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Diffusion-Weighted Imaging for Pretreatment Evaluation and Prediction of Treatment Effect in Patients Undergoing CT-Guided Injection for Lumbar Disc Herniation.

Niu XK, Bhetuwal A, Yang HF - Korean J Radiol (2015)

Bottom Line: The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001).When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up.This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province 610000, China.

ABSTRACT

Objective: To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

Materials and methods: A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O2-O3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) × 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined.

Results: Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up.

Conclusion: This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

No MeSH data available.


Related in: MedlinePlus

62-year-old male patient with left-sided sciatica.A. Transaxial T2-weighted MR image shows herniated disc at level L5/S1 (white arrow). B. CT-guided discography shows disk hernia (white arrow). C. Intradiscal injection of 3 mL of ozone-oxygen mixture (white arrow). D. Pullback of puncture needle to periganglionic position, followed by injection of 5 mL of ozone-oxygen mixture.
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Figure 1: 62-year-old male patient with left-sided sciatica.A. Transaxial T2-weighted MR image shows herniated disc at level L5/S1 (white arrow). B. CT-guided discography shows disk hernia (white arrow). C. Intradiscal injection of 3 mL of ozone-oxygen mixture (white arrow). D. Pullback of puncture needle to periganglionic position, followed by injection of 5 mL of ozone-oxygen mixture.

Mentions: The disc level to be treated was decided by comparing morphological data, patient's history, MR imaging, and clinical examination in consensus with an experienced neurosurgeon. Computed tomographic (CT) (MX 16, Philips Medical Systems, Eindhoven, the Netherlands) sections for planning were obtained in 3-mm slice thickness, parallel to the edge of the vertebra, with the patient in prone position. Next, a CT-guided discography was performed under local anesthesia, according to the path and angle determined by the CT scan (Fig. 1). All interventions were performed by a single interventionist with more than 8 years of experience in spine interventions. Under CT guidance, all patients received an identical intradiscal (3 mL) and periganglionic (5 mL) injection of O2-O3 mixture (ratio = 3:97; ozone concentration of 30 g/mL) followed by a periganglionic injection of corticosteroid (1 mL triamcinolone acetonide; Lisapharma, Vio Licinio, Italy) and anesthetic agent (2 mL lidocaine hydrochloride 0.25%; Southwest Pharmaceutical Co., Ltd., Chongqing, China) in the same session (Fig. 1). Intradiscal and periganglionic injection was performed by the means of an extraspinal lateral approach with a 19-gauge, 14-cm puncture needle (Monopty 2016B, Bard Inc., Covington, GA, USA) from the same side as the main location of symptoms. In the present study, we treated a single lumbar disc level with a single session of O2-O3 injection. The access side corresponded to the site of pain, in the case of unilateral pain. After the nucleolysis procedure, the patients were asked to take a bed rest for 12 hours and to avoid strenuous activities for 3 days. All patients were discharged on the following day.


Diffusion-Weighted Imaging for Pretreatment Evaluation and Prediction of Treatment Effect in Patients Undergoing CT-Guided Injection for Lumbar Disc Herniation.

Niu XK, Bhetuwal A, Yang HF - Korean J Radiol (2015)

62-year-old male patient with left-sided sciatica.A. Transaxial T2-weighted MR image shows herniated disc at level L5/S1 (white arrow). B. CT-guided discography shows disk hernia (white arrow). C. Intradiscal injection of 3 mL of ozone-oxygen mixture (white arrow). D. Pullback of puncture needle to periganglionic position, followed by injection of 5 mL of ozone-oxygen mixture.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499553&req=5

Figure 1: 62-year-old male patient with left-sided sciatica.A. Transaxial T2-weighted MR image shows herniated disc at level L5/S1 (white arrow). B. CT-guided discography shows disk hernia (white arrow). C. Intradiscal injection of 3 mL of ozone-oxygen mixture (white arrow). D. Pullback of puncture needle to periganglionic position, followed by injection of 5 mL of ozone-oxygen mixture.
Mentions: The disc level to be treated was decided by comparing morphological data, patient's history, MR imaging, and clinical examination in consensus with an experienced neurosurgeon. Computed tomographic (CT) (MX 16, Philips Medical Systems, Eindhoven, the Netherlands) sections for planning were obtained in 3-mm slice thickness, parallel to the edge of the vertebra, with the patient in prone position. Next, a CT-guided discography was performed under local anesthesia, according to the path and angle determined by the CT scan (Fig. 1). All interventions were performed by a single interventionist with more than 8 years of experience in spine interventions. Under CT guidance, all patients received an identical intradiscal (3 mL) and periganglionic (5 mL) injection of O2-O3 mixture (ratio = 3:97; ozone concentration of 30 g/mL) followed by a periganglionic injection of corticosteroid (1 mL triamcinolone acetonide; Lisapharma, Vio Licinio, Italy) and anesthetic agent (2 mL lidocaine hydrochloride 0.25%; Southwest Pharmaceutical Co., Ltd., Chongqing, China) in the same session (Fig. 1). Intradiscal and periganglionic injection was performed by the means of an extraspinal lateral approach with a 19-gauge, 14-cm puncture needle (Monopty 2016B, Bard Inc., Covington, GA, USA) from the same side as the main location of symptoms. In the present study, we treated a single lumbar disc level with a single session of O2-O3 injection. The access side corresponded to the site of pain, in the case of unilateral pain. After the nucleolysis procedure, the patients were asked to take a bed rest for 12 hours and to avoid strenuous activities for 3 days. All patients were discharged on the following day.

Bottom Line: The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001).When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up.This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan Province 610000, China.

ABSTRACT

Objective: To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

Materials and methods: A total of 52 patients with unilateral mono-radiculopathy received a single intradiscal (3 mL) and periganglionic (5 mL) injection of an O2-O3 mixture. An ADC index of the involved side to the intact side was calculated using the following formula: pre-treatment ADC index = ([ADC involved side - ADC intact side] / ADC intact side) × 100. We analyzed the relationship between the pre-treatment Oswestry Disability Index (ODI) and the ADC index. In addition, the correlation between ODI recovery ratio and ADC index was investigated. The sensitivity and specificity of the ADC index for predicting response in O2-O3 therapy was determined.

Results: Oswestry Disability Index and the ADC index was not significantly correlated (r = -0.125, p = 0.093). The ADC index and ODI recovery ratio was significantly correlated (r = 0.819, p < 0.001). When using 7.10 as the cut-off value, the ADC index obtained a sensitivity of 86.3% and a specificity of 82.9% for predicting successful response to therapy around the first month of follow-up.

Conclusion: This preliminary study demonstrates that the patients with decreased ADC index tend to show poor improvement of clinical symptoms. The ADC index may be a useful indicator to predict early response to CT-guided O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

No MeSH data available.


Related in: MedlinePlus