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The Journal of Veterinary Medical... Apr 2022The purpose of this observational study was to determine the characteristic computed tomographic (CT) myelography findings of cervical vertebral stenotic myelopathy... (Observational Study)
Observational Study
The purpose of this observational study was to determine the characteristic computed tomographic (CT) myelography findings of cervical vertebral stenotic myelopathy (CVSM) lesions in Thoroughbred horses. A total of 23 Thoroughbred horses (age range, 155-717 days on CT examination; mean, 410.9 days) were analyzed. All 23 Thoroughbred horses underwent unenhanced radiography, radiographic myelography, and CT myelography. Unenhanced radiographs were observed the presence of cervical vertebral malalignment and osseous lesions. Radiographic myelograms were observed for signs of cervical spinal cord compression; additionally, CT myelograms were used to detect cervical vertebral osseous lesions. Ventral compressions were frequently observed in the cranial cervical vertebrae (C2-C4), whereas dorsal compressions were frequently observed in the caudal cervical vertebrae (C5-C7). Furthermore, osseous lesions of the caudal articular process developed more frequently than those of the cranial articular process. CT myelography in Thoroughbred horses is a useful method for detecting CVSM changes.
Topics: Animals; Cervical Vertebrae; Horse Diseases; Horses; Myelography; Spinal Cord Diseases; Spinal Stenosis; Tomography, X-Ray Computed
PubMed: 35197397
DOI: 10.1292/jvms.22-0036 -
The Veterinary Clinics of North... Mar 2017A variety of diagnostic tests can be used to help further characterize and diagnose neurologic disease in ruminant species. Cerebrospinal fluid is easily collected, and... (Review)
Review
A variety of diagnostic tests can be used to help further characterize and diagnose neurologic disease in ruminant species. Cerebrospinal fluid is easily collected, and analysis can help in defining the broad category of disease. Diagnostic imaging, including radiography, myelography, ultrasonography, computed tomography, and MRI, have all been used to varying degrees in ruminants. Advanced cross-sectional imaging techniques have the capacity to aid greatly in diagnosis, but their cost can often be prohibitive. Currently, electrodiagnostic tests are not well evaluated or used in the diagnosis of neurologic disease in ruminants.
Topics: Animal Diseases; Animals; Cattle; Cattle Diseases; Goat Diseases; Goats; Humans; Magnetic Resonance Imaging; Nervous System Diseases; Neurologic Examination; Ruminants; Sheep; Sheep Diseases
PubMed: 28166937
DOI: 10.1016/j.cvfa.2016.09.002 -
European Spine Journal : Official... May 2020CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural...
PURPOSE
CT myelography has been used since 1976 to diagnose neural compression in the axial skeleton. With the advent of routine MRI, its role in accurately diagnosing neural compression has been questioned as its normal appearances are not defined in the study. In this study, we examine a series of CT myelograms to define the normal appearances of the neural elements of the spine.
METHODS
The CT myelograms of patients with unilateral symptoms were examined by four independent physicians. The lateral extent of contrast was examined and recorded. Concordance between the recorded extents was assessed using kappa scores.
RESULTS
Thirty-six scans were reviewed. Kappa analysis shows that there is a fair agreement in the lateral extent of contrast at L1, L3 and L4. At L2 and L5, agreement is slight.
CONCLUSION
The interpretation of CT myelography shows significant interobserver variability. As a result, the usefulness of this diagnostic tool can be questioned, and if misinterpreted, it could lead to questionable diagnoses and inadvertently erroneous management if used in isolation. These slides can be retrieved under Electronic Supplementary Material.
Topics: Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Myelography; Spinal Stenosis; Tomography, X-Ray Computed
PubMed: 31901999
DOI: 10.1007/s00586-019-06287-5 -
Current Opinion in Neurology Aug 2014To illustrate clinical presentations, imaging findings, and diagnostic and therapeutic approaches associated with various conditions of intracranial hypotension. (Review)
Review
PURPOSE OF REVIEW
To illustrate clinical presentations, imaging findings, and diagnostic and therapeutic approaches associated with various conditions of intracranial hypotension.
RECENT FINDINGS
Intracranial hypotension occurs spontaneously, following (lumbar) dural puncture, accidental dural opening, or excessive surgical cerebrospinal fluid drainage. The typical clinical manifestation - orthostatic headache - may be masqueraded by atypical clinical findings, including coma, frontotemporal dementia, leptomeningeal hemosiderosis-associated symptoms, and others. MRI signs are highly specific, but the imaging strategy to search for spinal cerebrospinal fluid leaks (none, computed tomography myelography, magnetic resonance myelography with gadolinium, digital subtraction myelography) is a matter of debate. The same is true for the mode of treatment (bed rest, blind, fluoroscopy or computed tomography-guided epidural blood patching, fibrin patching, surgery).
SUMMARY
Clinical presentation as well as diagnostic and therapeutic approaches in intracranial hypotension are very heterogenous.
