Contrast-enhanced MRI versus myelography and contrast-enhanced CT in postdiskectomy problems

Summary The differentiation between scar tissue and disk herniation is essential in postdiskectomy problems of the lumbar spine, since reoperation on scar tissue alone is often unfavourable. Epidural scar is a vascularized tissue, and enhancement can be seen after intravenous contrast injection, allowing differentiation from avascular disk material. Ten patients who had previously undergone surgery for lumbar disk herniation and with recurrent symptoms severe enought to warrant repeat surgery were examined by myelography, magnetic resonance imaging (MRI), and computed tomography (CT) before reoperation. MRI was performed with T1- and T2-weighted sequences in sagittal and axial projections before and after intravenous contrast injection. CT scans were obtained before and during intravenous contrast infusion. Reoperation revealed scar tissue, alone or together with disk, in 9 of 10 patients. Enhancement of scar but not of disk material was observed on MRI in 8 cases, but in none on CT. No enhancement of disk was seen with either modality. The correct diagnosis was given by MRI in 9 of 10 patients and by CT in 3 of 10. CT was superior to MRI in only 1 patient, who had a bony stenosis. Myelography could not separate disk from scar in any case. In conclusion, contrast-enhanced MRI was superior to MRI without contrast, CT before and after contrast, as well as myelography in discriminating disk from scar tissue.     

Spina bifida occulta: Radiographic and operative correlation

The clinical and myelographie evaluation in 24 children with spina bifida occulta has been correlated with the operative findings. Myelograms were done using Myodil in 11 patients and Metrizamide in 13 patients. The diagnostic quality of myelograms done with Metrizamide was comparatively better. Myodil myelography failed to demonstrate diastematomyelia in one case and a durai sac in 3 cases of lipomeningomyelocele, whereas, Metrizamide failed to demonstrate a sac in one case of lipomeningomyelocele only. Worsening of the neurological status was observed in only 3 cases in whom myelography was done with Myodil. The radiographie and operative correlation has been discussed.     

颈椎病手术效果不佳原因分析(附46例报告)

从1978年5月至1992年5月手术治疗颈椎病400例,其中46例（11.5％）手术效果不满意。46例中有22例（47.8％）经再次手术治疗。作者通过手术前后脊髓造影或CT检查分析了各种因素,发现与手术有关（31例67％）为主要因素。提出年龄大、病史长、广泛椎管狭窄、多节段病变常导致脊髓横断面积减少,如有上述两种以上的综合因素,疗效会更差。     

原发性椎管内肿瘤与腰背痛（附73例临床分析）

73例原发性椎管内肿瘤回顾性研究表明，早期症状不典型，易误诊为其它原因引起的颈、肩、腰、背及坐骨神经痛。MRI检查，非离子碘水溶性造影剂脊髓造影为诊断椎管内肿瘤的重要手段。根据临床症状体征特点，针对性选择影像学检查方法，才能早期诊断治疗椎管内肿瘤。     

Lumbar myelography with iopamidol: A methodological approach to the investigation of side effects

Summary Pathophysiology of adverse reactions occurring during myelography with non-ionic contrast agents, such as iopamidol, seem related to their direct action on the nervous system. The authors try a multivariate approach, involving neurophysiological, neuropsychological and neurochemical parameters on a pilot group of twelve subjects. Any possible change in the above examinations is throughly analyzed and correlated to the postulated neurotoxic properties of contrast media.     

Combined use of spin-echo and gradient-echo MR-imaging in cervical disk disease

Summary In a prospective study we compared the diagnostic value of combined gradient-echo (GE) and spinecho (SE) MR imaging with cervical myelography in 30 patients with clinical signs and symptoms of cervical radiculopathy and/or myelopathy due to disk disease. Only patients who subsequently underwent surgery (anterior interbody approach) were included. By means of MRI the clinically relevant segment was identified in all cases, by means of myelography in all but two patients. Using both spin-echo (SE) and gradient-echo (GE) techniques it was possible to differentiate between bone tissue and disk material by MR in all but one. It is concluded that MRI-especially gradient-echo imgaging is a viable alternative to cervical myelography and can be considered as an initial diagnostic procedure for suspected cervical disk disease.     

Primitive neuroectodermal tumor in a 57-year-old man

Primitive neuroectodermal tumors are rare cerebral neoplasms previously described only in children and young adults. This report describes such a tumor arising in the left frontal lobe of a 57-year-old man. After surgical resection and radiation therapy to the primary site, the patient developed extensive central nervous system metastases that led to his death. The histopathologic, radiographic, and clinical features of this case suggest that future therapeutic protocols for primitive neuroectodermal tumor should be similar to those for childhood medulloblastoma or neuroblastoma.     

Aseptic meningoencephalitis following iohexol myelography

We report a case of aseptic meningoencephalitis complicating iohexol myelography and compare this case with previous reports of neurotoxicity from intrathecal contrast media.     

116例腰椎管狭窄症临床分析

本文报告手术治疗的116例腰椎管狭窄症。以脊髓造影改变为主要诊断依据,将其分为5种类型、手术根据狭窄类型、部位和程度采用全椎板、半椎板切除或椎板开窗。强调侧隐窝充分减压。79例术后随访1～9年,痊愈达62％,良好为20.3％。着重讨论了本症的诊断及手术要点。     

AF复位固定术中造影对判断椎管减压的意义

目的分析AF系统治疗胸腰段爆裂型骨折术中造影的意义。方法总结应用AF系统对伤椎进行复位及内固定,术中结合椎管造影决定是否直接开放椎管减压的28例病例,从影像学、手术操作过程及神经功能恢复等方面分析疗效。结果伤椎高度从46.1%恢复到正常的94.2%,水平移位完全恢复,Cobb氏角由术前21.6°恢复到术后3.7°。椎管受压程度:删除椎管开放减压的5例病例,受压面积从术前41%恢复到术后16%,受压的矢状径从术前54.7%恢复到80.8%。脊髓神经功能恢复依照Frankel分级标准有1级以上改善。结论AF系统对胸腰段爆裂型骨折治疗效果良好,对其合理选用并结合术中造影可以达到优于其它固定方法的效果。