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AJNR. American Journal of Neuroradiology Mar 2023Dynamic CT myelography can identify spinal CSF leaks secondary to dural tears (type 1) and ruptured meningeal diverticula (type 2), but the radiation can be high...
BACKGROUND AND PURPOSE
Dynamic CT myelography can identify spinal CSF leaks secondary to dural tears (type 1) and ruptured meningeal diverticula (type 2), but the radiation can be high secondary to multiple successive acquisitions. The purpose of this article is to discuss the procedural approach of a modified dynamic CT myelography technique with single scan acquisitions, reduced contrast volume, and condensed scan coverage and compare its radiation dose with that in traditional dynamic CT myelography.
MATERIALS AND METHODS
Retrospective review was performed for patients with spontaneous CSF leaks showing extradural collections on spine MR imaging who underwent traditional and modified dynamic CT myelography. The radiation doses between the 2 cohorts were compared.
RESULTS
Thirty-seven patients (25 women, 12 men) had a type 1 or 2 CSF leak on dynamic CT myelography. Thirty-one patients had a type 1 CSF leak, and 6 patients had type 2 leaks. The traditional dynamic CT myelography was performed in 25 patients, and the average number of acquisitions per dynamic CT myelography was 3.6. The mean total effective dose per dynamic CT myelography was 31.3 mSv (range, 11.3-68.4 mSv). The modified dynamic CT myelography was performed in 12 patients, and the average number of acquisitions was 2.8. The mean total effective dose per dynamic CT myelography was 15.1 mSv (range, 4.8-24.6 mSv). The effective dose and dose-length product between the cohorts were statistically significant ( < .0001 and .01, respectively).
CONCLUSIONS
Modified dynamic CT myelography performed with single scan acquisitions, smaller volume of contrast, and reduced scan coverage can reduce the radiation dose for type 1 and 2 CSF leak detection.
Topics: Male; Humans; Female; Myelography; Cerebrospinal Fluid Leak; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Retrospective Studies; Intracranial Hypotension
PubMed: 36732032
DOI: 10.3174/ajnr.A7784 -
CMAJ : Canadian Medical Association... Feb 1989Low back pain is one of the commonest disorders, yet is the most confusing. The cost in work-time lost and in the search for and treatment of its many causes amounts to... (Review)
Review
Low back pain is one of the commonest disorders, yet is the most confusing. The cost in work-time lost and in the search for and treatment of its many causes amounts to billions of dollars annually. The traditional techniques for anatomic visualization have been plain-film radiography and myelography, but they have limitations. The development of computed tomography and magnetic resonance imaging have substantially improved anatomic imaging. However, invasive procedures, such as discography, percutaneous nerve-root blocking and percutaneous facet injection, may be helpful in patients with disabling pain in whom noninvasive methods give negative findings, show abnormalities that do not correlate with the symptoms or identify multiple sites of disease. The invasive procedures are believed by some to be associated with too many complications. We have attempted to clarify the strengths and weaknesses of the currently available methods of investigating low back pain and the indications for their use.
Topics: Adult; Back Pain; Humans; Intervertebral Disc; Magnetic Resonance Imaging; Middle Aged; Myelography; Nerve Block; Radionuclide Imaging; Tomography, X-Ray Computed
PubMed: 2521569
DOI: No ID Found -
Annals of Clinical and Translational... Feb 2021CNS vascular malformation is an umbrella term that encompasses a wide variety of pathologies, with a wide range of therapeutic and diagnostic importance. This range... (Review)
Review
CNS vascular malformation is an umbrella term that encompasses a wide variety of pathologies, with a wide range of therapeutic and diagnostic importance. This range spans lesions with a risk of devastating neurological compromise to lesions with a slow, static or benign course. Advances in neurovascular imaging along with increased utilization of these advances, have resulted in more frequent identification of these lesions. In this article, we provide an overview on definitions and classifications of CNS vascular malformations and outline the etiologic, diagnostic, prognostic, and therapeutic features for each entity. This review covers intracranial and spinal cord vascular malformations and discusses syndromes associated with CNS vascular malformations.
Topics: Central Nervous System Vascular Malformations; Cerebral Angiography; Computed Tomography Angiography; Humans; Magnetic Resonance Imaging; Myelography
PubMed: 33434339
DOI: 10.1002/acn3.51277 -
Journal of Neurology, Neurosurgery, and... Apr 1975Four cases of syringomyelia in two separate families are reported.
