Korean J Pain.  2017 Oct;30(4):281-286. 10.3344/kjp.2017.30.4.281.

Effect of epidural corticosteroid injection on magnetic resonance imaging findings

• Kim MS
• Jeong TY
• Cheong YS
• Jeon YW
• Lim SY
• Kang SS
• Kim IN
• Chang TB
• Seong HH
• Hwang BM

• KMID: 2392905
• DOI: http://doi.org/10.3344/kjp.2017.30.4.281

Abstract

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.

Keyword

Air; Artifacts; Epidural injection; Epidural space; Glucocorticoids; Magnetic resonance imaging; Needle

MeSH Terms

Artifacts
Epidural Space
Glucocorticoids
Humans
Incidence
Injections, Epidural
Low Back Pain
Magnetic Resonance Imaging*
Medical Records
Needles
Spinal Diseases
Spine
Glucocorticoids

Figure

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  Fig. 1 Sagittal (A) and axial (B) magnetic resonance images. (A) Arrow indicates air in the epidural space. (B) Arrow indicates a needle track.

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  Fig. 2 Numbers of patients with changes in magnetic resonance imaging findings after epidural corticosteroid injection.

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