CT metrizamide myelography for intraspinal and paraspinal neoplasms in infants and children.

Computed tomography (CT) metrizamide myelography is an accurate and satisfactory method for examining the spinal cord in infants and children with suspected intraspinal neoplasms. It was performed in 13 infants and children and in one adult with intra- and paraspinal neoplasms. CT metrizamide myelography in paraspinal masses provides the total geography of the mass; that is, possible intraspinal extension, as well as the paraspinal portion itself. As such, it is superior to conventional myelography.     

CT脊髓造影诊断椎管内占位病变的意义

The value of omnipaque myelography and CT myelography in 77 cases of intraspinal space-occupying lesions (51 extramedullary and 26 intramedullary confirmed by operation) was reviewed. In 69 cases the preoperative diagnosis was accurate, but not in the other 8 cases. It is not advisable according to the authors' experience to have both myelography and postmyelography CT scan done for all intraspinal space-occupying lesions. For most of the extramedullary tumors, myelography alone proved to be adequate. For intramedullary lesions the information obtained from myelography was inconclusive and postmyelography CT scan as a supplementary procedure was necessary.     

CT myelography in spinal cysticercosis

Four cases of spinal cysticercosis were found in a series of 356 cases of CNS cysticercosis studied neuroradiologically. Cysticercal cysts were seen to migrate within the spinal subarachnoid space on myelographic studies. All four patients presented initially with hydrocephalus, which supports the notion that spinal leptomeningeal cysts have migrated from an intracranial site of origin. Computed tomographic myelography (metrizamide) allowed better localization and definition of the spinal cysticercal lesions.     

CT myelography in communicating syringomyelia

Although the etiology of syringomyelia is not clearly understood, many surgical methods have been proposed for its treatment. One widely used technique in cases of communicating syringomyelia is that of posterior fossa decompression and plugging of the obex (Gardner's Operation). In this paper we present five cases of syringomyelia which were investigated using detailed myelo-computerized tomographic techniques, of which two appeared to be communicating syringomyelia and which were treated by posterior fossa decompression and obex plugging. We also discuss the place of computed tomography in the differential diagnosis of communicating syringomyelia.     

CT myelography in cervical nerve root avulsion

Computed tomographic myelography (CTM) with metrizamide was performed in six patients to delineate the CTM appearance of avulsed cervical nerve roots. Twelve cervical nerve root avulsions were found and confirmed by cervical myelography and physical examination. The CTM findings in cervical nerve root avulsion closely matched those found myelographically: outpouchings of metrizamide extending ventrolaterally from the thecal sac into the neural foramen in an expanding or "mushroom-like" manner and separated from the thecal sac proximally by a 1-2 mm thick dural plane. This CTM appearance differs from that seen in such normal variants as dilated nerve root sleeves or root diverticula. We conclude that CTM is as sensitive as myelography. In addition, it can provide useful information regarding bony fragments or contiguous soft tissue injury.     

Delayed CT myelography in spinal intramedullary metastasis

Solitary intramedullary metastasis to the spinal cord is rare and difficult to diagnose clinically. We report a case of lung carcinoma metastasizing to cervical spinal cord with an unusual feature of delayed metrizamide enhancement of the widened portion of the spinal cord. The role of CT in the diagnosis is well demonstrated in this case.     

CT myelography of spontaneous spinal epidural hematoma

A case of so-called spontaneous epidural hematoma is presented. A new constellation of myelographic and CT myelographic signs are described that may assist in localizing a mass within the spinal epidural space.     

CT after myelography in complete spinal cord blocks

In each patient (two meningiomas, two lymphomas, one spine fracture) myelography demonstrated only the lower level of the block, but not enough contrast medium leaked past the block to allow myelographic identification of the upper level. On the contrary, thanks to its high power of contrast resolution, CT immediately after myelography clearly outlined the subarachnoid space both below and above the level of the block. Descending myelography was therefore not necessary. Moreover, CT also revealed associated bone and soft tissue lesions, in two cases, providing a more accurate diagnosis. It is therefore concluded that combined myelography+CT can provide complete diagnosis of spinal blocks and any associated lesions.     

CT脊髓成像检测臂丛神经产伤的价值

目的利用CT脊髓成像对臂丛神经产伤(OBPL)病人进行检查,并大样本评价其在检测神经根损伤及鉴别神经根撕裂与神经断裂的价值。材料与方法本研究得到学术委员会的同意,医学伦理委员会认为本研究不需要病人的知情同意。选择118例头位分娩的臂丛神经产伤患儿和6例臀位分娩的臂丛神经产伤患儿作为研究对象,由一个多学科组     

臂丛神经节前损伤的脊髓造影后CT诊断

目的 评价脊髓造影后CT扫描(CTM)诊断臂丛神经节前损伤的临床应用。方法 27例臂丛神经损伤患者术前做脊髓造影后，使用GE CT／e单排螺旋CT机薄层螺旋扫描，骨重建获取影像。由高年资医生阅片做CTM影像诊断，临床臂丛神经探查术及术后随访结果作为金标准计算CTM诊断的准确性。结果 臂丛神经节前损伤CTM的直接征象是：椎管内不同节段患侧颈神经根充盈缺损连续性消失，共91个。间接征象为：(1)假性脊膜膨出：患侧硬膜囊失去正常形态，为片状高密度影替代，并可沿椎间孔向外延伸，形成神经根鞘膜囊肿，与蛛网膜下腔间有细线状分隔44个。(2)蛛网膜囊肿：硬膜囊一侧膨大变形呈囊样扩张，与蛛网膜下腔间无细线状分隔17个。(3)蛛网膜下腔不对称：一侧腔变窄，脊髓有或无移位27个。(4)硬膜囊壁不完整：一侧囊腔闭锁，脊髓表面部分裸露3个。直接征象阳性，加上间接征象之一，则诊断为臂丛神经节前损伤。27例患者CTM共检出神经根128个，诊断神经根损伤91个，正常37个。手术及随访证实真阳性84个，假阳性7个，真阴性34个，假阴性3个。CTM检查的敏感度、特异度及准确度分别为96．6％、82．9％及92．2％。结论 CTM可以清楚显示臂丛神经节前段并准确诊断其损伤和部位。