腰椎间盘病变的CT和脊髓造影检查以及与手术比较(附61例分析)

本文回顾分析经手术证实的腰椎间盘病变61例,51例行CT 和脊髓造影双重检查,10例单纯经CT 检查。51例中,CT 和脊髓造影均与手术符合39例,另12例中,CT 与手术符合9例,部分符合1例,假阳性2例;脊髓造影失败3例,假阴性3例,假阳性5例,部分符合1例。10例单纯CT 检查,9例与手术符合,1例部分符合。与手术比较,CT 总的正确率为95%;脊髓造影为78%。本组统计资料表明,CT 对腰椎间盘病变的诊断正确性明显高于脊髓造影。     

腰椎间盘突出症定位诊断的有关问题(附128例分析)

本文分析了128例腰椎间盘突出症定位诊断的有关问题。阐述了体征表现对定位诊断的重要意义,并对CT和脊髓造影检查在诊断中的应用作了分析。     

Side effects after lumbar iohexol myelography

Summary Side effects of iohexol lumbar myelography have been analyzed with respect to the influence of the type of radiological abnormality, sex and age in a group of 200 patients. Headache, postural headache, nausea and back/leg pain were significantly more frequent in patients without definite radiological abnormalities. Postural headache, nausea, dizziness and mental symptoms were more frequent in women, while headache, postural headache, nausea, dizziness, minor mental symptoms (i. e. anxiety or depression) and pain became less frequent with age. This pattern is similar to that reported after lumbar puncture. Young women without definite clinical signs of nerve root lesions probably have the greatest risk of experiencing side effects after iohexol lumbar myelography.     

Which factors affect reported headache incidences after lumbar myelography?

Summary Nineteen publications were reviewed and subjected to a combined statistical analysis (meta-analysis) regarding the influence of study design factors upon reported headache and total symptom incidences after lumbar iohexol myelography. A significant association was found between reported side effects on one hand and needle diameter, follow up time and the method of questioning respectively on the other. The combination of long follow-up time and specific questioning and the combination between larger diameter (20G) needles and long follow-up time, both seemed to be strong predictors for reporting high side effect incidences. Nine studies were similarly analyzed regarding the influence of early ambulation and contrast type upon reported headache incidences. Early ambulation significantly increased headache after iohexol or iopamidol lumbar myelography as opposed to metrizamide myelography.     

一种新型脊髓造影剂在椎管疾患中的应用观察

本文报告了使用Ｏｍｎｉｐａｑｕｅ造影剂进行脊髓造影６１例。经临床观察表明该造影剂不良反应占１１４％，且较轻微。副作用远较使用Ｃｏｎｒａｙ、Ｄｉｍｅｒ Ｘ和Ａｍｉｐａｑｕｅ为低。结果表明该造影剂是一种使用安全方便，显影良好，能用于全脊髓造影的较理想水溶性造影剂。本文同时介绍了造影时的注意事项     

臂丛神经节前损伤的脊髓造影多层螺旋CT诊断

目的探讨脊髓造影多层螺旋CT(CTM)诊断臂丛神经节前损伤的可行性。方法 8例臂丛神经损伤患者术前行多层螺旋CTM检查。应用曲面重组获得冠状位图像和轴位图像观察神经根损伤情况,并与手术探查结果相对照.结果多层螺旋CTM能清晰显示正常神经根的前后支。臂丛神经损伤的主要征象包括椎管内脊髓神经前后支充盈缺损的缺失、创伤性脊膜囊肿、脊髓移位。CTM表现与手术探查所见一致。结论多层螺旋CTM可清晰显示臂丛神经椎管内的前后支,对椎管内根丝的损伤能进行准确的术前诊断。     

Spinal stenosis subsequent to juvenile lumbar osteochondrosis

This paper describes eight patients with spinal stenosis associated with marked osteochondrous changes in the vertebral bodies due to juvenile lumbar osteochondrosis (Scheuermann's disease). In no case was the midsagittal or interpedicular diameter of the spinal canal indicative of bony stenosis. On the other hand, in the myelograms the sagittal diameter of the dural sac was in all cases significantly narrowed, a diagnostic sign of central spinal stenosis. Therefore, myelography should always be contemplated when osteochondrous changes are present and spinal stenosis is suspected clinically regardless of whether the spinal canal diameters are normal in plain films.     

Chronic Focal Seizure Disorder as a Manifestation of Intracranial Iophendylate

A 46-year-old woman developed focal seizures 10-15 years following iophendylate myelography. Focal epileptogenic abnormalities on electroencephalogram corresponded to the localization of residual iophendylate in the right sylvian fissure. Intracranial iophendylate may have produced chronic meningeal reaction leading to cortical irritation and a chronic seizure disorder.     

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.