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

Abstract

Use of mesenchymal stem cells from bone marrow has gained significant popularity. The iliac crest has been determined to be an effective site for harvesting mesenchymal stem cells. Review of the literature reveals that multiple techniques are used to harvest bone marrow aspirate from the iliac crest, but the descriptions are based on the experience of various authors as opposed to studied anatomy. A safe, reliable, and reproducible method for aspiration has yet to be studied and described. We hypothesized that there would be an ideal angle and distance for aspiration that would be the safest, most consistent, and most reliable. Using magnetic resonance imaging (MRI), we reviewed 26 total lumbar spine MRI scans (13 males, 13 females) and found that an angle of 24° should be used when entering the most medial aspect of the posterior superior iliac spine (PSIS) and that this angle did not differ between the sexes. The distance that the trocar can advance after entry before hitting the anterior ilium wall varied significantly between males and females, being 7.53 cm in males and 6.74 cm in females. In addition, the size of the PSIS table was significantly different between males and females (1.20 cm and 0.96 cm, respectively). No other significant differences in the measurements gathered were found. Using the data gleaned from this study, we developed an aspiration technique. This method uses ultrasound to determine the location of the PSIS and the entry point on the PSIS. This contrasts with most techniques that use landmark palpation, which is known to be unreliable and inaccurate. The described technique for aspiration from the PSIS is safe, reliable, reproducible, and substantiated by data.

A three-dimensional computed tomography study to determine the ideal method for fluoroscopically-guided bone marrow aspiration from the iliac crest

“…The divergence is even wider with measures of contralateral obliquity, measuring at approximately 25° in the new approach, and approximately 50° in the traditional approach. The trajectory angles of needle direction for the new technique are consistent with those described by Hirahara et al [ 18 ]. The presence of sex-related differences in needle trajectory angle in both the traditional and new techniques was expected as studies have often reported sex-related differences in pelvic and iliac crest anatomy [ 25 - 27 ].…”

“…When inserted to a maximum depth of 6 cm, this trajectory may ensure safe passage between the tables of the ilium, while avoiding the greater sciatic notch. A similar BMA approach was described by Hirahara et al [ 18 ], although there were notable differences from our proposed approach. Hirahara et al defined the trajectory as an angle between the vector from the most medial aspect of the PSIS through the ilium and a vector going through the midline of the pelvis, while our study employed a trajectory from the PSIS to the AIIS [ 18 ].…”

“…Hirahara et al defined the trajectory as an angle between the vector from the most medial aspect of the PSIS through the ilium and a vector going through the midline of the pelvis, while our study employed a trajectory from the PSIS to the AIIS [ 18 ]. In addition, Hirahara et al described an ultrasonography-based technique, while we proposed a fluoroscopically-guided needle injection utilizing the obturator-outlet view [ 18 ].…”

Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

“…Nossos resultados estão de acordo com o que já foi publicado em relação à amplitude de movimento após a RCS, tanto em estudos que utilizaram enxerto autólogo 4 13 23 quanto em estudos que utilizaram enxerto da derme acelular humana. 15 16 17 18…”

The Rationale of Autologously Prepared Bone Marrow Aspirate Concentrate for use in Regenerative Medicine Applications

“…The probe is then translated contralaterally from the physician, keeping the hyperechoic sacrum visualized. Next, the probe is translated proximally, with the hyperechoic ilium coming into view, while maintaining the hyperechoic sacrum, until the most superficial depth of the ilium is reached, known as the PSIS, contralateral to the examiner [51]. After identification of the PSIS, the most superficial depth is confirmed in both transverse and longitudinal orientation (Figure 4).…”