AJR. American journal of roentgenology
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Spinal injections are common pain management procedures using corticosteroids and local anesthetics. Most corticosteroid preparations are particulate suspensions, such as methylprednisolone acetate and triamcinolone acetonide. In the cervical spine, particulate corticosteroids have been linked to catastrophic complications, including blindness, paralysis, and death. Serious neurologic injuries have also been reported at the thoracic, lumbar, and sacral levels. ⋯ Nonparticulate preparations, such as dexamethasone, are safer but have shorter-lived antiinflammatory effects. Local anesthetics are often mixed with corticosteroids in pain management procedures. Although everyday risks are minimal, injection techniques should take into account neural and cardiac toxicities. In this article, we discuss the potential for serious adverse events associated with injected medications. We review the current literature to make conclusions on medication combinations that balance safety and efficacy.
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AJR Am J Roentgenol · Sep 2016
Technique for CT Fluoroscopy-Guided Lumbar Medial Branch Blocks and Radiofrequency Ablation.
The purpose of this study is to describe the procedure for CT fluoroscopy-guided lumbar medial branch blocks and facet radiofrequency ablation. ⋯ CT fluoroscopic guidance allows more-precise needle tip positioning and is an alternative method for performing medial branch blocks and facet radiofrequency ablation.
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Peripheral nerves are well seen using ultrasound (US) imaging, making US an ideal modality for image-guided nerve injections. This article provides a technical guide for common upper and lower extremity peripheral nerve injections, including the median, ulnar, and radial nerves in the upper extremity and the lateral femoral cutaneous, sciatic, common peroneal, tibial, and sural nerves in the lower extremity. ⋯ US is an effective modality for use in common upper and lower extremity peripheral nerve injections. With correct technique, peripheral nerve injections can be performed safely and are useful for both diagnostic evaluation of and therapy for peripheral neuropathy.
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AJR Am J Roentgenol · Sep 2016
Comparative StudyEffectiveness of a Rapid Lumbar Spine MRI Protocol Using 3D T2-Weighted SPACE Imaging Versus a Standard Protocol for Evaluation of Degenerative Changes of the Lumbar Spine.
Reducing lumbar spine MRI scanning time while retaining diagnostic accuracy can benefit patients and reduce health care costs. This study compares the effectiveness of a rapid lumbar MRI protocol using 3D T2-weighted sampling perfection with application-optimized contrast with different flip-angle evolutions (SPACE) sequences with a standard MRI protocol for evaluation of lumbar spondylosis. ⋯ Isotropic SPACE T2-weighted imaging provides high-quality imaging of lumbar spondylosis, with multiplanar reformatting capability. Our SPACE-based rapid protocol had sensitivities and specificities for herniations and neural compromise comparable to those of the protocol without SPACE. This protocol fits within a 15-minute slot, potentially reducing costs and discomfort for a large subgroup of patients.
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AJR Am J Roentgenol · Sep 2016
Surrogate Imaging Biomarkers of Response of Colorectal Liver Metastases After Salvage Radioembolization Using 90Y-Loaded Resin Microspheres.
The purpose of the present study is to evaluate Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, tumor attenuation criteria, Choi criteria, and European Organization for Research and Treatment of Cancer (EORTC) PET criteria as measures of response and subsequent predictors of liver progression-free survival (PFS) after radioembolization (RE) of colorectal liver metastases (CLM). The study also assesses interobserver variability for measuring tumor attenuation using a single 2D ROI on a simple PACS workstation. ⋯ RECIST 1.1 has poor sensitivity for detecting metabolic responses classified by EORTC PET criteria. EORTC PET criteria, Choi criteria, and tumor attenuation criteria appear to be equally reliable surrogate imaging biomarkers of liver PFS after RE in patients with CLM.