Spinal subdural metastasis A case report

Summary A case of metastasis to the thoracic spinal subdural space is reported. Metrizamide myelography showed narrowing of the upper thoracic subarachnoid space. A tumor in the spinal subdural space is unusual; only a few cases have been reported. The myelographic appearance is not specific; an epidural metastasis can produce the same myelographic picture.     

Percutaneous needle evaluation of intradural extramedullary lesions of the lumbar spine

Summary A total of eight patients in whom five intradural extramedullary lesions and three epidural lesions were present were evaluated by percutaneous needle biopsy. In four patients the level of aspiration biopsy was determined using the initial myelogram and in those patients fluoroscopic guided percutaneous needle biopsies were performed. Three of these patients had large intradural extramedullary masses (above 1 cm); one patient had an epidural lesion. Diagnostic material was obtained in all cases (medulloblastoma, astrocytoma, small cell carcinoma, adenocarcinoma). Immediate post procedure CT and clinical followup showed no complications. In three patients with small lesions (below 1 cm), post myelographic CT was used to determine the level of aspiration. Post myelographic CT showed an intradural extramedullary mass in one patient and epidural lesions in two cases. Plain CT showed a high attenuation lesion in one patient. CT guided percutaneous needle biopsies in these four patients yielded diagnostic specimens (neurofibroma, uroepithelial carcinoma, hematoma, Thorotrast deposit). Clinical follow up showed no complications. Our experience indicates that percutaneous needle biopsy of intradural extramedullary and epidural lesions of the lumbar spine is safe and efficacious. Depending upon the size of the lesions, myelography or CT can be utilized to determine the level of aspiration.     

Diagnostic value of spinal computer tomography in patients with intraspinal metastases causing complete block on myelography

The value of post-myelographic spinal computer tomography (CT) was evaluated in cancer patients with spinal metastases causing complete myelographic block. In 22 out of 25 lumbar myelographies (88%) showing complete blockade, sufficient contrast medium had leaked proximally to allow determination of the cranial limit of the metastasis on the CT-scan. It is concluded that the post-myelographic spinal CT can replace a supplementary cervical myelography in the majority of patients with epidural metastasis, causing a complete myelographic block.     

Localization of a rapid CSF leak with digital subtraction myelography

A 53-year-old woman with superficial siderosis underwent spinal MR imaging, which demonstrated a large cervicothoracic epidural fluid collection compatible with a CSF leak. Conventional and dynamic CT myelography failed to localize the dural tear because of rapid equilibration of myelographic contrast between the thecal sac and the extradural collection. The superior temporal resolution of digital subtraction myelography precisely localized the CSF leak preoperatively and led to the successful surgical correction of the dural tear.     

Epidural venography: diagnosis of herniated lumbar intervertebral disc and other disease of the epidural space.

Epidural venography is a simple and safe procedure for the diagnosis of herniated intervertebral disc and other disease of the epidural space. It is especially useful in symptomatic patients with normal or equivocal myelographic findings. The accuracy rate of positive venograms is 88.2% in this series of 58 patients. Five illustrative cases are presented.     

The role of MR imaging in evaluating metastatic spinal disease

Fifty-eight patients with suspected epidural metastases were evaluated with MR imaging. Six patients were examined on two separate occasions. MR was judged to be diagnostic in 60 of the 64 examinations. Twenty-two patients also underwent myelography. MR was as diagnostic as myelography in all cases of epidural metastases. In addition, MR offered several advantages over myelography in the evaluation of metastatic spinal disease, including demonstration of paravertebral tumor extension, identification of additional osseous metastatic lesions, and visualization of areas of spinal cord compression occurring between areas of myelographic blocks. We conclude that MR imaging is the examination of choice for evaluating suspected metastatic spinal disease.     

Intracranial hypotension due to leakage of cerebrospinal fluid: could myelography be a therapeutic option?

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid leakage. We report of a 29-year-old woman with typical symptoms in whom initial cranial MRI and CT were normal . A clinical diagnosis of SIH, but the symptoms did not resolve with conservative therapy or a lumbar epidural blood patch. Repeat MRI revealed (indirect) findings consistent with SIH but failed to directly demonstrate a cerebrospinal fluid fistula. Subsequent CT myelography revealed leakage of contrast medium into the epidural space bilaterally along the nerve roots at C3–7. Following the myelography the patient reported dramatic clinical improvement with complete resolution of symptoms. The adhesive quality of the myelographic contrast medium might have precipitated closure of the meningeal tears. Myelography may be not only of diagnostic value but also therapeutic in SIH.     

Computed tomography and myelography of the postoperative lumbar spine

Postoperative myelographic changes in the thecal sac, epidural tissues, and bony canal, as well as nerve roots, may be difficult to interpret. A series of 32 postoperative patients, all of whom had a metrizamide myelogram and subsequent lumbar computed tomogram, was reviewed to examine the ability of computed tomography to recognize abnormalities when the myelogram is equivocal or uninterpretable. Criteria to distinguish recurrent herniated disk from postoperative changes are presented, including the demonstration of mass densities similar to and in continuity with the intervertebral disk. In 12 reoperated cases, five recurrent herniated disks and two new herniated disks were diagnosed and confirmed. In 20 nonreoperated cases, no recurrent herniated disks were identified, although two new herniated disks were found at levels not believed clinically significant. Computed tomography after metrizamide myelography appears to be a reliable technique for distinguishing abnormalities in the postoperative spine.     

