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.
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: James P McLean; James D Sigler; Christopher T Plastaras; Cynthia Wilson Garvan; Joshua D Rittenberg Journal: PM R Date: 2009-07 Impact factor: 2.298
Authors: Jan Van Zundert; Donal Harney; Elbert A J Joosten; Marcel E Durieux; Jacob Patijn; Martin H Prins; Maarten Van Kleef Journal: Reg Anesth Pain Med Date: 2006 Mar-Apr Impact factor: 6.288