Diseases of the spinal canal in children: diagnosis with noncontrast CT scans

The spinal cord and its coverings were assessed in 131 CT studies performed without intrathecal contrast material in 108 patients ages newborn to 20 years old. The spinal cord, including the conus medullaris, and the theca can be readily identified in most patients, except in the upper thoracic region. Correlation with other radiologic studies and surgery showed few false-positive and false-negative results. Of particular importance, in no patient was unnecessary surgery performed nor was necessary surgery not performed as a result of the method. The technique was a useful screening test, often sufficient alone, for the assessment of congenital disease (proved lesions included 20 tethered spinal cords, 11 congenital mass lesions, five split cords, and 11 hydromyelic cysts or syrinxes). There were nine confirmed intraspinal neoplasms. The technique was good for identifying epidural lesions; however, we recommend myelography and/or CT myelography for suspected intradural tumors because of the greater anatomic definition required. Noncontrast CT requires careful attention to technique, and may be successful only with the use of late-model, high-resolution CT units. Noncontrast CT is a rapid, cost-effective method of assessing suspected disease in the pediatric spinal canal, at least while access to MR is still limited.