碘水剂椎管造影误入硬膜下腔的影像学分析

目的：观察碘水剂椎管造影误入硬膜下腔的Ｘ线造影表现,并分析了其误入原因和鉴别诊断方法。方法：从２８１例椎管造影中发现７例经脊髓造影ＣＴ（ＣＴＭ）证实有造影剂误入硬膜下腔者,进行Ｘ线征象分析,结果：发现其造影呈多样化影像表现,可产生多种假象,７例椎管造影中,假性硬膜外梗阻征５例,假性血管畸形４例,马尾神经不显影者５例等。结论：碘水剂椎管造影误入硬膜下的Ｘ线造影表现极易误诊硬膜外梗阻和血管畸形,充分认     

MR imaging of lumbar arachnoiditis

To assess the usefulness of MR in defining the changes of lumbar arachnoiditis, we reviewed retrospectively the MR, plain-film myelographic, and CT myelographic findings in 100 patients referred for evaluation of failed-back-surgery syndrome. In 11 of 12 cases of arachnoiditis demonstrated by plain-film and CT myelography, an abnormal configuration of nerve roots was seen by MR. The correlated MR and CT and plain-film myelographic changes were divided into three anatomic groups: group 1 showed conglomerations of adherent roots residing centrally within the thecal sac, group 2 demonstrated roots adherent peripherally to the meninges giving rise to an "empty-sac" appearance, and group 3 demonstrated a soft-tissue mass replacing the subarachnoid space. There was one false-negative MR study. For the diagnosis of moderate to severe arachnoiditis, we found MR to correlate excellently with CT myelographic and plain-film myelographic findings.     

Magnetic resonance imaging of an intradural spinal lipoma: a case report

A case of an extensive cervicothoracic intradural lipoma in an adolescent is presented. The myelographic, computed tomography and magnetic resonance findings are described.     

Cord shape and measurements in cervical spondylotic myelopathy and radiculopathy

A combined clinical myelographic and computed myelographic study was performed in 30 patients with cervical spondylotic myelopathy; computed myelography was also performed in 16 control patients. Good correlation was found between degree of deformity of cross-sectional shapes of the cord and the outcome of surgery, and measurements of anteroposterior diameter and area of the cord seemed helpful in this preliminary study. There was also reasonably good correlation between the clinical features when grouped according to specific tract involvement, and the pattern of deformity shown by the abnormal cross-sectional cord shapes.     

Large volume full columnar lumbar myelography

Summary A technique utilizing dilute water-soluble intrathecal contrast medium is described which allows a full columnar upright examination thereby facilitating sensitive simultaneous myelographic evaluation of the lumbar region and thoracolumbar junction.     

Primary lymphoma of the cauda equina: myelographic,CT myelographic,and MR appearance.

This case demonstrates the myelographic, CT myelographic, and MR appearance of primary lymphoma of the cauda equina. It also illustrates the utility of high-resolution CT myelography in certain lesions of the cauda equina. The authors feel that CT myelography, with its inherent ability to depict individual nerve roots and therefore any pathologic involvement as well, should be considered an adjunct to MR in imaging the cauda equina.     

Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks

In some patients with spontaneous spinal CSF leaks, leaks are numerous or tears are so large that extrathecal myelographic contrast material is seen at multiple levels during CT, making identification of their source impossible. This study introduces a dynamic CT myelographic technique that provides high temporal and spatial resolution. In this technical note, we describe the utility of this technique in four patients with challenging high-flow spinal CSF leaks.     

45例椎管肿瘤脊髓造影的分析

本文对４５例经手术和病理证实的椎管肿瘤的ｘ线表现与手术所见进行分析，认为梗阻端杯口形态和患侧蛛网膜下腔改变对诊断有重要意义。对不具特征表现的肿瘤作了扼要分析，强调多轴位观察的重要性，并指出椎管造影的局限性。     

Double discontinuous lipomyelomeningocele: CT findings

A 3-year-old girl with repaired cloacal exstrophy and two skin-covered dorsal lumbosacral masses was documented to have two lipomyelomeningoceles at noncontiguous levels of a tethered spinal cord. The clinical, radiographic, myelographic, CT, and surgical appearances are presented to illustrate the features of this extremely rare anomaly.     

腰椎管狭窄症的CTM研究

本文报告36例腰椎管狭窄症.着重对照其CTM所见与手术中发现.CTM是检查此症的理想方法.它能直接显示椎间盘、硬膜囊、神经根袖和硬膜外间隙的细微改变.     

Lumbar myelography with iohexol in outpatients: prospective multicenter evaluation of safety

A multicenter open, noncomparative evaluation of the safety of iohexol was prospectively conducted in 81 adult outpatients undergoing screen-film lumbar myelography. Iohexol (180 milligrams of iodine per milliliter) was administered via a lumbar route at a dose of 8-17 mL. Computed tomography (CT) was performed after myelography. The safety of iohexol was assessed by monitoring adverse reactions and neurologic status and by measuring vital signs and serum laboratory values. The most frequent adverse reaction was headache (16 of 81 patients [19.7%]). Twelve patients complained of a headache on the day of the myelographic procedure, and four patients reported a headache 24 hours after the procedure. Nausea or vomiting occurred in four of 81 patients (4.9%) only on the day myelography was performed. No other neurologic abnormalities were found. Iohexol produced myelographic and CT studies of good to excellent quality in all patients. This study indicates that iohexol can be employed safely in lumbar myelography of adult outpatients.     

Myelographic features of mucopolysaccharidoses: a new sign.

A new mechanism of myelopathic changes in patients with mucopolysaccharidosis is described. Two similar cases had myelographic evidence of marked concentric impingement of the cervical subarachnoid space and cord compression due to thickening of the dura. Myelography is indicated in the evaluation of these patients because surgical decompression may reverse the progressive neurological deficits.