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

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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.

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Authors and Affiliations

  1. Département de Radiologie et Imagerie Diagnostique et interventionnelle, CHU Dijon Bocage Central, Dijon, France

    Pierre Pottecher, Denis Krausé, Lucy Di Marco, Romaric Loffroy & Louis Estivalet

  2. Service de radiologie musculosquelettique, CCIAL, laboratoire d’anatomie, faculté de médecine de Lille, Hôpital Roger Salengro, CHRU de Lille, Lille, France

    Romain Duhal & Xavier Demondion

Authors
  1. Pierre Pottecher
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  2. Denis Krausé
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  3. Lucy Di Marco
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  4. Romaric Loffroy
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  5. Louis Estivalet
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  6. Romain Duhal
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  7. Xavier Demondion
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Correspondence to Pierre Pottecher.

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Pottecher, P., Krausé, D., Di Marco, L. et al. Cervical foraminal steroid injections under CT guidance: retrospective study of in situ contrast aspects in a serial of 248 cases. Skeletal Radiol 44, 1–8 (2015). https://doi.org/10.1007/s00256-014-2028-x

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  • DOI: https://doi.org/10.1007/s00256-014-2028-x

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