Original Research

An MRI Analysis of the Pelvis to Determine the Ideal Method for Ultrasound-Guided Bone Marrow Aspiration from the Iliac Crest

Publish date: May 30, 2018

References

1. Chahla J, Mannava S, Cinque ME, Geeslin AG, Codina D, LaPrade RF. Bone marrow aspirate concentrate harvesting and processing technique. Arthrosc Tech. 2017;6(2):e441-e445. doi:10.1016/j.eats.2016.10.024.

2. Hernigou J, Alves A, Homma Y, Guissou I, Hernigou P. Anatomy of the ilium for bone marrow aspiration: map of sectors and implication for safe trocar placement. Int Orthop. 2014;38(12):2585-2590. doi:10.1007/s00264-014-2353-7.

3. Hernigou J, Picard L, Alves A, Silvera J, Homma Y, Hernigou P. Understanding bone safety zones during bone marrow aspiration from the iliac crest: the sector rule. Int Orthop. 2014;38(11):2377-2384. doi:10.1007/s00264-014-2343-9.

4. Bain BJ. Bone marrow biopsy morbidity: review of 2003. J Clin Pathol. 2005;58(4):406-408. doi:10.1136/jcp.2004.022178.

5. Bain BJ. Bone marrow biopsy morbidity and mortality: 2002 data. Clin Lab Haematol. 2004;26(5):315-318. doi:10.1111/j.1365-2257.2004.00630.x.

6. Bain BJ. Morbidity associated with bone marrow aspiration and trephine biopsy - a review of UK data for 2004. Haematologica. 2006;91(9):1293-1294.

7. Berkoff DJ, Miller LE, Block JE. Clinical utility of ultrasound guidance for intra-articular knee injections: a review. Clin Interv Aging. 2012;7:89-95. doi:10.2147/CIA.S29265.

8. Henkus HE, Cobben LP, Coerkamp EG, Nelissen RG, van Arkel ER. The accuracy of subacromial injections: a prospective randomized magnetic resonance imaging study. Arthroscopy. 2006;22(3):277-282. doi:10.1016/j.arthro.2005.12.019.

9. Hirahara AM, Panero AJ. A guide to ultrasound of the shoulder, part 3: interventional and procedural uses. Am J Orthop. 2016;45(7):440-445.

10. Jackson DW, Evans NA, Thomas BM. Accuracy of needle placement into the intra-articular space of the knee. J Bone Joint Surg Am. 2002;84-A(9):1522-1527.

11. Naredo E, Cabero F, Beneyto P, et al. A randomized comparative study of short term response to blind versus sonographic-guided injection of local corticosteroids in patients with painful shoulder. J Rheumatol. 2004;31(2):308-314.

12. Panero AJ, Hirahara AM. A guide to ultrasound of the shoulder, part 2: the diagnostic evaluation. Am J Orthop. 2016;45(4):233-238.

13. Sethi PM, El Attrache N. Accuracy of intra-articular injection of the glenohumeral joint: a cadaveric study. Orthopedics. 2006;29(2):149-152.

14. Sibbit WL Jr, Peisajovich A, Michael AA, et al. Does sonographic needle guidance affect the clinical outcome of intraarticular injections? J Rheumatol. 2009;36(9):1892-1902. doi:10.3899/jrheum.090013.

15. Smith J, Brault JS, Rizzo M, Sayeed YA, Finnoff JT. Accuracy of sonographically guided and palpation guided scaphotrapeziotrapezoid joint injections. J Ultrasound Med. 2011;30(11):1509-1515. doi:10.7863/jum.2011.30.11.1509.

16. Yamakado K. The targeting accuracy of subacromial injection to the shoulder: an arthrographic evaluation. Arthroscopy. 2002;18(8):887-891.

17. Hirahara AM, Andersen WJ. Ultrasound-guided percutaneous reconstruction of the anterolateral ligament: surgical technique and case report. Am J Orthop. 2016;45(7):418-422, 460.

18. Hirahara AM, Andersen WJ. Ultrasound-guided percutaneous repair of medial patellofemoral ligament: surgical technique and outcomes. Am J Orthop. 2017;46(3):152-157.

19. Hirahara AM, Mackay G, Andersen WJ. Ultrasound-guided InternalBrace of the medial collateral ligament. Arthrosc Tech. Submitted.

20. Jamaludin WFW, Mukari SAM, Wahid SFA. Retroperitoneal hemorrhage associated with bone marrow trephine biopsy. Am J Case Rep. 2013;14:489-493. doi:10.12659/AJCR.889274.

21. Bianco P, Cao X, Frenette PS, et al. The meaning, the sense and the significance: translating the science of mesenchymal stem cells into medicine. Nat Med. 2013;19(1):35-42. doi:10.1038/nm.3028.

RESULTS

The results are reported in the Table.

