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http://dx.doi.org/10.3348/kjr.2015.16.4.874

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

Niu, Xiang-Ke (Department of Radiology, Affiliated Hospital of Chengdu University)
Bhetuwal, Anup (Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College)
Yang, Han-Feng (Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College)
Publication Information
Korean Journal of Radiology / v.16, no.4, 2015 , pp. 874-880 More about this Journal
Abstract
Objective: To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CTguided Oxygen-Ozone ($O_2-O_3$) 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 $O_2-O_3$ 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) $\times$ 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 $O_2-O_3$ 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 $O_2-O_3$ injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.
Keywords
CT-guided spinal injections; Periradicular injection; Diffusion weighted image; Apparent diffusion coefficient; Dorsal root ganglion;
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