Sacroiliac pain and CT-guided steroid injection treatment: high-grade arthritis has an adverse effect on outcomes in long-term follow-up.

OBJECTIVE: The sacroiliac joint (SIJ) is one of the major sources of low back pain that can lead to severe morbidity. Possible SIJ pain requires a thorough evaluation and treatment option. The purpose of this study was to analyze the possible relationships between computed tomography (CT) grading of SIJ arthritis and the effectiveness of intraarticular steroid injection treatment under CT guidance. PATIENTS AND METHODS: A total of 61 patients with SIJ pain who were treated with CT guided intraarticular steroid injection were retrospectively reviewed. Visual analog scale (VAS) scores for pain control were recorded for short-term (day after injection, first week, third week) and long-term (sixth months and final control) follow-up times. SIJ arthritis was graded using CT images according to the New York criteria. Patients were assigned into low-grade (0, 1 and 2) and high-grade (3 and 4) groups. The relationship between arthritis grades and VAS scores in short and long-term follow-ups were statistically analyzed. RESULTS: Mean age and follow-up was 54.8 years (range: 41-68 years) and 27.8 months (range: 24-36 months), respectively. In 40 patients there was low-grade arthritis, while 21 patients were characterized on having high-grade sacroiliac arthritis detected during the radiological evaluation. There was no statistically significant difference between low and high-grade arthritis in regard to short-term VAS scores. On contrary, for long-term VAS scores, there was significant difference between low- and high-grade arthritis. CONCLUSIONS: Steroid injection treatment for SIJ pain is not effective on a long-term basis for patients with high-grade arthritis, and although they have had decreased VAS scores in the short-term, after 2 years of follow-up, their VAS scores significantly increased leading to symptomatic sacroiliac joint pain.

Accuracy and safety of percutaneous US-guided needle biopsies in specific focal liver lesions: comparison of large and small needles in 1300 patients.

AIM: The aim of this study was to compare small size aspiration needles with large size cutting needles in focal liver lesions for using small needles instead of large ones without on-site cytopathologist. METHODS: Percutaneous ultrasonography-guided liver biopsy was evaluated retrospectively in a biopsy cohort study of 1300 patients. In this series, 690 patients were biopsied with large size (<19G) cutting needles and 610 with small size (20G) aspiration needles. On-site cytopathologist was not present in the biopsy-room at any intervention. Needles were compared for diagnostic accuracy and safety for various focal liver diseases. RESULTS: We had diagnostic accuracy rate of 85.0% in small needle group vs. 96.9% in large needle group with metastasis (P<0.001). This rate was 85.5% in small needle group vs. 97.9% in large needle group with hepatocellular carcinoma (P=0.039). Accuracy rates of them were not different in hemangioma (P=0.277) and infection-inflammation (P=0.470). This rate was 75.0% in small needle group vs. 98.9% in large needle group with regenerative nodules (P=0.018). These rates were not different in focal steatosis (P=1.000). Sensitivity, specificity, and accuracy were 85.1%, 100%, and 89.2%, respectively. Only 2 (0.15%) major complications were found with small needles in uncooperative patients. Any major complication was not seen in hemangioma. CONCLUSION: In uncertain diagnosis with modern imaging, we propose that large size cutting needles should be used in suspected liver metastasis, hepatocellular carcinoma, and regenerative nodules if cytopathologist was not present. Small needles can be successfully used as well as large ones in focal steatosis, infection-inflammation, and hemangioma of liver in unclear diagnosis.