Download PDF
Neuroradiologie Scan 2022; 12(03): 211-229
DOI: 10.1055/a-1673-1029
CME-Fortbildung

CT-Myelografie: klinische Indikationen und Bildgebungsbefunde

CT myelography: clinical indications and imaging findings
Dhruv M. Patel
,
Brent D. Weinberg
,
Michael J. Hoch
› Further Information
Also available at
    Permissions and Reprints

Trotz der unbestreitbaren Vorteile der MRT bleibt die CT-Myelografie eine wichtige diagnostische Methode zur Darstellung der Wirbelsäule, etwa bei Lokalisation einer Erkrankung im intraduralen extramedullären Raum oder wenn aus patientenbezogenen Gründen die MRT nicht eingesetzt werden kann. Deshalb gehen die Autoren auf einige Indikationen der CT-Myelografie ein und zeigen ihren Nutzen bei verschiedenen Wirbelsäulenerkrankungen.

Abstract

CT myelography is an important imaging modality that combines the advantages of myelography and the high resolution of CT. It provides a detailed delineation of pathologic spine conditions, especially those involving the thecal sac and its contents. However, the role of CT myelography has dramatically and appropriately decreased with the advent of MRT, which provides a noninvasive method to demonstrate pathologic spine conditions with high signal intensity in soft tissues. At the present time, CT myelography is often performed in patients who require evaluation of the thecal sac but have a contraindication to undergoing MRI. However, there remain many situations in which CT myelography is indicated and plays a critical role in patient treatment. The authors review common and uncommon indications for CT myelography and demonstrate various pathologic conditions in which CT myelography plays a vital role in patient treatment in this modern era of MRI.

Kernaussagen

  • Mit der CT-Myelografie lassen sich die Prozesse, die das Rückenmark, die Nervenwurzeln und den Duralsack berühren, einengen oder verschieben, am besten darstellen.

  • Große Vorteile der CT-Myelografie gegenüber der MRT sind ihre Dynamik und die Möglichkeit, verzögerte Bilder aufzunehmen.

  • Gegenwärtig wird die CT-Myelografie häufig bei Patienten und Patientinnen durchgeführt, die eine Beurteilung des Duralsacks benötigen, bei denen jedoch eine Kontraindikation für eine MRT besteht.

  • Die Möglichkeit, die zu untersuchende Person während der CT-Myelografie auf verschiedene Weise zu lagern, ist ein weiterer Vorteil gegenüber der MRT.

  • Die Extravasation des intrathekalen Kontrastmittels in den extrathekalen Raum hilft, die genaue Austrittsstelle zu identifizieren.

  • Obwohl die MRT insgesamt eine bessere Kontrastauflösung bietet, sorgt das intrathekale Kontrastmittel in der CT-Myelografie für eine hervorragende Kontrastauflösung zwischen den Liquorräumen und dem angrenzenden Weichgewebe.

