Kranz P G, Amrhein T J, Gray L
From the Department of Radiology, Duke University Medical Center, Durham, North Carolina.
AJNR Am J Neuroradiol. 2015 May;36(5):1000-7. doi: 10.3174/ajnr.A4219. Epub 2015 Jan 22.
Inadvertent intravascular injection during epidural steroid injection can result in complications and has been investigated previously with conventional fluoroscopy, but not CT fluoroscopy. The purpose of this study was to determine the incidence of intravascular injections recognized during CT fluoroscopy-guided epidural steroid injection.
We retrospectively reviewed 575 consecutive CT fluoroscopy-guided epidural steroid injections. Procedures were assessed to determine the incidence of intravascular injection. Cases positive for intravascular injection were classified on the basis of anatomic location, distance from the needle tip, washout pattern, and presence of combined epidural and vascular injection. Cases were also graded as either venous or arterial by using a 5-point scale.
Intravascular injection was observed in 26% of cervical transforaminal epidural steroid injections (7/27), 9% of cervical interlaminar epidural steroid injections (4/47), 8% of lumbar transforaminal epidural steroid injections (22/275), and 2% of lumbar interlaminar epidural steroid injections (4/222). Vessels were most commonly identified close to the needle, but in 30% of cases, they were visualized in the anterior paraspinal soft tissues remote from the needle. Washout was most commonly delayed (86%), though rapid washout occurred in 14% of cases. Simultaneous epidural and vascular injections occurred in 32% of cases. Most visualized vessels were venous, but 2 cases were classified as probably arterial.
Intravascular injections can be detected with CT fluoroscopy. The incidence in our study was similar to that in previous reports using conventional fluoroscopy. Technical factors such as the "double-tap" on CT fluoroscopy following contrast injection, assessment for discordance between injected and visualized contrast volume, and maintenance of an appropriate FOV facilitate the detection of such events.
硬膜外类固醇注射过程中意外血管内注射可导致并发症，此前已通过传统荧光透视法进行研究，但未采用CT荧光透视法。本研究的目的是确定在CT荧光透视引导下硬膜外类固醇注射过程中识别出的血管内注射的发生率。
我们回顾性分析了575例连续的CT荧光透视引导下硬膜外类固醇注射。评估操作以确定血管内注射的发生率。血管内注射阳性的病例根据解剖位置、距针尖的距离、冲洗模式以及硬膜外和血管注射合并情况进行分类。还使用5分制将病例分为静脉或动脉。
在26%的颈椎椎间孔硬膜外类固醇注射（7/27）、9%的颈椎椎板间硬膜外类固醇注射（4/47）、8%的腰椎椎间孔硬膜外类固醇注射（22/275）和2%的腰椎椎板间硬膜外类固醇注射（4/222）中观察到血管内注射。血管最常出现在靠近针头处，但在30%的病例中，它们出现在远离针头的椎旁前软组织中。冲洗最常见的是延迟（86%），不过14%的病例出现快速冲洗。32%的病例同时存在硬膜外和血管注射。大多数可见血管为静脉，但2例被分类为可能为动脉。
CT荧光透视可检测到血管内注射。我们研究中的发生率与先前使用传统荧光透视法的报告相似。技术因素，如注射造影剂后CT荧光透视上的“双击”、评估注射造影剂体积与可见造影剂体积之间的不一致以及保持适当的视野，有助于检测此类事件。