Topics: Diagnostic Imaging; Humans; Incidence; Intracranial Hypotension
PubMed: 24978633
DOI: 10.1097/WCO.0000000000000105 -
Journal of Neurological Surgery. Part... Jul 2018The diagnosis of a lumbar spinal stenosis demands advanced diagnostic radiologic techniques. In recent decades magnetic resonance imaging (MRI) has replaced...
BACKGROUND AND STUDY AIMS
The diagnosis of a lumbar spinal stenosis demands advanced diagnostic radiologic techniques. In recent decades magnetic resonance imaging (MRI) has replaced myelography, now considered an old-fashioned technique. It was our hypothesis that functional myelography still plays an important role in selected cases. We investigated how our surgical strategy was influenced by the results of MRI, functional myelography, and postmyelography computed tomography (CT) in patients with a lumbar spinal stenosis.
METHODS
The sagittal diameters of the lumbar spinal canal were measured from L1 to S1 on patients with lumbar spinal stenosis. MRI, functional myelography, and postmyelography CT were compared in each of the patients. Sensitivity and specificity were calculated in each method. We examined how the surgical strategy was influenced by the results of these different methods.
RESULTS
Fifty consecutive patients (21 women and 29 men; mean age: 70 years, [range: 49-86 years]) fulfilled the inclusion criteria. Functional myelography revealed a sensitivity of 0.99, a specificity of 0.79, and a positive predictive value of 0.45. The MRI exhibited a sensitivity of 0.93, a specificity of 0.74, and a positive predictive value of 0.39. Postmyelography CT showed a sensitivity of 0.96, a specificity of 0.75, and a positive predictive value of 0.41. A functional myelography revealed more information than the MRI and resulted in a change in the surgical strategy in 11 of 50 patients (22%) in comparison with the sole results of MRI or a postmyelography CT.
CONCLUSIONS
In selected cases with multilevel lumbar spinal stenosis, functional myelography revealed the highest precision in reaching a correct diagnosis. It resulted in a change in the surgical approach in every fifth patient in comparison with the MRI and proved most helpful, especially in elderly patients.
Topics: Aged; Aged, 80 and over; Female; Humans; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Myelography; Sensitivity and Specificity; Spinal Stenosis; Tomography, X-Ray Computed
PubMed: 29346832
DOI: 10.1055/s-0037-1618563 -
Clinical Neuroradiology Dec 2023Dural tears at the level of the cervical, thoracic, and lumbar spine cause spontaneous intracranial hypotension (SIH) in patients with a spinal longitudinal extradural...
PURPOSE
Dural tears at the level of the cervical, thoracic, and lumbar spine cause spontaneous intracranial hypotension (SIH) in patients with a spinal longitudinal extradural CSF collection (SLEC); however, sacral dural tears have rarely been reported so far. This study focuses on sacral dural tears as a cause of SIH.
METHODS
Retrospective data from SIH patients with confirmed sacral dural tears studied between October 2020 and November 2022 were analyzed with respect to demographic, clinical and imaging features. Digital subtraction myelography (DSM) and lumbar epidural blood patch (EBP) were modified by placing the patient in reversed Trendelenburg position.
RESULTS
Of the SIH patients, 9 (all women; mean age, 38.5 years; mean body mass index, BMI, 22.9) out of 149 had a sacral dural leak (6%) that occurred spontaneously in 7/9, while 2/9 were likely associated with minor trauma. None had a sacral fracture. The mean SIH score was 6.8. All patients showed SLEC on heavily T2-weighted MR myelography (T2-MRM), 4/9 exclusively sacral and 5/9 with partial or complete involvement of the remaining spine. 4/9 had none, but 5/9 had meningeal sacral cysts, 2/5 had large cysts/ectasia. Confirmation of the sacral origin of the leak was provided in 4/9 by T2-MRM, in 2/9 by DSM and 3/9 by CT myelography (CTM) whereas 0/9 revealed the exact site of leak within the sacrum.
CONCLUSION
Sacral dural tears should be considered as a possible cause for SIH. It is concluded to implement T2-MRM covering the entire sacrum in the standard MRI protocol and propose EBP in the reverse Trendelenburg position as a therapeutic approach.
Topics: Humans; Female; Adult; Intracranial Hypotension; Cerebrospinal Fluid Leak; Retrospective Studies; Sacrum; Magnetic Resonance Imaging; Cysts
PubMed: 37261452
DOI: 10.1007/s00062-023-01292-0 -
Cureus Jun 2021Introduction Myelography is a radiological examination method that has been used for the diagnosis of spinal canal pathologies for a long time. More than 90 years of...
The Role and Contribution of Lumbar Myelography in the Diagnosis and Treatment of Patients With Lumbar Degenerative Disorders: Clinical and Statistical Evaluation of Post-Myelography Treatment of 63 Patients.
