Main description:

To study the phenomenon of disease without books is to sail an uncharted sea. While to study books without patients is not to go to sea at all. Sir William Osler Over a period of five years, the impact of computed tomography (CT) on pediatric neuroradiology at The Hospital for Sick Children, Toronto, has been, as expected, in the assessment of the brain and its abnormalities. Concurrent with this application was the introduction of Metrizamide (Amipaque, Nyegaard & Co. AS, Oslo, Norway), a water-soluble CSF contrast medium, used primarily as a myelog raphic agent. The subsequent application of the wide-aperture CT scanner to imaging of the spine in children provided remarkable advances in the clinical management of spinal disease since CT is far more accurate than standard neuroradiologic procedures. The com bination of CT and Metrizamide added a further dimension to the imaging of the spine and of the spinal cord and nerve roots. Such spinal CT and CT Metrizamide myelography in children now occupies a significant part of day-to-day pediatric neuroradiologic practice. They have dramatically enhanced our understanding of the normal anatomy and pathologic entities of the spine and its contents in children; have altered and improved the surgical management of such diseases; and have significantly improved the clinical manage ment of such diseases in the specialties of neurosurgery, orthopedic surgery, and genito-urinary surgery . .

Contents:

1 Introduction.- References.- 2 Technique.- Sedation and Anesthesia.- Puncture of the Thecal Sac.- Metrizamide Injection.- Positioning of the Patient for CT.- Observation of the Patient.- Intravenous Contrast Medium Injection.- Computed Tomographic Technique.- Localization of the CT Section.- 1. Conventional radiograph with radiopaque ruler.- 2. Digital radiography ("Scout view").- Exposure Data and Radiation Dose.- The Image.- Window Setting.- High Spatial Resolution and Contrast Discrimination (ReView).- Image Reconstruction to Planes Angled to the Initial Transaxial Section.- Direct Coronal Sections.- References.- 3 The Normal Spine and Spinal Cord.- The Spinal Column and Canal.- Shape of the Spinal Column.- Vertebral Ossification.- The Cartilagenous Junctions.- The Spinal Canal.- The Dural Sac and Spinal Cord.- Shape.- Size.- Attenuation Values.- References.- 4 Spinal Dysraphism.- Widened Dural Sac.- Tethered Cord Syndrome.- Meningocele.- Syringohydromyelia.- Diastematomyelia.- Neurenteric Cyst.- Developmental Mass Lesions.- Dermoid.- Teratoma.- Lipoma.- Arachnoid Cyst.- Chiari Malformation.- The Complexity of the Dysraphic State.- References.- 5 Neoplasms.- Primary Neoplasms of Neural Origin.- Astrocytoma.- Ependymoma.- Neurofibroma, Neurofibrosarcoma.- Neuroblastoma, Ganglioneuroma.- Primary Neoplasms of the Spinal Column and Paraspinal Structures.- Metastases.- Enhancement of Lesions After Intravenous Contrast Medium Injection.- References.- 6 Trauma, Infection, and Inflammation.- Trauma.- Fractures.- Herniation of Intervertebral Discs.- Avulsion of the Vertebral Apophysis.- Spondylolysis and Spondylolisthesis.- Avulsion of the Nerve Roots.- Intramedullary Hematomas.- Cord Atrophy.- Infection and Inflammation.- Osteomyelitis.- Intraspinal Infections.- Transverse Myelitis.- Arachnoiditis.- References.- 7 Musculoskeletal Disorders and Dysplasias Involving the Spinal Column and Canal.- Spinal Stenosis.- Localized Narrowing of the Spinal Canal.- Widened Spinal Canal.- Neurofibromatosis.- References.- 8 Scoliosis.- Conventional Radiography.- Computed Tomography.- References.- 9 The Diagnostic Accuracy of CTMM.- Comparison Between Information Provided by MM and CTMM.- Dysraphism.- Neoplastic Lesions.- Trauma, Infection, and Inflammation.- Musculoskeletal Dysplasias and Miscellaneous Lesions.- Appropriate Areas to be Scanned.- Comparison Between Findings at CTMM and at Operation or Autopsy.- Conclusion.- References.- 10 Adverse Effects of the Examination.- General and CNS Effects.- Immediate Effects.- Late Effects.- Local Damage Caused by Lumbar Puncture and Metrizamide Injection.- References.- 11 Diagnostic Protocols.- Present Protocols.- Dysraphism.- Neoplastic Lesions.- Trauma, Infection, and Inflammation.- Musculoskeletal Dysplasias and Miscellaneous Lesions.- Future Protocols.- Complete Reference List.