单独的前后位对比剂扩散模式不足以区分腰椎硬膜外扩散与硬膜外腔扩散：一项前瞻性研究。

Standalone anteroposterior contrast spread pattern is insufficient to distinguish lumbar epidural from extradural spread: A prospective study.

作者信息

Sagir Afrin, Simopoulos Thomas T, Nagda Jyotsna V, Fonseca Alexandra C G, Cai Viet L, Hussain Nasir, Liang Chen, Gill Jatinder S

机构信息

Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Penn Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Perelman School of Medicine, 3400 Spruce Street, Suite 680 Dulles, Philadelphia, PA, 19104, USA.

Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.

出版信息

Interv Pain Med. 2025 Aug 25;4(3):100634. doi: 10.1016/j.inpm.2025.100634. eCollection 2025 Sep.

DOI:10.1016/j.inpm.2025.100634

PMID:40896551

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12398812/

Abstract

BACKGROUND

There is debate about whether a standalone anteroposterior (AP) view can distinguish epidural contrast from non-epidural contrast spread.

OBJECTIVES

This study aims to assess the accuracy of the AP (anteroposterior) and Contralateral Oblique (CLO) views in distinguishing epidural contrast spread patterns from non-epidural contrast spread patterns.

METHODS

Patients undergoing lumbar epidural steroid injections consented to participate in the study. A 20-gauge Tuohy needle was advanced very close to the epidural space, and 0.5-1 ml of contrast was then injected. CLO, AP, and lateral images of non-epidural spread were saved. The AP and CLO images were randomly mixed with images from historical controls with actual epidural spread.

RESULTS

A total of 24 false epidurograms in the AP and CLO views were mixed with an equal number of true epidurograms, resulting in 48 images each in the AP and the CLO views, respectively. Among the cohort of 10 experienced interventional pain physicians, the mean accuracy of correctly identifying epidural spread as epidural using the AP view alone was 51 % (SD 19 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the AP view alone was 64 % (SD 15 %). Cohen's Kappa was 0.15, indicating minimal agreement between the interventionalists. In contrast, the mean accuracy of correctly identifying epidural spread as epidural using the CLO view alone was 99 % (SD 2 %). In addition, the accuracy of correctly identifying non-epidural spread as non-epidural using the CLO view alone was 96 % (SD 9 %). Excluding one outlier, the accuracy for the rest of the reviewers in determining non-epidural spread as non-epidural was 99 %. Cohens' Kappa was 0.95, indicating a high degree of agreement between the interventionalists.

CONCLUSION

This study reveals that utilizing a standalone AP view without a CLO view was inadequate to distinguish epidural from non-epidural spread. Specifically, our study supports the continued use of CLO depth views to identify epidural contrast spread correctly.

摘要

背景

关于单独的前后位（AP）视图能否区分硬膜外造影剂扩散与非硬膜外造影剂扩散存在争议。

目的

本研究旨在评估前后位（AP）和对侧斜位（CLO）视图在区分硬膜外造影剂扩散模式与非硬膜外造影剂扩散模式方面的准确性。

方法

接受腰椎硬膜外类固醇注射的患者同意参与本研究。将一根20号的Tuohy针推进至非常靠近硬膜外腔的位置，然后注入0.5 - 1毫升造影剂。保存非硬膜外扩散的CLO、AP和侧位图像。AP和CLO图像与来自有实际硬膜外扩散的历史对照的图像随机混合。

结果

AP和CLO视图中共有24张假硬膜外造影图像与数量相等的真硬膜外造影图像混合，AP和CLO视图分别各有48张图像。在10名经验丰富的介入疼痛科医生中，仅使用AP视图正确将硬膜外扩散识别为硬膜外的平均准确率为51%（标准差19%）。此外，仅使用AP视图正确将非硬膜外扩散识别为非硬膜外的准确率为64%（标准差15%）。科恩kappa系数为0.15，表明介入医生之间的一致性极小。相比之下，仅使用CLO视图正确将硬膜外扩散识别为硬膜外的平均准确率为99%（标准差2%）。此外，仅使用CLO视图正确将非硬膜外扩散识别为非硬膜外的准确率为96%（标准差9%）。排除一个异常值后，其余审阅者将非硬膜外扩散识别为非硬膜外的准确率为99%。科恩kappa系数为0.95，表明介入医生之间的一致性程度很高。