Schlüsselwörter

CT-Myelografie - Wirbelsäule - Indikationen - Bildgebungsbefunde

Keywords

CT myelography - spine, indications - imaging findings


Publication History

Article published online:
02 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Pomerantz SR. Myelography: modern technique and indications. Handb Clin Neurol 2016; 135: 193-208
    CrossrefPubMedGoogle Scholar
  • 2 Kretzschmar K. Degenerative diseases of the spine. The role of myelography and myelo-CT. Eur J Radiol 1998; 27: 229-234
    CrossrefPubMedGoogle Scholar
  • 3 Harreld JH, McMenamy JM, Toomay SM. et al. Myelography: a primer. Curr Probl Diagn Radiol 2011; 40: 149-157
    CrossrefPubMedGoogle Scholar
  • 4 Englund J. Lumbar spinal stenosis. Curr Sports Med Rep 2007; 6: 50-55
    PubMedGoogle Scholar
  • 5 Menon SK, Onyia CU. A short review on a complication of lumbar spine surgery: CSF leak. Clin Neurol Neurosurg 2015; 139: 248-251
    CrossrefPubMedGoogle Scholar
  • 6 Reardon MA, Raghavan P, Carpenter-Bailey K. et al. Dorsal thoracic arachnoid web and the „scalpel sign“: a distinct clinical-radiologic entity. AJNR Am J Neuroradiol 2013; 34: 1104-1110
    CrossrefPubMedGoogle Scholar
  • 7 Hagerty SE, Steinmetz BD, Furman MB. Lumbar myelography. Furman MB. Atlas of image-guided spinal procedures. 2. Philadelphia, Pa: Elsevier; 2018: 237-248
    Google Scholar
  • 8 Sudha SP, Gopalakrishnan MS, Saravanan K. The role of CT myelography in sparing the spinal cord during definitive radiotherapy in vertebral hemangioma. J Appl Clin Med Phys 2017; 18: 174-177
    CrossrefPubMedGoogle Scholar
  • 9 Redmond KJ, Lo SS, Soltys SG. et al. Consensus guidelines for postoperative stereotactic body radiation therapy for spinal metastases: results of an international survey. J Neurosurg Spine 2017; 26: 299-306
    CrossrefPubMedGoogle Scholar
  • 10 Krol G, Sze G, Malkin M. et al. MR of cranial and spinal meningeal carcinomatosis: comparison with CT and myelography. AJR Am J Roentgenol 1988; 151: 583-588
    CrossrefPubMedGoogle Scholar
  • 11 Hughes G, Ugokwe K, Benzel EC. A review of spinal arachnoid cysts. Cleve Clin J Med 2008; 75: 311-315
    CrossrefPubMedGoogle Scholar
  • 12 Velz J, Fierstra J, Regli L. et al. Spontaneous spinal subarachnoid hemorrhage with development of an arachnoid cyst: a case report and review of the literature. World Neurosurg 2018; 119: 374-380
    CrossrefPubMedGoogle Scholar
  • 13 Diyora B, Bhende B, Dhall G. et al. Ventral craniovertebral junction arachnoid cyst in an elderly patient: a case report of a unique occurrence at extremes of age. World Neurosurg 2019; 122: 577-582
    CrossrefPubMedGoogle Scholar
  • 14 Ospina Moreno C, Vela Marín AC, Castán Senar A. et al. Radiological diagnosis of spinal arachnoid cysts: a pictorial essay. J Med Imaging Radiat Oncol 2016; 60: 632-638
    CrossrefPubMedGoogle Scholar
  • 15 Silbergleit R, Brunberg JA, Patel SC. et al. Imaging of spinal intradural arachnoid cysts: MRI, myelography and CT. Neuroradiology 1998; 40: 664-668
    CrossrefPubMedGoogle Scholar
  • 16 Ben Ali H, Hamilton P, Zygmunt S. et al. Spinal arachnoid web: a review article. J Spine Surg 2018; 4: 446-450
    CrossrefPubMedGoogle Scholar
  • 17 Brooks BS, Duvall ER, el Gammal T. et al. Neuroimaging features of neurenteric cysts: analysis of nine cases and review of the literature. AJNR Am J Neuroradiol 1993; 14: 735-746
    PubMedGoogle Scholar
