driving condition found slow breathing to be an unusual activity inside the car. In this paper, we discuss such considerations, offer guidelines for designing in-car breathing interventions, and propose future research that extends our work to on-road studies. Altogether, this paper serves as foundational work on guided breathing interventions for automobile drivers.

Enabling Technology for MRI-Guided Intervention.

The use of magnetic resonance imaging (MRI) for image-guided intervention poses both great opportunity and challenges. Although MRI is distinguished by its excellent contrast resolution and lack of ionizing radiation, it was not till the 1990s that technologic innovations allowed for adoption of MRI as a guidance modality for intervention. With advances in magnet, protocol, coil, biopsy needle, and ablation probe design, MRI has emerged as a viable, and increasingly, preferable alternative to other image guidance modalities. With the development of targeting software, augmented reality, robotic assist devices, and MR thermometry, the future of MRI-guided interventions remains promising.

Analysis of Complications of Percutaneous Transthoracic Needle Biopsy Using CT-Guidance Modalities In a Multicenter Cohort of 10568 Biopsies.

ObjectiveTo analyze the complications of percutaneous transthoracic needle biopsy using CT-based imaging modalities for needle guidance in comparison with fluoroscopy in a large retrospective cohort.Materials and MethodsThis study was approved by multiple Institutional Review Boards and the requirement for informed consent was waived. We retrospectively included 10568 biopsies from eight referral hospitals from 2010 through 2014. In univariate and multivariate logistic analyses, 3 CT-based guidance modalities (CT, CT fluoroscopy, and cone-beam CT) were compared with fluoroscopy in terms of the risk of pneumothorax, pneumothorax requiring chest tube insertion, and hemoptysis, with adjustment for other risk factors.ResultsPneumothorax occurred in 2298 of the 10568 biopsies (21.7%). Tube insertion was required after 316 biopsies (3.0%), and hemoptysis occurred in 550 cases (5.2%). In the multivariate analysis, pneumothorax was more frequently detected with CT {odds ratio (OR), 2.752 (95% confidence interval [CI], 2.325–3.258), p < 0.001}, CT fluoroscopy (OR, 1.440 [95% CI, 1.176–1.762], p < 0.001), and cone-beam CT (OR, 2.906 [95% CI, 2.235–3.779], p < 0.001), but no significant relationship was found for pneumothorax requiring chest tube insertion (p = 0.497, p = 0.222, and p = 0.216, respectively). The incidence of hemoptysis was significantly lower under CT (OR, 0.348 [95% CI, 0.247–0.491], p < 0.001), CT fluoroscopy (OR, 0.594 [95% CI, 0.419–0.843], p = 0.004), and cone-beam CT (OR, 0.479 [95% CI, 0.317–0.724], p < 0.001) guidance.ConclusionHemoptysis occurred less frequently with CT-based guidance modalities in comparison with fluoroscopy. Although pneumothorax requiring chest tube insertion showed a similar incidence, pneumothorax was more frequently detected using CT-based guidance modalities.

Greater occipital nerve infiltration under MR guidance: Feasibility study and preliminary results.

To assess the feasibility of greater occipital nerve (GON) intermediate site infiltration with MRI guidance. Eleven consecutive patients suffering from chronic refractory cranio-facial pain who underwent 16 GON infiltrations were included in this prospective study. All of the procedures were performed on an outpatient basis in the research facility of our institution, with a 1.5T scanner. The fatty space between inferior obliquus and semispinalis muscles at C1-C2 level was defined as the target. Technical success was defined as the ability to accurately inject the products at the target, assessed by post-procedure axial and sagittal proton density-weighted sequences. Clinical success was defined as a 50% pain decrease at 1month. Technical success was 100%. GON was depicted in 6/11 cases on planning MRI sequences. Mean duration of procedure was 22.5min (range 16-41). Clinical success was obtained in 7/11 included patients (63.6%) with a mean self-reported improvement of 78%. Interventional MR-guidance for GON infiltration is a feasible technique offering similar results to an already established effective procedure. It may appear as a useful tool in specific populations, such as young patients and repeat infiltrations, and should be considered in these settings. • MR guidance for GON infiltration is a feasible technique. • Preliminary results are in agreement with other guidance modalities. • MR guidance may be seen as a useful tool in specific populations. • Specific populations include young patients and repeat infiltrations. • Target patients may also include patients with potentionally previously reported complications (torticollis).