Introduction Myelography is a radiological examination method that has been used for the diagnosis of spinal canal pathologies for a long time. More than 90 years of experience has been improved by the development of increasingly less toxic contrast agents. Nowadays, although there are many advanced diagnostic tools, lumbar myelography is a direct imaging technique and so it is a powerful diagnostic method for patients whose treatment has not been decided. The aim of our study is to evaluate the effect of lumbar myelography as a diagnostic method and its contribution to treatment. Materials and methods Between January 2016 and April 2018, 63 patients who were admitted to our neurosurgery clinic due to lumbar degenerative disorders and underwent myelography were included in our study. Patients over 30 years of age with lumbar disc disease, narrow spinal canal, and spinal instability, but for whom a surgical decision could not be made, were included in this study. Results After lumbar myelography, 55 of 63 patients underwent a surgical procedure and 8 were directed to non-surgical treatment options. The results of the patients were evaluated by Roland-Morris Low Back Pain and Disability Questionnaire (RMQ). Results showed that the contribution of selected treatment protocols to the recovery after myelography was statistically significant. Conclusion Nowadays, myelography is not the first choice for the diagnosis of lumbar degenerative disorders. However, according to the results of our study, lumbar myelography is an effective diagnostic tool for specific purposes.
PubMed: 34336478
DOI: 10.7759/cureus.15987 -
Headache Sep 2014A broadening of the clinical and imaging features of the spontaneous cerebrospinal fluid (CSF) leaks is now well recognized, far beyond what was thought only two decades... (Review)
Review
A broadening of the clinical and imaging features of the spontaneous cerebrospinal fluid (CSF) leaks is now well recognized, far beyond what was thought only two decades ago. This has resulted in increasing number of patients with atypical and unusual features who, not unexpectedly, are directed to headache specialists and tertiary referral centers. In many cases, obviously the fundamental question of presence or absence of CSF leak will need to be addressed prior to proceeding with further and often more involved, more invasive, and more costly diagnostic and therapeutic considerations. Radioisotope cisternography often proves to be very helpful in these situations by demonstrating reliable, although indirect, evidences of CSF leak while it is less helpful in directly identifying the exact site of the CSF leakage. In this overview article, the expectations from and the limitations of this diagnostic method are described along with some personal observations in the past 25 years.
Topics: Cerebrospinal Fluid Leak; Humans; Indium Radioisotopes; Myelography; Pentetic Acid; Radiopharmaceuticals
PubMed: 25041119
DOI: 10.1111/head.12421 -
Magnetic Resonance Imaging Clinics of... Nov 2017Myelographic contrast media of various types have been used over the past 100 years. Many of the early contrast agents had significant toxicities. Gas myelography was... (Review)
Review
Myelographic contrast media of various types have been used over the past 100 years. Many of the early contrast agents had significant toxicities. Gas myelography was tried, but the contrast between gas and soft tissue is poor. Pantopaque, an oil-based iodinated medium was successfully used for decades, but was not compatible with computed tomography (CT) scanning because it was viscous, insoluble, and caused streak artifact. The development of water-soluble agents allowed even distribution in the subarachnoid space and excellent depiction of spinal anatomy on post-myelographic CT scanning. Although invasive, myelography will remain a useful tool for the foreseeable future.
Topics: Contrast Media; Gadolinium; Humans; Image Enhancement; Lipids; Myelography; Spinal Diseases
PubMed: 28964461
DOI: 10.1016/j.mric.2017.06.005 -
Journal of Clinical Neuroscience :... Mar 2016The aim of this review is to determine the efficacy and optimal strategy for epidural blood patch placement in the treatment of spontaneous intracranial hypotension. We... (Review)
Review
The aim of this review is to determine the efficacy and optimal strategy for epidural blood patch placement in the treatment of spontaneous intracranial hypotension. We present a 37-year-old man who developed a 4 week duration postural headache without sustaining significant trauma. The diagnosis of spontaneous intracranial hypotension with associated subdural hygromas was confirmed with lumbar puncture and radiologic imaging. Spontaneous intracranial hypotension is generally due to cerebrospinal fluid leak from the thecal sac or nerve root sleeves, although the cause of leakage is unknown. In our patient, the site of leakage was identified at cervical C1-C2 level in the spine on myelography. Conservative management with repeated epidural blood patches was successful in symptom relief and complete resolution of cerebrospinal fluid leak and subdural hygromas. We reviewed the literature for efficacy of blood patches delivered directly to the site of leakage (targeted) or to the lumbar or thoracic spine away from the site of leakage or where the site cannot be determined (blind). No clear evidence exists on comparative efficacy due to paucity of randomized trials. However, epidural blood patches in general result in positive outcomes with overall efficacy near 90%. Some trials have suggested greater efficacy for targeted rather than blind epidural blood patches, but randomized studies and long-term prognosis remain to be evaluated.
Topics: Adult; Blood Patch, Epidural; Cerebrospinal Fluid Leak; Cervical Vertebrae; Humans; Intracranial Hypotension; Male; Myelography; Spinal Puncture; Subdural Effusion; Thoracic Vertebrae
PubMed: 26461907
DOI: 10.1016/j.jocn.2015.07.009