Miskin Nityanand, Gaviola Glenn C, Ghazikhanian Varand, Mandell Jacob C
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Skeletal Radiol. 2018 Dec;47(12):1615-1623. doi: 10.1007/s00256-018-3002-9. Epub 2018 Jun 18.
To determine the effect of needle position and foraminal stenosis on contrast flow directionality during CT-guided transforaminal epidural steroid injections (TFESI).
One hundred five consecutive CT-guided injections were performed in 68 patients (mean age, 65.5 years) from January 1 to December 31 2017, all with preceding MRI. Two readers independently reviewed CT images to assess needle position and to determine direction of contrast flow, which was defined as central or peripheral. The MRIs were independently reviewed by the readers to determine the degree of foraminal stenosis. Inter-reader agreement for both was evaluated with the kappa statistic. Analyses were performed to determine effect of needle position, degree of foraminal stenosis, and volume of contrast injected with directionality of contrast flow, and association between contrast flow directionality with immediate post-procedural pain scores.
Central direction of contrast flow was demonstrated in 41/78 (52.6%) of cases with posterolateral needle position, and 20/27 (74.1%) with central or anteromedial needle position (p = 0.07). There was no difference in direction of contrast flow with high-grade versus absence of high-grade neuroforaminal narrowing, or with volume of contrast injected. There was no difference in immediate post-procedure pain scores regardless of contrast flow directionality.
Needle position is not significantly associated with contrast flow directionality during CT-guided TFESI, although there was a trend towards relatively decreased central flow with posterolateral positioning. Degree of foraminal stenosis and volume of injected contrast did not affect contrast flow directionality. There was no difference in immediate post-procedural pain scores with either direction of contrast flow.
确定在CT引导下经椎间孔硬膜外类固醇注射（TFESI）过程中，针的位置和椎间孔狭窄对造影剂流动方向的影响。
2017年1月1日至12月31日，对68例患者（平均年龄65.5岁）连续进行了105次CT引导下的注射，所有患者之前均进行过MRI检查。两名阅片者独立审查CT图像，以评估针的位置并确定造影剂的流动方向，造影剂流动方向定义为向中央或向周边。阅片者独立审查MRI，以确定椎间孔狭窄的程度。使用kappa统计量评估两者之间的阅片者间一致性。进行分析以确定针的位置、椎间孔狭窄程度、注入造影剂的体积对造影剂流动方向的影响，以及造影剂流动方向与术后即刻疼痛评分之间的关联。
在后外侧针位的78例病例中，41例（52.6%）显示造影剂向中央流动，在中央或前内侧针位的27例病例中，20例（74.1%）显示造影剂向中央流动（p = 0.07）。在存在与不存在高度椎间孔狭窄的情况下，造影剂的流动方向没有差异，注入造影剂的体积也不影响造影剂的流动方向。无论造影剂流动方向如何，术后即刻疼痛评分均无差异。
在CT引导下的TFESI过程中，针的位置与造影剂流动方向没有显著关联，尽管后外侧定位有造影剂向中央流动相对减少的趋势。椎间孔狭窄程度和注入造影剂的体积不影响造影剂流动方向。造影剂向任何一个方向流动时，术后即刻疼痛评分均无差异。
