Neuroimaging clinics of North America
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The spinal cord is a common site of involvement in multiple sclerosis (MS), and a major cause of the disability suffered by MS patients. High quality MR imaging of the spinal cord is therefore important for diagnosis and research. ⋯ Major studies are underway involving spinal cord imaging, and clinical trials of disease-modifying agents are beginning to include spinal cord imaging, especially measurements of atrophy, as part of their protocols. In clinical practice, spinal cord imaging is essential for ruling out other causes of myelopathies, particularly spinal cord compression, and can help in the diagnosis of MS when brain imaging is normal, or in older individuals in whom findings in the brain are less specific.
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Neuroimaging Clin. N. Am. · Nov 2000
ReviewHow to participate in a multiple sclerosis clinical trial.
MR imaging has made a significant contribution to the understanding of the natural history of multiple sclerosis (MS). MR imaging is an important technique for investigating the pathologic process in the MS patient's brain and spinal cord, and it is now considered an essential part of all clinical trials being performed on new agents in the treatment of MS. This article provides an overview for those wishing to become involved in MS clinical research. Discussion includes the use of conventional and newer MR imaging techniques in clinical trials, current thoughts regarding the role of MR imaging as a surrogate outcome measure, and various types of trial designs.
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Epidural steroid injection is a safe outpatient procedure, which is performed best using image guidance in conjunction with epidurography. Using the techniques described earlier, complications are minimized, and serious complications can be avoided, in experienced hands. The author has performed several thousand procedures in an outpatient setting without any serious complications. ⋯ The use of sedation to perform these procedures is unnecessary, and deep sedation may be dangerous when injections are performed in the vicinity of the spinal cord. The author's experience, which includes clinical feedback and formal trials, shows the technique described in this article to be performed safely without sedation in an outpatient setting, with a high success rate for alleviating pain symptoms. When properly performed, epidural steroid injections have a clinically established role in the management of neck and back pain.
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Technological advances in imaging and needle systems have made percutaneous needle biopsy of the spine safe and effective. Today, this procedure has largely replaced more invasive and costly open surgical procedures.