  • 18 Savage JJ, Casey JN, McNeill IT. et al. Neurenteric cysts of the spine. J Craniovertebr Junction Spine 2010; 1: 58-63
    CrossrefPubMedGoogle Scholar
  • 19 Visvanathan V, Crowther J, Taylor W. Neurenteric cyst presenting with stridor and dysphagia: case report and literature review. Scott Med J 2015; 60: e4-e7
    CrossrefPubMedGoogle Scholar
  • 20 Garg N, Sampath S, Yasha TC. et al. Is total excision of spinal neurenteric cysts possible?. Br J Neurosurg 2008; 22 : 241-251
    CrossrefPubMedGoogle Scholar
  • 21 Mohindra S, Gupta R, Bal A. Intra-dural spinal arachnoid cysts: a short series of 10 patients. Br J Neurosurg 2010; 24: 679-683
    CrossrefPubMedGoogle Scholar
  • 22 Aiyer R, El-Sherif Y, Voutsinas L. Dorsal thoracic arachnoid web presenting as neuropathic pain: „scalpel“ sign found on MRI. Neuroradiol J 2016; 29: 393-395
    CrossrefPubMedGoogle Scholar
  • 23 Dolan RA. Spinal adhesive arachnoiditis. Surg Neurol 1993; 39: 479-484
    CrossrefPubMedGoogle Scholar
  • 24 Deshmukh VR. Arachnoiditis. Aminoff MJ, Daroff RB. Encyclopedia of the neurological sciences. 2. Oxford, England: Academic Press; 2014: 258-259
    Google Scholar
  • 25 Anderson TL, Morris JM, Wald JT. et al. Imaging appearance of advanced chronic adhesive arachnoiditis: a retrospective review. AJR Am J Roentgenol 2017; 209: 648-655
    CrossrefPubMedGoogle Scholar
  • 26 Schievink WI, Wasserstein P, Maya MM. Intraspinal hemorrhage in spontaneous intracranial hypotension: link to superficial siderosis? Report of 2 cases. J Neurosurg Spine 2016; 24: 454-456
    CrossrefPubMedGoogle Scholar
  • 27 Kumar N. Neuroimaging in superficial siderosis: an in-depth look. AJNR Am J Neuroradiol 2010; 31: 5-14
    CrossrefPubMedGoogle Scholar
  • 28 Yoshida H, Takai K, Taniguchi M. Leakage detection on CT myelography for targeted epidural blood patch in spontaneous cerebrospinal fluid leaks: calcified or ossified spinal lesions ventral to the thecal sac. J Neurosurg Spine 2014; 21: 432-441
    CrossrefPubMedGoogle Scholar
  • 29 Dobrocky T, Mosimann PJ, Zibold F. et al. Cryptogenic cerebrospinal fluid leaks in spontaneous intracranial hypotension: role of dynamic CT myelography. Radiology 2018; 289: 766-772
    CrossrefPubMedGoogle Scholar
  • 30 Luetmer PH, Mokri B. Dynamic CT myelography: a technique for localizing high-flow spinal cerebrospinal fluid leaks. AJNR Am J Neuroradiol 2003; 24: 1711-1714
    PubMedGoogle Scholar
  • 31 Davidson B, Nassiri F, Mansouri A. et al. Spontaneous intracranial hypotension: a review and introduction of an algorithm for management. World Neurosurg 2017; 101: 343-349
    CrossrefPubMedGoogle Scholar
  • 32 Williams EC, Buchbinder BR, Ahmed S. et al. Spontaneous intracranial hypotension: presentation, diagnosis, and treatment. Anesthesiology 2014; 121: 1327-1333
    CrossrefPubMedGoogle Scholar
  • 33 Farb RI, Nicholson PJ, Peng PW. et al. Spontaneous intracranial hypotension: a systematic imaging approach for CSF leak localization and management based on MRI and digital subtraction myelography. AJNR Am J Neuroradiol 2019; 40: 745-753
    PubMedGoogle Scholar
  • 34 Kim S, Hoch MJ, Patel S. et al. Evaluation and treatment of spontaneous intracranial hypotension. Interdiscip Neurosurg 2019; 18: 100517
    CrossrefGoogle Scholar
  • 35 Kranz PG, Amrhein TJ, Schievink WI. et al. The „hyperdense paraspinal vein“ sign: a marker of CSF-venous fistula. AJNR Am J Neuroradiol 2016; 37: 1379-1381
    CrossrefPubMedGoogle Scholar
