Technical efficacy and safety of CT-guided transforaminal periradicular infiltration using CT foot switches and MPR images.

PURPOSE: To demonstrate the technical efficacy and safety of CT-guided transforaminal periradicular infiltration in the treatment of the radicular pain without surgical intervention, using CT foot switches and MPR images. MATERIALS AND METHODS: Four hundred and eighty two patients (286 males and 196 females, age range 27-71 years, mean age 56 years) with a unilateral or bilateral radiculopathy who underwent CT-guided transforaminal periradicular infiltration without surgical intervention, were retrospectively selected in the period from January 2019 to February 2020.  Patients who had received surgery for herniated disc or laminectomy, patients with a previous vertebral fractures, and patients with inflammatory syndrome or risk of bleeding were excluded. RESULTS: There were no major or minor clinically relevant complications. Many patients a marked reduction or resolution of pain after the CT-guided infiltration (P<0.05). No patient required hospitalization. One patient reported an episode of intense headache, which resolved after twenty minutes. In eleven cases, a slight increase in pain related to spinal compression caused by the administration of the drug was reported, even if administrated extremely slowly. Sixteen patients reported pain in the upper limbs during and after the procedure, however this was not related to infiltration but to the forced and prolonged arm position. CONCLUSION: CT-guided transforaminal periradicular infiltration is a semi-invasive and well tolerated procedure, moreover it has a reduced comorbidity and no observed major or minor complications. The CT foot switches and MPR evaluation may help to make the procedure more efficient.

Dual energy CT and research of the bone marrow edema: Comparison with MRI imaging.

AIMS: To evaluate the diagnostic accuracy of the Dual Energy Computed Tomography (DECT) in the research of the bone marrow edema. METHODS AND MATERIAL: The MRI images of 100 patients with episodes of articular and or bone pains with or without traumatic lesion were prospectively evaluated during a period between March 2018 and February 2019. In the presence of bone marrow edema, a DECT was performed. The measurement of the density of the bone marrow edema in the DECT was compared with healthy bone in the same patient by two operators. RESULT: The DECT and MRI images of 15 patients with bone marrow edema were compared. The mean of pathologic bone marrow edema was 1008.20 (Standard Deviation (SD) 23.00), for healthy bone marrow 947.53 (SD 16.42), and t = 11.75, with a statistical significance P < 0.05 (Statistical significance 95%). The agreement between the measurements of the two radiologists has a statistical significance (P < 0.05). CONCLUSION: The DECT presents an excellent diagnostic accuracy to detect the bone marrow edema, comparable to MRI. The utility of these recent possibilities is maximum where access to MRI is still very difficult.