Cervical foraminal steroid injections under CT guidance: retrospective study of in situ contrast aspects in a serial of 248 cases.

Abstract

OBJECTIVES:

To describe all the CT findings after in situ contrast injection just before steroid injection and to recognize the abnormal aspects associated with intravascular contamination.

MATERIAL AND METHODS:

We retrospectively evaluated 248 cervical transforaminal steroid injections done at the university hospital in Dijon, France, in 2008-2012, to treat cervicobrachial neuralgia inadequately improved by optimal medical treatment for at least 3 weeks. Features describing the opacification patterns were recorded.

RESULTS:

Five main nonvascular opacification patterns were identified: clumps of contrast agent outside the foramen (16 %), a crab claw pattern surrounding the ganglion (13 %), a "French" circumflex accent pattern (15 %), reflux along the needle (7 %), and facet joint capsule opacification (22 %). Concerning the situations requiring a change in needle position, intravenous injection occurred in 26 % of the patients, with a crab claw pattern in half the cases and a clump pattern in half the cases. Intraarteriolar injection was noted in two patients.

CONCLUSION:

CT after in situ contrast injection ensures proper needle positioning outside the blood vessels before steroid injection. Penetration of the needle tip into a vein is very common, whereas arteriolar puncture is extremely rare.

• Authors: Pierre Pottecher, Denis Krausé, Lucy Di Marco, Romaric Loffroy, Louis Estivalet, Romain Duhal, Xavier Demondion
• Journal: Skeletal radiology (Skeletal Radiol) Vol. 44 Issue 1 Pg. 1-8 (Jan 2015) ISSN: 1432-2161 [Electronic] Germany
• PMID: 25316168 (Publication Type: Journal Article, Review)

Chemical References

• Steroids

Topics

• Adolescent
• Brachial Plexus Neuritis (diagnostic imaging, drug therapy)
• Cervical Vertebrae (diagnostic imaging)
• Female
• Humans
• Injections, Intralesional
• Male
• Radiculopathy (diagnostic imaging, drug therapy)
• Radiography, Interventional (methods)
• Steroids (administration & dosage)
• Tomography, X-Ray Computed (methods)
• Treatment Outcome