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

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If the PSIS is not accurately identified, penetration laterally will result in entering the ilium wing, where it is quite narrow. We found the distance between the posterior ilium wall and the SI joint to be only 1.10 cm wide (Figure 3); we defined this area as the narrow corridor. Superior and lateral entry could damage the superior cluneal nerves coming over the iliac crest, which are located 6 cm lateral to the SI joint. Inferior and lateral entry 6 cm below the PSIS could reach the greater sciatic foramen, damaging the sacral plexus and superior gluteal artery and vein. If the entry slips above the PSIS over the pelvis, the trocar could enter the retroperitoneal space and damage the femoral nerve and common iliac artery and vein, leading to a retroperitoneal hemorrhage.^4-6,20

MSCs are found as perivascular cells and lie in the cortices of bones.²¹ Following the approach angle and directed line from the PSIS to the anterior ilium wall described in this study (Figures 1 and 2), the trocar would pass through the narrow corridor as it advances farther into the ilium. The minimum width of this corridor was measured in this study and, on average, was 1.10 cm wide from cortex to cortex (Figure 3). As the bone marrow is aspirated from this narrow corridor, the clinician is gathering MSCs from both the lateral and medial cortices of the ilium. By aspirating from a greater surface area of the cortices, it is believed that this will increase the total collection of MSCs.

CONCLUSION

Although there are reports in the literature that describe techniques for bone marrow aspiration from the iliac crest, the techniques are very general and vague regarding the ideal angles and methods. Studies have attempted to quantify the safest entry sites for aspiration but have not detailed ideal parameters for collection. Blind aspiration from the iliac crest can have serious implications if adverse events occur, and thus there is a need for a safe and reliable method of aspiration from the iliac crest. Ultrasound guidance to identify anatomy, as opposed to palpation guidance, ensures anatomic placement of the trocar while minimizing the risk of aspiration. Based on the measurements gathered in this study, an optimal angle of entry and safe distance of penetration have been identified. Using our data and relevant literature, we developed a technique for a safe, consistent, and reliable method of bone marrow aspiration out of the iliac crest.