Neuroimaging clinics of North America
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Facet nerve blockade and RF neurotomy procedures are valuable techniques for diagnosis and management of spinal pain relating to facets. These procedures are rapidly evolving, and substantial improvements in patient selection and technique are certain to occur in the future. These are ideal neuroradiologic procedures, as they require the use of imaging equipment and can be performed safely and easily by procedurally oriented individuals.
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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.
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The diagnosis and treatment of central nervous system fungal infections typically pose problems for the clinician. With an increased incidence of fungal infections in immunocompromised patients, neuroradiologic imaging has become essential in determining complications and outcomes. This article provides a summary of the more common organisms encountered in fungal infections of the central nervous system and the imaging features primarily seen with CT and MR imaging.
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The radiologist frequently is asked to contribute to the diagnosis of a patient with central nervous system infections, although radiologic findings usually are nonspecific. The radiologist can consider diagnostic possibilities with more accuracy if the clinician includes accurate demographic and epidemiologic information. This article organizes a broad range of central nervous system infections into demographic and epidemiologic perspective.