[CT-guided pain management of specific low back pain : Disc impairment vs. osseous degeneration]. / CT-gesteuerte Schmerztherapie des spezifischen Rückenschmerzes : Bandscheibenschädigung vs. ossäre Degeneration.

BACKGROUND: Back pain is common and leads the patient to the radiologist both for diagnosis and in specific cases for therapy. OBJECTIVES: The current study compares the pain-reducing effect of microinvasive computed tomography (CT)-guided pain therapy for specific back pain caused by herniated discs or spondylarthrosis. MATERIALS AND METHODS: Over a period of 3.3 years, a total of 239 patients were included, in whom 686 CT-guided periradicular therapies (PRT) and 264 CT-guided facet joint therapies (FAC) were performed. In all patients, the pain score was determined using a visual analog pain scale (VAS) before the intervention, during the course of treatment and at the end of treatment. Finally, treatment success was correlated to the type of treatment performed and to the morphological changes present. RESULTS: Both groups showed good improvement of pain under treatment (74% of the PRT patients and 60% of the FAC patients). Patients who underwent PRT showed an average improvement in pain score of 3.1, while those who underwent FAC showed an average improvement of 2.1. The efficacy of FAC was dependent on the degree of degenerative changes present. The more extensive the proven degeneration was in the treated segment, the more interventions were necessary for a good treatment response. CONCLUSION: CT-guided PRT and CT-guided FAC both lead to a good reduction of pain symptoms. In comparison, PRT achieves significantly higher pain reduction than FAC.

Multi-detector CT in the evaluation of patients with recurrence of rectal cancer.

The advantages of multiplanar reconstruction in rectal cancer recurrence diagnostics using medium resolution multi-detector CT are evaluated. We included 40 patients after a rectal cancer operation in this study. During follow-up ten patients developed a recurrence. All patients received a minimum of two CT-examinations in their follow-up program. A total of 131 CT-scans were evaluated. Each examination was reviewed by two experienced radiologists in respect to recurrence. Each examination was presented in axial reconstruction with a slice thickness of 8mm with an increment of 7 mm and a slice thickness of 3 mm with an increment of 2 mm. The thin slices were used for the multi-planar reconstruction. Multi-planar reconstructions showed better results for the detection of recurrence than axial reconstruction. A reduced slice thickness did not lead to better results in axial reconstruction. Multi-planar reconstruction showed a sensitivity of 0.88, a specificity of 1.0 and an accuracy of 0.97. Our axial reconstruction results were: 0.86, 0.96, and 0.93, respectively. Sensitivity and accuracy showed a significant increase after the first and second examinations. Multi-planar reconstructions allow for better detection of rectal cancer recurrence when compared to axial reconstructions. Thinner axial slice thickness shows no diagnostic advantage.