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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