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Myelography: modern technique and indications.

Stuart R Pomerantz1

  • 1Department of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.

Handbook of Clinical Neurology
|July 20, 2016
PubMed
Summary

Myelography, intrathecal contrast imaging, remains vital for spinal canal pathology when MRI is unsuitable. This technique is crucial for diagnosing spinal stenosis, CSF leaks, and brachial plexus injuries.

Keywords:
CSF leakbrachial plexus injurylumbar puncture arachnoiditismyelographyradiotherapy treatment planningspinal stenosis

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Area of Science:

  • Radiology
  • Neurology
  • Medical Imaging

Background:

  • Myelography involves intrathecal contrast media for spinal canal imaging.
  • The technique has evolved over 90 years with safer agents and advanced imaging (CT, MRI).
  • MRI's advent has reduced routine myelography use due to superior soft-tissue contrast and non-invasiveness.

Purpose of the Study:

  • To review modern myelographic procedural techniques.
  • To discuss the current indications for myelography.
  • To highlight myelography's continued importance in specific clinical scenarios.

Main Methods:

  • Instillation of intrathecal contrast media.
  • Integration with advanced imaging modalities like computed tomography (CT) and magnetic resonance imaging (MRI).
  • Plain radiographic projections.

Main Results:

  • Myelography is still critical for spinal stenosis when MRI is contraindicated or nondiagnostic.
  • It is the study of choice for brachial plexus injury.
  • It is essential for radiation therapy planning and cerebrospinal fluid (CSF) leak detection.

Conclusions:

  • Despite MRI advancements, myelography retains essential roles in diagnosing specific spinal pathologies.
  • Modern myelography techniques ensure its continued utility in neuroimaging.
  • Understanding current indications is key for effective patient management.