Update on recent developments in imaging of inflammation in osteoarthritis: a narrative review
AbstractSynovitis is an important component of the osteoarthritis (OA) disease process, particularly regarding the “inflammatory phenotype” of OA. Imaging plays an important role in the assessment of synovitis in OA with MRI and ultrasound being the most deployed imaging modalities. Contrast-enhanced (CE) MRI, particularly dynamic CEMRI (DCEMRI) is the ideal method for synovitis assessment, but for several r easons CEMRI is not commonly performed for OA imaging in general. Effusion-synovitis and Hoffa-synovitis are commonly used as surrogate markers of synovitis on non-contrast-enhanced (NCE) MRI and have been used in ...
Source: Skeletal Radiology - September 20, 2023 Category: Radiology Source Type: research
The role of imaging in disentangling the enigma of osteoarthritis
(Source: Skeletal Radiology)
Source: Skeletal Radiology - September 20, 2023 Category: Radiology Source Type: research
Percutaneous spine biopsy: reaching those hard-to-reach places
AbstractCancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personalised oncology, the need to establish a definitive histopathologic diagnosis to guide management is more important than ever. Percutaneous biopsy has proven to be safe and efficient in establishing a reliable histopathologic diagnosis. The spine, however, can be a chall...
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Facets of facet joint interventions
This article discusses fluoroscopic and CT-guided intraarticular FJ injections, medial branch (MB) radiofrequency ablation (RFA), and lumbar facet synovial cyst (LFSC) aspiration, rupture, or fenestration. Additionally, the article will highlight medial branch blocks (MBBs) utilized to diagnose facet-mediated pain and to predict outcomes to RFA. (Source: Skeletal Radiology)
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Discitis-osteomyelitis: optimizing results of percutaneous sampling
AbstractVertebral discitis-osteomyelitis is an infection of the spine that involves the intervertebral disc and the adjacent vertebral body but may also extend into the paraspinal and epidural soft tissues. If blood cultures and other culture data fail to identify a causative microorganism, percutaneous sampling is indicated to help guide targeted antimicrobial therapy. Despite limited supporting evidence, withholding antimicrobial therapy for up to 2 weeks is recommended to maximize microbiological yield, although literature supporting this recommendation is limited. During the procedure, technical factors that may impr...
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Lower extremity peripheral nerve pathology: Utility of preoperative ultrasound-guided needle localization before operative intervention
AbstractHistorically, the use of ultrasound (US) in the management of peripheral nervous system (PNS) pathology has been limited to diagnostic confirmation or guidance for interventional injections. This technical case series will demonstrate the utility and versatility of preoperative US-guided needle localization for the excision of lower extremity neuromas and other pathology of the PNS. Five patients with symptomatic lower extremity PNS tumors were retrospectively reviewed. This case series corroborates the technical nuances of localizing lower extremity neuromas by US-guided needle and wire placement prior to operativ...
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Rationale for fluoroscopic guidance in spine injections
AbstractSpine injections are commonly performed in the treatment of back pain. The purpose of this article is to review the current literature surrounding image guided spine injections focusing on scenarios where fluoroscopic guidance can be advantageous in addition to discussing similarities among the different modalities. (Source: Skeletal Radiology)
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Transforaminal versus interlaminar CT-guided lumbar epidural steroid injections: prospective study of 237 patients with unilateral radicular pain and up to 5 years of follow-up
ConclusionOutcomes after CTESI by ILA approaches are similar to those by TFA for the treatment of persistent LRP. (Source: Skeletal Radiology)
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Intra-arterial injection of particulate corticosteroids: mechanism of injury
AbstractMechanism of neurologic complications after epidural spinal injections (ESI) of particulate steroids at the cervical spine include intrathecal injection, epidural hematoma, direct spinal cord injury, and brain stem or cord infarction due to an arterial spasm or inadvertent intra-arterial injection of particulate steroids. At the lumbar spine, there is evidence that a spinal cord infarction secondary to an inadvertent intra-arterial injection of particulate steroids through a transforaminal approach is the leading mechanism.Variations in the arterial supply of the spinal cord help to understand how a lumbar ESI may ...
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Arterial embolization during percutaneous vertebroplasty resulting in bilateral renal infarcts and ischemic colitis
AbstractThis case report documents an arterial embolic event that occurred during vertebroplasty for a pathological compression fracture of T12 in a 54-year-old female with known metastatic breast carcinoma. A CT angiogram performed after the procedure demonstrated cement migration into the aorta, both kidneys, and the inferior mesenteric artery and its branches, with ischemic colitis involving the descending colon and sigmoid colon. A CT scan 4 months post-procedure demonstrated resolution of the colitis. Neovascularity and cortical destruction in malignant bone lesions are thought to contribute to arterial cement leak....
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
An update on epidural steroid injections: is there still a role for particulate corticosteroids?
AbstractEpidural steroid injections (ESIs) play an important role in the multifaceted management of neck and back pain. Corticosteroid preparations used in ESIs may be considered “particulate” or “non-particulate” based on whether they form a crystalline suspension or a soluble clear solution, respectively. In the past two decades, there have been reports of rare but severe and permanent neurological complications as a result of ESI. These complications have principa lly occurred with particulate corticosteroid preparations when using a transforaminal injection technique at cervical or thoracic levels, and only rar...
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Selective MR neurography –guided lumbosacral plexus perineural injections: techniques, targets, and territories
This article offers a practical guide for MR neurography –guided lumbosacral plexus perineural injections, including interventional setup, pulse sequence protocols, lumbosacral plexus MR neurography anatomy, anatomic variations, and injection targets. (Source: Skeletal Radiology)
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Interlaminar versus transforaminal epidural steroid injections: a review of efficacy and safety
This article includes opinions based on the authors ’ experience with ESI indications and efficacy, and presents practical tips for coping with specific situations related to each complication. By combining the dedicated anatomical understanding of radiologists with image-guided interventions, ESI is expected to stand out in the rapidly expanding f ield of spine intervention. (Source: Skeletal Radiology)
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Effect of sacralization on the success of lumbar transforaminal epidural steroid injection treatment: prospective clinical trial
ConclusionTransforaminal epidural steroid injection is an effective and safe method for radicular low back pain. Sacralization presence should be evaluated before treatment considering that it may be a risk factor reducing treatment success. (Source: Skeletal Radiology)
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
Spine injections: the rationale for CT guidance
Abstract
Back pain is one of the most common medical problems and is associated with high socioeconomic costs. Imaging-guided spinal injections are a minimally invasive method to evaluate where the back pain is originating from, and to treat patients with radicular pain or spinal stenosis with infiltration of corticosteroids. CT-guided spine injections are a safe procedure, characterized by precise needle placement, excellent visualization of the relevant anatomical structures, and low radiation exposure for the patient and the interventional radiologist. In this review article, the variety of applications of CT-guided ...
Source: Skeletal Radiology - August 24, 2023 Category: Radiology Source Type: research
