MYELOGRAPHY

INDICATIONS

Demonstrate extrinsic spinal cord compression caused by a herniated

disk

Bone Fragment

Tumors

Spinal cord swelling resulting from traumatic injury

Identifying narrowing of the subarachnoid space

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MYELOGRAPHY

Is the general term applied to radiologic examination of the CNS

structures situated within the vertebral canal.

This examination is performed by introducing a contrast medium into

the subarachnoid space by spinal puncture, most commonly at the L2-13

or 13-14 interspace or at the cisterna magna between ci and the

occipital bone.

Most myelograms are perfomed on an outpatient basis, with patients

recovering for approximately 4 to 8 hours after the procedure before

being released to return home. CONTRAST MEDIA

Nonionic, water soluble contrast media

(metrizamide) provide good visualization of

nerve roots

Nonionic water soluble contrast agents such as

iohexol, iopamidol, and ioversol improvements

in nonionic contrast agents have resulted in

fewer side effects. The radiographic equipment should be checked.

Because the procedure involves aseptic technique.

The footboard should be attached to the table, and

the padded shoulder supports should be placed and

ready for adjustment to the patient's height.

The image intensifier should be locked so that it

cannot accidentally come in contact with the spinal

needle and/or sterile field. The radiographic equipment should be checked.

Because the procedure involves aseptic technique.

The footboard should be attached to the table, and

the padded shoulder supports should be placed and

ready for adjustment to the patient's height.

The image intensifier should be locked so that it

cannot accidentally come in contact with the spinal

needle and/or sterile field. PROCEDURE

1. Premedication of the patient for myelography is

rarely necessary.

2. The patient should be well hydrated, because a

non-ionic, water-soluble contrast medium is used.

3. The patient should be informed that the

angulation of the examining table will repeatedly

and acutely change

4. The patient should also be told why the head

must be maintained in a fully extended position

when the table is tilted to the Trendelenburg

position.

5. Scout images, including a cross table lateral

lumbar spine prone, are often requested

6. The physician usually withdraws CSF for

laboratory analysis and slowly injects

approximately 9 to 12 mL of contrast medium.

7. After completing the injection, the physician

removes the spinal needle.

8. Travel of the contrast medium column is

observed and controlled fluoroscopically

9. Angulation of the table allows gravity to direct the

contrast to the area of interest.

10. Spot images are taken throughout the procedure

11. Conventional radiographic studies, with the

central ray directed vertically or horizontally, may be

performed as requested by the radiologist

12. The conus projection is used to demonstrate the

conus medullaris.

MYELOGRAPHY

CONUS PROJECTION

AP

Central Ray: T12-L1.

A 24 x 30 cm (10x 12 inch) cassette is used.

Cross-table lateral radiographs are obtained

with grid-front cassettes or a stationary grid;

they must be closely collimated.

DISKOGRAPHY

Used in the investigation of internal disk lesions,

such as rupture of the nucleus pulposus, which

cannot be demonstrated by myelographic

examination

May be performed separately, or it may be

combined with myelography

Patients are given only a local anesthetic so that

they remain fully conscious

SPECT

Is a nuclear medicine procedure used for

demonstrating the brain.

It requires an IV injection of a radionuclide that

is taken up in the brain tissue and studied by a

specialized SPECT camera

This examination also assesses physiologic

function instead of anatomic detail.

PET

Uses a very specialized imaging unit in

combination with IV injection of a radionuclide

to evaluate brain function by demonstrating

metabolic activity within the brain.

PET is gaining popularity for the evaluation of

patients with suspected Alzheimer's disease,

Huntington's disease, schizophrenia, and

cocaine abuse.

MRA

Is an imaging technique that uses a

conventional MRI unit to provide images of

vessels within the body

MRA is more accurate than conventional digital

subtraction angiography in evaluating the

carotid arteries and the circle of Willis within

the brain.

MRA does not require catheterization of a

vessel or the injection of contrast material.

STEREOTACTIC SURGERY

Is used in the treatment of various diseases of the

nervous system, some of which cause loss of control

of body movement and some of which cause

intractable pain.

The most frequent use of this surgical technique

may be for the treatment of Parkinson's disease.

It is also used to obtain biopsy specimens from deep

tumors within the brain and to drain abscesses.

STEREOTACTIC AND

STEREOTROPIC SURGERY

Are terms used to denote a highly specialized

neurosurgical therapeutic technique for the

precise three-dimensional guidance of a slender

surgical instrument through a burr hole in the

cranium to a predetermined point deep within

the brain.