Film Review and Interpretation

Edited & Presented by ;Hussien A.B ALI DINAR. MscAssistant professor (National university) Reporting Sonographer (PHC)

Myelography

• General term applied to the radiologic examination of the CNS structures situated in the vertebral canal

• Requires contrast introduction into the subarachnoid space by spinal puncture

• Puncture made at L2-L3 or L3-L4 space

– May also be introduced into cisterna magna at C1 and occipital bone

Myelography

• Membranes that enclose the brain and spinal cord

– Dura Mater- outer layer

– Arachnoid = middle layer

– Pia mater = innermost layer

– Subarachnoid space = wide space between arachnoid and pia mater

Myelography

Indication

• spinal cord tumor

• Cysts

• Spinal nerve root injury

• compression of the spinal cord by a herniated disc.

Contra-indication

• Blood in the CSF

• Increase intracranial pressure

• Decreased platelet count, or patients on anticoagulation

• Arachnoditis

Myelography

• Contrast is generally water-soluble, nonionic, iodinated medium

OMNIPAQUE

ISOVUE

Puncture made at L2-L3 or L3-L4 space and Cisterna Magna

Spinal needle injection

MYELOGRAM WITH CONTRAST

Prone & Lateral Flexion

• Prone

– Pillow under abdomen for flexion of spine

• Lateral flexion is not commonly used

– Widens interspace for easier introduction of needle

Myelogram overview

Myelogram radiographs

Myelograms Images

CTM

• Performed after intrathecal injection

• Can be performed at any level of vertebral column

• Multiple slices taken (1.5 – 3mm) – Gantry is tilted

• Windowing allows for density and contrast changes

• Can obtain images with small amounts of contrast– Can be done 4 hours after initial injection

CTM

MRI of Spinal Cord and CSF flow

• Non-invasive

– Provides anatomic detail of brain, spinal cord, intravertebral disc spaces, and CSF within subarachnoid space

– Does not require intrathecal injection

– Does not have bone artifacts

Myelography Using MRI and Conventional methods

MYELOGRAM

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Purpose of Venography

• Venography is an x-ray exam that provides an image of the veins (leg) after a contrast is injected into a vein in the patient's foot

• Enables the condition of the deep leg veins to be assessed

• Primarily performed

to diagnose

deep vein thrombosis

DVT

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Indications• Distinguish blood clots

from obstructions in the veins

• Evaluate congenital vein problems

• Assess the functioning of deep leg vein valves

• Identify a vein for arterial bypass grafting (CABG)

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LOWER LIMB

VENOGRAMS

Unilateral or

Bilateral study

Venogram – The Procedure

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Venogram - RT LegVenous Study – The Procedure

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Explanation of Procedure: Legs• The catheter is inserted into PT vein

– (usually a vein in the foot)

• Contrast is slowly injected. • Tourniquet may be tied around the ankle of the

foot the contrast is injected into - may also place one on the thigh

• The procedure takes about 30 - 45 minutes

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• The patient is asked• to keep the leg still• Radiologist may • use fluoroscopy • A series of images • taken via fluoro and/or• overheads films are taken• fill the deep venous system with contrast• The body may be tilted

Venogram

Procedure

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Post contrast Imaging

may be done with

Fluoro and/or

“overhead” images

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FILMING • VARIES WITH RADIOLOGIST• MAY NEED SCOUT FILMS• 14 X 17 Cassettes starting at• Ankles, Knees, Femurs, Pelvis,• Abdomen & Chest may also be taken

• Overheads or• 14x14 Fluoro Cassettes• Or Digital

• Images taken With & Without Tourniquets

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AP & LATTAKEN

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Bronchography

Bronchography

– the study of the bronchial tree by means of the

introduction of opaque material into the bronchi.

Replaced by CT,fiberoptic bronchoscopy, brush biopsy,

percutaneous biopsy