Four cases of syringomyelia in two separate families are reported.
Topics: Adult; Female; Functional Laterality; Humans; Male; Middle Aged; Myelography; Syringomyelia; Time Factors
PubMed: 1141921
DOI: 10.1136/jnnp.38.4.346 -
AJNR. American Journal of Neuroradiology Apr 2023CSF-venous fistula can be diagnosed with multiple myelographic techniques; however, no prior work has characterized the time to contrast opacification and the duration... (Review)
Review
BACKGROUND AND PURPOSE
CSF-venous fistula can be diagnosed with multiple myelographic techniques; however, no prior work has characterized the time to contrast opacification and the duration of visualization. The purpose of our study was to evaluate the temporal characteristics of CSF-venous fistula on digital subtraction myelography.
MATERIALS AND METHODS
We reviewed the digital subtraction myelography images of 26 patients with CSF-venous fistulas. We evaluated how long the CSF-venous fistula took to opacify after contrast reached the spinal level of interest and how long it remained opacified. Patient demographics, CSF-venous fistula treatment, brain MR imaging findings, CSF-venous fistula spinal level, and CSF-venous fistula laterality were recorded.
RESULTS
Eight of the 26 CSF-venous fistulas were seen on both the upper- and lower-FOV digital subtraction myelography, for a total of 34 CSF-venous fistula views evaluated on digital subtraction myelography. The mean time to appearance was 9.1 seconds (range, 0-30 seconds). Twenty-two (84.6%) of the CSF-venous fistulas were on the right. The highest fistula level was C7, while the lowest was T13 (13 rib-bearing vertebral bodies). The most common CSF-venous fistula levels were T6 (4 patients) followed by T8, T10, and T11 (3 patients each). The mean age was 58.3 years (range, 31.7-87.6 years). Sixteen patients were women (61.5%).
CONCLUSIONS
This is the first study to report the temporal characteristics of CSF-venous fistulas using digital subtraction myelography. We found that on average, the CSF-venous fistula appeared 9.1 seconds (range, 0-30 seconds) after intrathecal contrast reached the spinal level.
Topics: Humans; Female; Middle Aged; Male; Myelography; Cerebrospinal Fluid Leak; Spine; Magnetic Resonance Imaging; Fistula; Intracranial Hypotension
PubMed: 36894299
DOI: 10.3174/ajnr.A7809 -
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 -
Open Veterinary Journal Jan 2021The techniques described for the identification of the lumbosacral (LS) epidural space in dogs do not guarantee the needle position or an accidental subarachnoid...
BACKGROUND
The techniques described for the identification of the lumbosacral (LS) epidural space in dogs do not guarantee the needle position or an accidental subarachnoid puncture, especially in small size dogs.
AIM
To determine the relationship between body weight and the location of the dural sac (DS) using myelography in dogs, and to determine the possibility of subarachnoid puncture during LS epidural based on the position of the DS.
METHODS
Four masked observers evaluated 70 myelographic studies of dogs, annotating the vertebrae where the DS ended, if it was localized before or after the LS space, and if accidental subarachnoid puncture during LS epidural injection was possible (yes/no). Body weight (kg) was categorized into: less than 10 kg, between 10 and 20 kg, and more than 20 kg and was also converted to body surface area (BSA) as a continuous variable.
RESULTS
The DS ended at the LS space or caudally in 50% of dogs. There was a statistically significant difference between the position of the DS and the dog's BSA ( = 0.001). The DS ended caudal to the LS space in 72.7% of dogs weighing <10 kg, in 25% of dogs between 10 and 20 kg and in 15% of dogs in the >20 kg category. The observers considered a possible subarachnoid puncture during LS epidural in 69.7% of patients <10 kg, 16.6% on those between 10 and 20 kg, and in 11.7% of the dogs >20 kg.
CONCLUSION
The DS ended caudal to the LS space in almost 3/4 dogs in the <10 kg category, so accidental subarachnoid puncture during LS epidural is highly possible in this weight range.
Topics: Animals; Dogs; Epidural Space; Female; Injections, Epidural; Lumbosacral Region; Male; Myelography; Needles; Punctures; Subarachnoid Space
PubMed: 33614431
DOI: 10.4314/ovj.v10i4.3 -
PloS One 2022Porcine models of spinal cord injury (SCI) have an irreplaceable role in the development of experimental therapies. There is little literature regarding CT myelogram...
