See the Difference: Ultrasound vs. Open MRI-Guided Injections

Welcome to our September newsletter highlighting Pelvic and Piriformis Injections.

In 2002, when we first started developing peripheral nerve treatment programs, there were very few doctors who had even heard of these conditions and even fewer radiology methods for correct diagnosis. Most patients who reached our clinic had suffered without any knowledge of exactly what was causing their pain.

Now, as the medical community is becoming more educated, the patients are becoming more educated about their treatment options — especially if they are considering spine fusion or spine surgery. They are learning that it pays to treat the underlying nerves and nerve root conditions in tandem with the spine problem.

We now see a larger number of patients who have already been diagnosed with Piriformis Syndrome or Pudendal Neuralgia. Doctors are referring patients for treatment services using everything from ultrasound to CT and Fluoroscopy guidance.

Unfortunately, their patients are still suffering without a comprehensive diagnosis. These traditional guidance tools are simply not the most effective or accurate means of pinpointing nerves.

CT and Fluoroscopy use X-ray guidance, which means that it cannot identify soft tissue structures at all so the injection is delivered virtually blind. Ultrasound does not use X-ray but provides such low resolution and fuzzy definition that the injection is a shot in the general area of the pain rather than an exact, targeted treatment.

Above and below are images from a recent patient visit. The patient came to our clinic with a referral from her local doctor to have Piriformis surgery. She saw Dr. Filler, who recommend an open MRI-guided interventional procedure to confirm the diagnosis before planning a staged surgical procedure.

The patient was confused and frustrated by the order to have “another injection” because she said that she had already had several ultrasound-guided injections which had worked somewhat but eventually failed to yield long term pain resolution.

Dr. Filler provided the patient with a comparative analysis showing the patient ultrasound images versus image guidance via Open MRI using real time optical guidance.



And now, ultrasound images…



The pictures are truly worth a thousand words.

There is no comparison between the clarity and focus of an interventional MRI-guided procedure.

If you are considering a minimally invasive surgery, you definitely want to have the most accurate imaging diagnosis as possible for surgical planning.

If you are considering treatment that involves ultrasound injections or CT/Fluoroscopy guided injections, please contact us before undergoing an injection that will not provide the best results.

Or, if you prefer, please have your treating doctor contact us for referral. We will be happy to work with your doctor to provide real time optical guided injections that will help them see the soft tissue damage and treat your pain condition accurately.

Treatment coordinators are available to speak with you or your physician, so give us a call at 310-314-6410 or email us at