Epidural Steroid Injection

Epidural Steroid Injection

Epidural steroid injections (ESIs) for the management of lumbar radicular pain provide the advantage of delivering potent anti-inflammatory agents in a localized fashion to the area of affected nerve roots, thereby decreasing the systemic side effects often seen with orally administered steroids. Lumbar ESIs have been endorsed by the North American Spine Society (2) and the Agency for Health Care Policy and Research (3) as an integral part of nonsurgical management of radicular pain from lumbar spine disorders. Cervical and…

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Age-Related Changes and Dementing Disorders

Age-Related Changes and Dementing Disorders

The aging brain is characterized on CT or MRI as demonstrating volume increases in both cortical sulci and ventricles (Fig. 6-96). T2-weighted MR images also frequently display small areas of hyperintense signal along the anterolateral margins of the anterior horns of the lateral ventricles. These changes may or may not be associated with neurologic findings. FIGURE 6-96. A case of cortical atrophy of aging as seen by CT. Enlargement of cortical sulci and sylvian fissures (arrows) with ex vacuo ventricular…

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White Matter Diseases

White Matter Diseases

White matter diseases can be divided into demyelinating diseases, in which the white matter is normally formed and then pathologically destroyed, and dysmyelinating diseases, in which there is usually a genetically determined enzymatic disorder that interferes with the normal production or maintenance of myelin (86). The enzymatic disturbances are relatively rare; therefore, their imaging characteristics will not be described. The most common of the demyelinating disorders is multiple sclerosis (MS). The demyelinating plaques of MS are better visualized by MRI…

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Coccygeal Junction Injection

Coccygeal Junction Injection

Indication Infiltration of the coccyx region can be useful as a therapeutic procedure in coccydynia after exclusion of infection or other significant pathology. Techniques After informed consent is obtained, the patient is positioned in the lateral Sims’ position with the left side down for right-handed clinicians. With the upper leg flexed, the buttocks are separated, allowing easy access to the sacrococcygeal junction. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of…

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Osteoarthritis Imaging

Osteoarthritis Imaging

Osteoarthritis or degenerative joint disease (DJD) is an asymmetric, usually bilateral mechanical degenerative process that involves joints significantly involved in weight bearing, such as the hip, knee, and spine, and those involved in frequent repetitive mechanical trauma, such as the distal interphalangeal joints of the fingers, trapezium–first metacarpal joint, trapezium- scaphoid joint, and metatarsophalangeal joint of the great toe. It is the most common arthritis, and it is estimated that 80% of the population with more than 50 years will…

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Spinal Trauma

Spinal Trauma

Although much spinal trauma is well visualized on plain films, CT has a number of advantages over this modality. These include the demonstration of fractures not seen in plain films, an accurate determination of the amount of spinal canal encroachment by fracture fragments (Fig. 6-66A,B), the identification of neural foramen impingement by fractures involving its boundaries, and a more precise evaluation of facet disruption. MR can display impingement on the dural sac or the spinal cord by bone fragments, as…

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Sacroiliac Joint Injection

Sacroiliac Joint Injection

Indications Sacroiliac joint injection is used to treat inflammation of the sacroiliac joints secondary to trauma, rheumatoid arthritis, degenerative joint disease, or stress secondary to mechanical changes in posture or gait. Techniques After informed consent is obtained, the patient is placed in the prone position. The patient is prepared in a standard aseptic fashion over an area large enough to allow palpation of landmarks, and sterile technique is used throughout the procedure. A 6-in. (16-cm), 22-gauge needle is inserted. The…

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Other Ankle Abnormalities

Other Ankle Abnormalities

Technetium-99 scintigraphy has been valuable for detecting stress fractures of metatarsal and tarsal bones, and CT has high accuracy for detecting osteochondral fracture. In foot pain of undetermined etiology, however, MRI is an excellent screening modality because it permits direct evaluation of all osseous and soft-tissue structures. MRI is superior to any other modality in displaying tendon pathology (47,48). In tenosynovitis, MRI detects fluid within the tendon sheath as having moderate signal intensity on T1-weighted images and as hyperintense on…

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Complications of Brain Injury

Complications of Brain Injury

Brain injuries may be accompanied by a number of late or long-term complications. These secondary brain injuries include cerebral herniations, which may occur under the falx cerebri or through the tentorium. Herniations can cause compression of adjacent brain substance or vessels, with the production of secondary signs and symptoms (Fig. 6-93). Penetrating injuries or fractures can injure nearby large or small vessels, producing thrombosis, embolism, traumatic aneurysm formation, or internal carotid–cavernous sinus fistula. Basal skull fractures involving the dura and…

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Ankle Ligament Imaging

Ankle Ligament Imaging

Previously, arthrography and tenography were the primary means of imaging ankle ligament injuries. They had the limitations of being invasive, providing only an indirect depiction of ankle ligament disruption, and yielding potentially false- negative results. MRI provides a noninvasive means of directly imaging all the ligaments in the vicinity of the ankle as well as all the other osseous and soft tissues. Axial MR images provide good visualization of the tibiofibular ligaments of the tibiofibular mortise. All the lateral collateral…

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