  • 36 Akbar JJ, Luetmer PH, Schwartz KM. et al. The role of MR myelography with intrathecal gadolinium in localization of spinal CSF leaks in patients with spontaneous intracranial hypotension. AJNR Am J Neuroradiol 2012; 33: 535-540
    CrossrefPubMedGoogle Scholar
  • 37 Ulus A, Kuruoglu E, Ozdemir SM. et al. CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites – case report and review of the literature. Childs Nerv Syst 2012; 28: 1843-1848
    CrossrefPubMedGoogle Scholar
  • 38 Thakkar RS, Malloy 4th JP, Thakkar SC. et al. Imaging the postoperative spine. Radiol Clin North Am 2012; 50 : 731-747
    CrossrefPubMedGoogle Scholar
  • 39 Bellini M, Ferrara M, Grazzini I. et al. Neuroimaging of the postoperative spine. Magn Reson Imaging Clin N Am 2016; 24: 601-620
    CrossrefPubMedGoogle Scholar
  • 40 Tse R, Nixon JN, Iyer RS. et al. The diagnostic value of CT myelography, MR myelography, and both in neonatal brachial plexus palsy. AJNR Am J Neuroradiol 2014; 35: 1425-1432
    CrossrefPubMedGoogle Scholar
  • 41 Walker AT, Chaloupka JC, de Lotbiniere AC. et al. Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma. AJR Am J Roentgenol 1996; 167: 1283-1287
    CrossrefPubMedGoogle Scholar
  • 42 Hashimoto T, Mitomo M, Hirabuki N. et al. Nerve root avulsion of birth palsy: comparison of myelography with CT myelography and somatosensory evoked potential. Radiology 1991; 178: 841-845
    CrossrefPubMedGoogle Scholar
  • 43 Vielvoye GJ, Hoffmann CFE. Neuroradiological investigations in cervical root avulsion. Clin Neurol Neurosurg 1993; 95 : S36-S38
    CrossrefPubMedGoogle Scholar
  • 44 Mahmud T, Basu D, Dyson PH. Crystal arthropathy of the lumbar spine: a series of six cases and a review of the literature. J Bone Joint Surg Br 2005; 87: 513-517
    CrossrefPubMedGoogle Scholar
  • 45 Lam H, Cheung K, Law S. et al. Crystal arthropathy of the lumbar spine: a report of 4 cases. J Orthop Surg (Hong Kong) 2007; 15: 94-101
    CrossrefPubMedGoogle Scholar
  • 46 Sekijima Y, Yoshida T, Ikeda S. CPPD crystal deposition disease of the cervical spine: a common cause of acute neck pain encountered in the neurology department. J Neurol Sci 2010; 296: 79-82
    CrossrefPubMedGoogle Scholar
  • 47 Fujishiro T, Nabeshima Y, Yasui S. et al. Pseudogout attack of the lumbar facet joint: a case report. Spine 2002; 27: E396-E398
    CrossrefPubMedGoogle Scholar
  • 48 Mikhael MM, Chioffe MA, Shapiro GS. Calcium pyrophosphate dihydrate crystal deposition disease (pseudogout) of lumbar spine mimicking osteomyelitis-discitis with epidural phlegmon. Am J Orthop 2013; 42 : E64-E67
    PubMedGoogle Scholar
  • 49 Epstein N. Diagnosis and surgical management of cervical ossification of the posterior longitudinal ligament. Spine J 2002; 2: 436-449
    CrossrefPubMedGoogle Scholar
  • 50 Ehara S, Shimamura T, Nakamura R. et al. Paravertebral ligamentous ossification: DISH, OPLL and OLF. Eur J Radiol 1998; 27: 196-205
    CrossrefPubMedGoogle Scholar
  • 51 Yoshii T, Yamada T, Hirai T. et al. Dynamic changes in spinal cord compression by cervical ossification of the posterior longitudinal ligament evaluated by kinematic computed tomography myelography. Spine 2014; 39: 113-119
    CrossrefPubMedGoogle Scholar
  • 52 Ito K, Yukawa Y, Machino M. et al. Spinal cord cross-sectional area during flexion and extension in the patients with cervical ossification of posterior longitudinal ligament. Eur Spine J 2013; 22: 2564-2568
    CrossrefPubMedGoogle Scholar