Medical Student, UT Southwestern Medical Center, Dallas, TX.
Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, TX.
Pain Physician. 2019 Jul;22(4):E333-E344.
Magnetic resonance neurography (MRN) has an increasing role in the diagnosis and management of pudendal neuralgia, a neurogenic cause of chronic pelvic pain.
The objective of this research was to determine the role of MRN in predicting improved pain outcomes following computed tomography (CT)-guided perineural injections in patients with pudendal neuralgia.
This study used a retrospective cross-sectional study design.
The research was conducted at a large academic hospital.
Patients: Ninety-one patients (139 injections) who received MRN and CT-guided pudendal blocks were analyzed.
A 3Tesla (T) scanner was used to evaluate the lumbosacral plexus for pudendal neuropathy. Prior to receiving a CT-guided pudendal perineural injection, patients were given pain logs and asked to record pain on a visual analog scale.
MRN findings for pudendal neuropathy were compared to the results of the CT-guided pudendal nerve blocks. Injection pain responses were categorized into 3 groups - positive block, possible positive block, and negative block.Statistical Tests: A chi-square test was used to test any association, and a Cochran-Armitage trend test was used to test any trend. Significance level was set at .05. All analyses were done in SAS Version 9.4 (SAS Institute, Inc., Cary, NC).
Ninety-one patients (139 injections) who received MRN were analyzed. Of these 139 injections, 41 were considered positive (29.5%), 52 of 139 were possible positives (37.4%), and 46 of 139 were negative blocks (33.1%). Of the patients who had a positive pudendal block, no significant difference was found between the MRN result and the pudendal perineural injection response (P = .57). Women had better overall response to pudendal blocks, but this response was not associated with MRN findings (P = .34). However, positive MRN results were associated with better pain response in men (P = .005). Patients who reported bowel dysfunction also had a better response to pudendal perineural injection (P = .02).
Some limitations include subjectivity of pain reporting, reporting consistency, absence of a control group, and the retrospective nature of the chart review.
Pudendal perineural injections improve pain in patients with pudendal neuralgia and positive MRN results are associated with better response in men.
MRI, MRN, CT injection, pudendal neuralgia, pudendal nerve, pelvic pain, chronic pelvic pain, pudendal neuropathy.
磁共振神经成像（MRN）在诊断和治疗阴部神经痛方面发挥着越来越重要的作用，阴部神经痛是慢性盆腔痛的一种神经源性病因。
本研究旨在确定 MRN 在预测阴部神经痛患者接受 CT 引导的神经周围注射后疼痛改善结果中的作用。
本研究采用回顾性横断面研究设计。
研究在一家大型学术医院进行。
患者：分析了 91 名（139 次注射）接受 MRN 和 CT 引导阴部神经阻滞的患者。
使用 3 特斯拉（T）扫描仪评估腰骶丛的阴部神经病变。在接受 CT 引导的阴部神经周围注射之前，患者会收到疼痛日志并要求他们在视觉模拟量表上记录疼痛。
将阴部神经病变的 MRN 结果与 CT 引导的阴部神经阻滞结果进行比较。注射疼痛反应分为 3 组 - 阳性阻滞、可能阳性阻滞和阴性阻滞。
使用卡方检验测试任何关联，使用 Cochran-Armitage 趋势检验测试任何趋势。显著性水平设定为.05。所有分析均在 SAS 版本 9.4（SAS Institute，Inc.，Cary，NC）中进行。
分析了 91 名（139 次注射）接受 MRN 的患者。在这 139 次注射中，41 次被认为是阳性（29.5%），139 次中有 52 次是可能阳性（37.4%），139 次中有 46 次是阴性阻滞（33.1%）。在接受阳性阴部阻滞的患者中，MRN 结果与阴部神经周围注射反应之间没有发现显著差异（P =.57）。女性对阴部阻滞的总体反应更好，但这一反应与 MRN 结果无关（P =.34）。然而，阳性 MRN 结果与男性的疼痛反应更好相关（P =.005）。报告肠道功能障碍的患者对阴部神经周围注射的反应也更好（P =.02）。
一些局限性包括疼痛报告的主观性、报告的一致性、缺乏对照组以及图表回顾的回顾性。
阴部神经周围注射可改善阴部神经痛患者的疼痛，阳性 MRN 结果与男性的更好反应相关。
MRI、MRN、CT 注射、阴部神经痛、阴部神经、盆腔痛、慢性盆腔痛、阴部神经病变。
