腰椎间盘突出症非离子型造影剂脊髓造影定位诊断探讨

腰椎间盘突出的脊髓造影诊断是一种重要的影像诊断方法。特别是非离子型造影剂如Omniopaque,Iopamiro 和Isovist 的问世,使脊髓造影的副反应和并发症明显减少,影像质量显著提高。脊髓一神经结构清晰显示,为腰椎间盘突出精确的定位诊断提供了基础。为此,我们将定位诊断分为三个内容,即定突出平面、突出方向和神经根受压部位。本组56例经手术证实的定位准确率分别达到94.6%,94.6%和82.1%。定性准确率为96.4%。     

Quantitative measurements of the spinal cord and canal by MR imaging and myelography

There is a large individual variation in human spinal cord and canal size, even in patients of different series studied by the same modality, and no authorized standard method has been established. A comparative study of sagittal diameters of the cervical spinal cord and canal using myelography and MRI is presented. The purposes of this paper are (a) to establish the correction factor (CF) needed for quantitative comparison of the two imaging modalities, and (b) to determine the different factors that may modify the measurement of these diameters. We studied 45 patients with clinical findings compatible with cervical spondilotic myelopathy. In our experience, the CF for accurate correlation of MRI and myelography measurements is 1.32 and depends almost entirely on the radiographic geometry of the myelographic procedure. In addition, there is a variability in the group of MRI results due to imprecision of the pressure-pad measuring/input device of the instrument itself and the sequence performed. Received 31 December 1996; Revision received 4 November 1997; Accepted 5 November 1997     

Fibrosis of the dura mater. A cause of "failed back" syndrome

A patient is presented in which a persistent deformity of the dural sac was caused by fibrosis of the dura mater. Postmortem documentation is presented.     

Percutaneous puncture of spinal cysts in the diagnosis and therapy of syringomyelia and cystic tumors

Summary The experience with percutaneous puncture of intraspinal cystic lesions is reported in four cases: an extradural cyst demonstrated with air, a spinal cord tumor with lipiodol and two cases of syringomyelia with metrizamide. Percutaneous puncture of cystic lesions makes possible an accurate delineation of the lesion and a histological approach through biochemical and cytological analysis of the aspirated cystic fluid, while aspiration of the fluid of cystic tumors decompresses the spinal cord and thus plays a therapeutic role.     

Importance of early radiologic diagnosis of congenital anomalies of the spine

Manifest or occult spinal dysraphism in the absence of neurological symptoms is likely to remain undetected. Therefore, accurate and early diagnosis of such underlying anomalies is of prime importance for early surgical intervention in order to avoid late irreparable damage. During a period of just over 1 year, 17 such cases of spinal congenital anomalies were diagnosed by myelography with metrizamide and computed tomography-myelography. There were 16 cases of tethered cord, six with myelomeningocele, two with diastematomyelia, two with a split spinal cord, three with a lipoma, and the remaining three with vertebral anomalies. Scoliosis was present in 60%, weakness of both legs in 45%, and asymmetry of the feet in 25%. Some of these patients were initially brought to the orthopedic department for corrective surgery before undergoing a complete neurological evaluation; thus the radiologist was acting as the link between patient and neurosurgeon. Clinical experience has shown that surgical treatment can be successful and can thereby obviate further progression of neurological symptoms.     

Solitary osteochondroma with spinal cord compression

Osteochondromas are unusual in the spine, and they are very rarely present with compression of the spinal cord. Two cases are reported with delineation of the tumor by metrizamide myelography and computed tomography.     

Haemorrhagic necrosis of the grey matter of the spinal cord due to accidental injection of iopamidol in a patient with multiple neurofibromas; a clinico-pathological study

Summary Cervical laminectomy was performed in a 34-year-old man with multiple spinal neurofibromas because of a slowly progressive medullary compression. Four weeks later a rapid deterioration necessitated iopamidol myelography by left lateral cervical puncture at C2 level. Despite the establishment of adequate spinal fluid contact, resulting in imaging of the subarachnoid space, part of the contrast medium entered the spinal cord, thus delineating a syrinx from the upper cervical extending to the upper thoracic level. After the puncture the patient developed triplegia, involving the left arm and both legs and a paresis of the right arm. He died from aspiration pneumonia. Autopsy revealed haemorrhagic necrosis of the spinal grey matter. This adverse effect of myelography is argued to have been conditioned by the extreme immobility and displacement of the spinal cord due to the presence of multiple neurofibromas. The deterioration four weeks after the operation was probably caused by a further compression of the spinal cord.     

Myelography in lumboperitoneal shunts

Summary Lumboperitoneal shunts have become more prevalent since the introduction of Silastic tubing. One disadvantage of this procedure is the difficulty in obtaining a subsequent myelogram. In the presence of a lumboperitoneal shunt, it may be advisable to modify the usual technique in obtaining a satisfactory myelogram. Use a low lumber puncture for a lumbar study, a C_1-2 puncture for the cervical and thoracic regions, and use metrizamide to avoid the potential problem of Pantopaque in the peritoneal cavity.     

Iopamidol (B 15000), a nonionic water-soluble contrast medium for neuroradiology

Summary The results of trials with a new nonionic contrast medium (Iopamidol, or B 15000) for radiological exploration of the spinal canal are presented: the innocuousness of Iopamidol and the uncommonly high iodine concentration afforded by it are emphasized. Thus, better diagnostic results are obtained with appreciable reduction of patient discomfort.     

Pantopaque pulmonary embolism following myelography

Summary A patient with radiological evidence of Pantopaque embolism in the lungs following myelography is reported.