From the Russell H. Morgan Department of Radiology and Radiological Science (J.F.), Department of Plastic and Reconstructive Surgery (A.L.D., E.H.W., G.D.R.), Department of Neurosurgery (A.J.B.), and Department of Surgery (F.E.E.), The Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287.
Radiology. 2017 Oct;285(1):176-185. doi: 10.1148/radiol.2017161415. Epub 2017 Apr 28.
Purpose To determine if 3-T magnetic resonance (MR) neurography-guided retroperitoneal genitofemoral nerve (GFN) blocks are safe and effective for the diagnosis of genitofemoral neuralgia. Materials and Methods Following institutional review board approval and informed consent, 26 subjects (16 men, 10 women; mean age, 42 years [range, 24-78 years]; mean body mass index, 28 kg/m [range, 20-35 kg/m]) with intractable groin pain were included. By using a 3-T MR imaging system, intermediate-weighted turbo spin-echo pulse sequences, and MR-conditional needles, diagnostic MR neurography-guided GFN blocks were performed in the retroperitoneum. Outcome variables included technical success, procedure time, complications, and rates of positive and negative GFN blocks in association with therapeutic outcomes. For the assessment of a learning curve, Mann-Whitney test was used. P values ≤ .05 were considered to indicate a statistically significant difference. Results In 26 subjects, 30 retroperitoneal GFN blocks were performed. Twelve (40%) were performed with an anterior needle path, 12 (40%) with a lateral needle path, and six (20%) with a posterior needle path. GFN blocks were technically successful in 24 of 26 (92%) subjects, achieving appropriate scrotal anesthesia. No complications occurred. The time required for a GFN block was 40 minutes (range, 18-67 minutes). The rate of a successful GFN intervention after a positive GFN block was 88% (14 of 16). The rate of a successful intervention of an alternative target after a negative GFN block was 71% (five of seven). Conclusion Selective retroperitoneally directed MR neurography-guided GFN blocks are safe and effective with high technical success and positive effect on surgical decision making in patients with presumed genitofemoral neuralgia. RSNA, 2017 Online supplemental material is available for this article.
确定 3-T 磁共振（MR）神经成像引导下的腹膜后生殖股神经（GFN）阻滞是否安全有效，用于诊断生殖股神经痛。
本研究经机构审查委员会批准并获得患者知情同意，共纳入 26 例（16 例男性，10 例女性；平均年龄 42 岁[范围，2478 岁]；平均体质指数 28 kg/m[范围，2035 kg/m]），这些患者均患有难治性腹股沟疼痛。采用 3-T MR 成像系统、中权重型涡轮自旋回波脉冲序列和 MR 条件下的针具进行腹膜后诊断性 MR 神经成像引导下的 GFN 阻滞。主要观察指标包括技术成功率、操作时间、并发症、GFN 阻滞阳性和阴性与治疗效果的关系以及阳性和阴性 GFN 阻滞的治疗效果。采用 Mann-Whitney 检验评估学习曲线。P 值≤0.05 为差异有统计学意义。
26 例患者共进行了 30 次腹膜后 GFN 阻滞。其中 12 例（40%）采用前路进针、12 例（40%）采用侧路进针、6 例（20%）采用后路进针。26 例患者中 24 例（92%）技术成功率高，即达到适当的阴囊麻醉效果。无并发症发生。GFN 阻滞的操作时间为 40 分钟（范围，18~67 分钟）。GFN 阻滞阳性后行 GFN 介入治疗成功率为 88%（14/16），GFN 阻滞阴性后行替代目标介入治疗成功率为 71%（5/7）。
在疑似生殖股神经痛患者中，选择性腹膜后 MR 神经成像引导下的 GFN 阻滞安全有效，技术成功率高，对手术决策有积极影响。
美国放射学会，2017 年
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