Porcine models of spinal cord injury (SCI) have an irreplaceable role in the development of experimental therapies. There is little literature regarding CT myelogram (CTM) techniques in swine and morphometry in miniature swine has not been established. A CT-guided method for performing myelography as well as reference values for spinal morphometry in healthy Yucatan miniature swine is lacking. The goal of this study is to describe a CT-guided method of performing CTM in a porcine model of SCI and to establish spinal morphometric reference values in mature Yucatan pigs. Six healthy, Yucatan sows, 9 months of age, weighing between 39-57.7kg, with no history of spinal disease, spinal injury, or neurologic deficits on physical exam were used in this study. CT myelography was performed in each sow under general anesthesia. CT scout images were used to guide needle placement at the L3-L4 intervertebral site. Once correct needle placement was confirmed using a 1ml test injection, a full dose of iodinated contrast (0.3ml/kg) was injected slowly over a 2-minute time period. Morphometry was performed using area measurements of the spinal cord (SC), vertebral body (VB), dural sac (DS), and vertebral canal (VC) at the mid-body and the intervertebral disc space of each spinal segment. Of the quantitative measurements, the spinal cord surface area had the widest range of values and the greatest coefficient of variance (CV) while those parameters for the vertebral canal had a low CV. Of the morphometric ratios, the DS:VC, had the lowest CV while the spinal cord ratios to DS and VC had the highest (>30). The vertebral canal surface area and the dural space: vertebral canal ratio may serve as reference values in future studies using this animal model.
Topics: Animals; Female; Myelography; Spinal Canal; Spinal Cord Injuries; Spine; Swine; Swine, Miniature; Tomography, X-Ray Computed
PubMed: 35482719
DOI: 10.1371/journal.pone.0266396 -
Canadian Medical Association Journal Mar 1969
Topics: Adult; Child, Preschool; Diagnosis; Female; Humans; Leg; Lumbar Vertebrae; Male; Myelography; Spinal Cord; Spinal Diseases; Spinal Dysraphism; Surgical Procedures, Operative; Thoracic Vertebrae
PubMed: 4889667
DOI: No ID Found -
Acta Medica Portuguesa Jan 1998Spinal arachnoiditis, an inflammatory process involving all three meningeal layers as well as the nerve roots, is a cause of persistent symptoms in 6% to 16% of... (Review)
Review
Spinal arachnoiditis, an inflammatory process involving all three meningeal layers as well as the nerve roots, is a cause of persistent symptoms in 6% to 16% of postoperative patients. Although spinal surgery is the most common antecedent associated with arachnoiditis, multiple causes have been reported, including infection, intrathecal steroids or anesthetic agents, trauma, subarachnoid hemorrhage and ionic myelographic contrast material--both oil soluble and water soluble. In the past, oil-based intrathecal contrast agents (Pantopaque) were associated with arachnoiditis especially when this material was introduced into the thecal sac and mixed with blood. Arachnoiditis is apparently rarely idiopathic. The pathogenesis of spinal arachnoiditis is similar to the repair process of serous membranes, such as the peritoneum, with a negligible inflammatory cellular exudate and a prominent fibrinous exudate. Chronic adhesive arachnoiditis of the lower spine is a myelographic diagnosis. The myelographic findings of arachnoiditis were divided into two types by Jorgensen et al. In type 1, "the empty thecal sac" appearance, there is homogeneous filling of the thecal sac with either absence of or defects involving nerve root sleeve filling. In type 2 arachnoiditis, there are localized or diffuse filling defects within the contrast column. MRI has demonstrated a sensitivity of 92% and a specificity of 100% in the diagnosis of arachnoiditis. The appearance of arachnoiditis on MRI can be assigned to three main groups. The MRI findings in group I are a conglomeration of adherent roots positioned centrally in the thecal sac. Patients in group II show roots peripherally adherent to the meninges--the so called empty sac. MRI findings in group III are a soft tissue mass within the subarachnoid space. It corresponds to the type 2 categorization defined by Jorgensen et al, where as the MRI imaging types I and II correspond to the myelographic type 1.
Topics: Arachnoiditis; Contrast Media; Humans; Lumbar Vertebrae; Myelography
PubMed: 9542180
DOI: No ID Found