Korean J Radiol.  2015 Aug;16(4):874-880. 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 XK
• Bhetuwal A
• Yang HF

• KMID: 2155562
• DOI: http://doi.org/10.3348/kjr.2015.16.4.874

Abstract

OBJECTIVE
To determine whether a change in apparent diffusion coefficient (ADC) value could predict early response to CT-guided Oxygen-Ozone (O2-O3) 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 O2-O3 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) x 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 O2-O3 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 O2-O3 injection therapy in patients with unilateral mono-radiculopathy due to lumbar disc herniation.

Keyword

CT-guided spinal injections; Periradicular injection; Diffusion weighted image; Apparent diffusion coefficient; Dorsal root ganglion

MeSH Terms

Adult
Aged
Diffusion Magnetic Resonance Imaging/*methods
Female
Humans
Intervertebral Disc Displacement/*diagnosis/*therapy
Lumbar Vertebrae/*pathology
Male
Middle Aged
Oxygen/therapeutic use
Ozone/therapeutic use
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods
Treatment Outcome
Young Adult
Oxygen
Ozone

Figure

• 

  Fig. 1 62-year-old male patient with left-sided sciatica. A. Transaxial T2-weighted MR image shows herniated disc at level L5/S1 (white arrow). B. CT-guided discography shows disk hernia (white arrow). C. Intradiscal injection of 3 mL of ozone-oxygen mixture (white arrow). D. Pullback of puncture needle to periganglionic position, followed by injection of 5 mL of ozone-oxygen mixture.

• 

  Fig. 2 50-year-old female patient with right-sided sciatica. A. Transaxial diffusion-weighted image at b = 0 s/mm2. B. Transaxial diffusion-weighted image at b = 1000 s/mm2. Measurement of signal intensity in region of interest (red circle).

• 

  Fig. 3 Scatter plot of ADC index for responders and non-responders. ADC index for responders (13.022 ± 9.946) were significantly higher than non-responders (-14.484 ± 12.756) (p = 0.012). ADC = apparent diffusion coefficient

• 

  Fig. 4 Relationship between ADC index and Oswestry Disability Index. No correlation was found between Oswestry Disability Index and ADC index (r = -0.125, p = 0.093). ADC = apparent diffusion coefficient

• 

  Fig. 5 Relationship between ADC index and ODI recovery ratio. Statistically positive correlation was observed (r = 0.819, p < 0.001). ADC = apparent diffusion coefficient, ODI = Oswestry Disability Index

• 

  Fig. 6 Receiver operating characteristic curve evaluating optimal ADC index to predict successful outcomes after 1-month follow-up. When using 7.10 as cut-off value, ADC index obtained sensitivity of 86.3% and specificity of 82.9% for predicting successful outcomes. ADC = apparent diffusion coefficient

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