metrizamide and Fractures--Bone

High-resolution computed tomography (CT) is superior to other imaging modalities in assessing the extent and degree of spinal fractures. The determination of bone fragments within the spinal canal and the detection of posterior neural arch damage are major advantages offered by computed tomography. The addition of intrathecal contrast allows proper assessment of the oftentimes confusing neurologic picture. Plain roentgenograms of the spine are only the initial diagnostic examinations of spinal fractures. Roentgenograms in conjunction with high-resolution CT, performed with or without intrathecal contrast, provide the best evaluation of thoracolumbar spinal fractures.

Topics: Fractures, Bone; Humans; Joint Dislocations; Lumbar Vertebrae; Metrizamide; Myelography; Thoracic Vertebrae; Tomography, X-Ray Computed

Computed tomography is an extremely valuable adjunct to the evaluation of the cervical spine and spinal cord. When combined with intrathecal metrizamide enhancement and with computer reformatted images in sagittal and coronal planes, CT is a thorough diagnostic modality that can be applied to congenital/developmental, degenerative, and trauma-induced abnormalities. Its major deficiency is the potential to miss defects that are oriented in the transverse plane because of partial volume averaging of adjacent surrounding bone. CT scanning of the cervical spine has been used sparingly to date, probably because available scanners are used for higher-priority demands. However, anecdotal information in the literature document the value of CT in evaluations of the cervical spine, intervertebral disks, neural foramina, and spinal cord. In the future, magnetic resonance scanners may shift some of the imaging burden away from x-ray CT. More widespread use of CT for evaluation of cervical radiculopathies and myelopathy may then occur.

Topics: Adult; Cervical Vertebrae; Child; Fractures, Bone; Humans; Intervertebral Disc Displacement; Metrizamide; Myelography; Spinal Diseases; Spinal Stenosis; Tomography, X-Ray Computed

Dynamic sequential computed tomographic scanning with automatic table incrementation uses low milliampere-second technique to eliminate tube cooling delays between scanning slices and, thus, markedly shortens examination times. A total of 25 patients with spinal column trauma involving 28 levels were studied with dynamic scans and retrospectively reviewed. Dynamic studies were considerably faster than conventional spine examinations and yielded reliable diagnoses. Bone disruption and subluxation was accurately evaluated, and the use of intrathecal metrizamide in low doses allowed direct visualization of spinal cord or radicular compromise. Multiplanar image reformation was aided by the dynamic incrementation technique, since motion between slices (and the resulting misregistration artifact on image reformation) was minimized. A phantom was devised to test spatial resolution of computed tomography for objects 1--3 mm in size and disclosed minimal differences for dynamic and conventional computed tomographic techniques in resolving medium-to-high--contrast objects.

Topics: Adult; Evaluation Studies as Topic; Female; Fractures, Bone; Humans; Injections, Spinal; Male; Metrizamide; Retrospective Studies; Spinal Canal; Spinal Cord; Spinal Cord Injuries; Spinal Injuries; Time Factors; Tomography, X-Ray Computed