Table. Measurements of Patients Taken on Axial T2-Weighted Views of Lumbosacral MRI Scans^a

Patient	SI Joint Angle (°)	Approach Angle (°)	PSIS Table Width (cm)	PSIS to Anterior Ilium Wall (cm)	Perpendicular Distance PSIS to Anterior Joint (cm)	Post Ilium Wall to SI Joint Width (cm)
Males	SI Joint Angle (°)	Approach Angle (°)	PSIS Table Width (cm)	PSIS to Anterior Ilium Wall (cm)	Perpendicular Distance PSIS to Anterior Joint (cm)	Post Ilium Wall to SI Joint Width (cm)
1	28.80	19.50	1.24	8.80	4.16	1.52
2	31.80	27.60	1.70	7.89	3.49	1.02
3	33.70	27.70	1.12	8.14	3.15	1.28
4	23.70	26.40	0.95	6.66	3.22	0.65
5	35.90	28.40	0.84	7.60	2.57	0.95
6	33.80	29.30	1.20	7.73	2.34	0.90
7	30.30	21.20	1.36	8.44	3.95	1.18
8	34.50	20.40	1.53	7.08	3.98	1.56
9	28.70	24.00	1.34	8.19	3.51	1.31
10	22.40	20.10	1.37	7.30	3.87	1.28
11	33.60	20.80	0.88	6.43	3.26	0.94
12	48.50	31.00	1.15	6.69	2.97	1.38
13	20.20	20.90	0.94	6.95	3.79	1.05
Averages	31.22	24.41	1.20	7.53	3.40	1.16
Standard Deviation	7.18	4.11	0.26	0.75	0.56	0.26

Females
14	22.80	23.20	1.54	7.21	3.45	1.39
15	33.30	21.40	1.09	7.26	3.57	0.98
16	19.70	15.60	0.78	8.32	3.76	0.86
17	17.50	15.60	0.61	7.57	3.37	1.03
18	48.20	26.60	0.94	6.62	3.16	0.71
19	38.20	28.30	0.90	6.32	2.23	0.91
20	44.50	31.70	0.99	6.19	3.06	0.76
21	24.10	18.00	0.92	6.99	3.23	0.71
22	17.20	14.80	0.81	6.00	2.81	1.13
23	42.00	38.50	1.00	5.33	2.47	1.42
24	32.00	25.50	0.98	6.01	2.79	1.21
25	24.70	24.80	0.87	6.09	2.79	1.02
26	19.80	22.30	1.04	7.71	2.37	1.36
Averages	29.54	23.56	0.96	6.74	3.00	1.04
Standard Deviation	10.84	6.88	0.21	0.85	0.48	0.25

All patients Averages	30.38	23.98	1.08	7.14	3.20	1.10
Standard Deviation	9.05	5.57	0.26	0.88	0.55	0.26
Standard Deviation	9.05	5.57	0.26	0.88	0.55	0.26

^aStatistical significance is denoted as P < .02.

Abbreviations: MRI, magnetic resonance imaging; PSIS, posterior iliac spine; SI, sacroiliac.

For the 13 males, the mean SI joint angle was 31.22° ± 7.18° (range, 20.20° to 48.50°). The mean approach angle was 24.41° ± 4.11° (range, 19.50° to 31.00°). The mean PSIS table width was 1.20 cm ± 0.26 cm (range, 0.84 cm to 1.70 cm). The mean distance from the PSIS to the anterior ilium wall was 7.53 cm ± 0.75 cm (range, 6.43 cm to 8.80 cm). The mean perpendicular distance from the PSIS table to the anterior ilium was 3.40 cm ± 0.56 cm (range, 2.34 cm to 4.16 cm). The mean minimum width of the ilium to the SI joint was 1.16 cm ± 0.26 cm (range, 0.65 cm to 1.56 cm).

For the 13 females, the mean SI joint angle was 29.54° ± 10.84° (range, 17.20° to 48.20°). The mean approach angle was 23.56° ± 6.88° (range, 14.80° to 38.50°). The mean PSIS table width was 0.96 cm ± 0.21 cm (range, 0.61 cm to 1.54 cm). The mean distance from the PSIS to the anterior ilium wall was 6.74 cm ± 0.85 cm (range, 5.33 cm to 8.32 cm). The mean perpendicular distance from the PSIS table to the anterior ilium was 3.00 cm ± 0.48 cm (range, 2.23 cm to 3.76 cm). The mean minimum width of the ilium to the SI joint was 1.04 cm ± 0.25 cm (range, 0.71 cm to 1.42 cm).

For the 26 total patients, the mean SI joint angle was 30.38° ± 9.05° (range, 17.20° to 48.50°). The mean approach angle was 23.98° ± 5.57° (range, 14.80° to 38.50°). The mean PSIS table width was 1.08 cm ± 0.26 cm (range, 0.61 cm to 1.70 cm). The mean distance from the PSIS to the anterior ilium wall was 7.14 cm ± 0.88 cm (range, 5.33 cm to 8.80 cm). The mean perpendicular distance from the PSIS table to the anterior ilium was 3.20 cm ± 0.55 cm (range, 2.23 cm to 4.16 cm). The mean minimum width of the ilium to the SI joint was 1.10 cm ± 0.26 cm (range, 0.65 cm to 1.56 cm).

There was a statistically significant difference between the male and female groups for the maximum distance the trocar can be advanced from the PSIS to the anterior ilium wall (P < .02), and a statistically significant difference for the PSIS table width (P < .02). There were no significant differences between the male and female groups for the approach angle, the SI joint angle, the perpendicular distance from the PSIS to the anterior ilium, and the minimum width of the ilium to the SI joint.

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