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The radiological evaluation of the child with a myelomeningocele
1Department of Radiology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL 60614.
Insights
This study proposes a diagnostic radiology model for evaluating neurological issues in children with myelomeningocele. Magnetic resonance imaging (MRI) is optimal for spine and posterior fossa, with other methods aiding diagnosis when MRI is insufficient.
Area of Science:
- Pediatric Radiology
- Neuroscience
- Medical Imaging
Background:
- Myelomeningocele is a complex congenital condition requiring accurate neurological assessment.
- Radiological evaluation is crucial for understanding the neurological sequelae in affected children.
Purpose of the Study:
- To develop a diagnostic radiological model for evaluating neurological problems in pediatric myelomeningocele patients.
- To determine the optimal imaging modalities for assessing various neurological complications.
Main Methods:
- Retrospective analysis of radiological findings in 755 children with myelomeningocele.
- Utilized magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, myelography, and plain radiographs.
- Correlated imaging findings with clinical symptoms.
Main Results:
- MRI demonstrated superiority in evaluating the posterior fossa and entire spine.
- CT and ultrasound are valuable for assessing ventricular size.
- Advanced imaging like ultrasound and water-soluble myelography with CT are necessary for subtle spinal cord abnormalities (tethering, infarction, cysts, diastematomyelia) when MRI is inconclusive.
- Water-soluble myelography with CT is indicated for severe scoliosis obscuring MRI visualization of the spinal cord.
Conclusions:
- A comprehensive radiological model integrating multiple imaging modalities is essential for accurate neurological assessment in myelomeningocele.
- The choice of imaging modality should be tailored to the specific clinical presentation and suspected complication.
- MRI is a primary tool, but its limitations necessitate complementary techniques for complete evaluation.
Abstract:
Seven hundred fifty-five children with myelomeningoceles were evaluated radiologically at the Children's Memorial Hospital in Chicago. From our material, we propose a diagnostic radiologic model to accurately evaluate the neurological problems in the myelomeningocele child. This model is based on the clinical symptoms in these children and the radiologic modalities of magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, myelography, and plain radiographs. We found MRI to be the best modality to evaluate the posterior fossa and total spine. Computed tomography and ultrasound are used to evaluate ventricular size. At times MRI may not adequately diagnose subtle cases of tethering of the spinal cord, cord infarction, arachnoid cysts, or diastematomyelia. In these cases, further evaluation may be necessary with real time ultrasound to look at cord pulsations and water soluble myelography with follow through CT to differentiate cord infarction, arachnoid cyst, localized hydromyelia, or diastematomyelia. If MRI is not adequate to completely visualize the cord because of the severe nature of the scoliosis, then water soluble myelography with CT is indicated.