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Diffusion Tensor Magnetic Resonance Imaging in Chronic Spinal Cord Compression
Published on: May 7, 2019
Effect of epidural corticosteroid injection on magnetic resonance imaging findings
Min Soo Kim1, Tae Yoon Jeong1, Yu Seon Cheong1
1Department of Anesthesiology and Pain Medicine, Institute of Medical Sciences, Kangwon National University Hospital, School of Medicine, Chuncheon, Korea.
Background:
Magnetic resonance imaging (MRI) of the spine is the preferred diagnostic tool for pathologic conditions affecting the spine. However, in patients receiving epidural corticosteroid injection (ESI) for treatment of spinal diseases, there is a possibility of misreading of MR images because of air or fluid in the epidural space after the injection. Therefore, we defined the characteristics of abnormal changes in MRI findings following an ESI in patients with low back pain.
Methods:
We reviewed the medical records of 133 patients who underwent MRI of the lumbar spine within 7 days after ESI between 2006 and 2015.All patients were administered an ESI using a 22-gauge Tuohy needle at the lumbar spine through the interlaminar approach. The epidural space was identified by the loss of resistance technique with air.
Results:
The incidences of abnormal changes in MRI findings because of ESI were 54%, 31%, and 25% in patients who underwent MRI at approximately 24 h, and 2 and 3 days after ESI, respectively. Abnormal MRI findings included epidural air or fluid, needle tracks, and soft tissue changes. Epidural air, the most frequent abnormal finding (82%), was observed in 41% of patients who underwent MRI within 3 days after injection. Abnormal findings due to an ESI were not observed in MR images acquired 4 days after ESI or later.
Conclusions:
Pain physicians should consider the possibility of abnormal findings in MR images acquired after epidural injection using the interlaminar approach and the loss of resistance technique with air at the lumbar spine.
Insights
Magnetic resonance imaging (MRI) of the spine can show abnormal findings after epidural corticosteroid injection (ESI). These changes, including epidural air, are typically seen within 3 days post-injection and resolve by 4 days.
Area of Science:
- Radiology
- Pain Management
- Spinal Imaging
Background:
- Spine MRI is crucial for diagnosing spinal conditions.
- Epidural corticosteroid injections (ESI) can cause post-procedural changes in MRI, potentially leading to misinterpretation.
- Understanding these changes is vital for accurate diagnosis in patients with low back pain.
Purpose of the Study:
- To characterize abnormal MRI findings following epidural corticosteroid injection (ESI) in patients with low back pain.
- To determine the temporal relationship between ESI and abnormal MRI findings.
- To aid clinicians in differentiating post-procedural changes from true pathology.
Main Methods:
- Retrospective review of 133 patients who underwent lumbar spine MRI within 7 days post-ESI (2006-2015).
- All ESIs utilized a Tuohy needle via interlaminar approach with air for loss of resistance technique.
- Analysis of MRI findings including epidural air, fluid, needle tracks, and soft tissue changes.
Main Results:
- Abnormal MRI findings post-ESI occurred in 54% (24h), 31% (2 days), and 25% (3 days) of patients.
- Epidural air was the most frequent finding (82% of abnormal cases), present in 41% within 3 days.
- No abnormal findings related to ESI were observed on MRI scans acquired 4 days or later post-injection.
Conclusions:
- Physicians must consider post-ESI changes in lumbar spine MRIs performed after interlaminar epidural injections using air.
- Awareness of these transient findings, particularly epidural air, is essential for accurate interpretation.
- These findings typically resolve within 4 days, aiding in differential diagnosis.
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