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Neuroradiology

Neuroradiology Quick Links Cranial Computerized Tomography Face & Paranasal Sinuses Computerized Tomography Neck Computed Tomography Orbital Computed Tomography Spinal Computerized Tomography Cerebral Interventional Radiology Spinal Interventaional Radiology Interventional Neuroradiology Myelography Angiographic Computed Tomography (CTA) Venographic Computed Tomography (CTV) Vertebroplasty/ Kyphoplasty

 

COMPUTERIZED TOMOGRAPHY OF THE FACE AND PARANASAL SINUSES

 

Description:

Multiple axial and coronal cuts of the paranasal sinuses or facial bones are made. The study of choice to evaluate paranasal sinuses and facial bones.

Indications:

1. To demonstrate the extent of disease processes involving the paranasal sinuses (tumor, infection).
   
   
2. To demonstrate the extent of facial disfigurement in such processes as plexiform neurofibromatosis, neurofibromatosis, and various congenital anomalies.
   
   
3. To identify and characterize the nature of mass lesions within the orbit such as hemangioma, optic glioma, subperiosteal abscess orbital pseudotumor, thyroid exophthalmus.
   
   
4. To assess a complex facial fracture.
   
   
5. Sinus Disease.

Preparation:

See Cranial Computerized Tomography

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COMPUTED TOMOGRAPHY OF THE NECK

 

Description:

Multiple axial cuts of the neck are performed from the base of the skull to the aorto-pulmonary window. These are performed without and with contrast. Particular attention is paid to detecting calcifications within salivary glands on the unenhanced study.

Indications:

1. Calculus disease.
   
   
2. To evaluate the renal collecting systems and ureters for a urothelial abnormality when intravenous contrast material cannot be given for intravenous urography.
   
   
3. Diseases of the neck including nodule disease, thyroid, larynx, etc.
   
   
4. Contraindications for MR

Preparation:

See Cranial Computerized Tomography

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ORBITAL COMPUTED TOMOGRAPHY

 

Description:

To identify and characterize the nature of mass lesions within the orbit, destructive or expansive lesions of the orbital wall, and lesions disturbing ocular motility that are either within the orbit or the cavernous sinus. Examples would include disease processes such as intraorbital tumors (e.g., hemangioma, optic glioma), infectious diseases (e.g., subperiosteal abscess contiguous with paranasal sinusitis), and benign inflammatory conditions (e.g., orbital pseudotumor, thyroid exophthalmos).

Contraindications, Preparations, Description, and Complications, see Cranial Computed Tomography.

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SPINAL COMPUTERIZED TOMOGRAPHY

 

Description:

Multiple axial cuts of the area of interest are made, usually with the patient in the supine position. An intrathecal non-ionic contrast material may be required. This study may be performed after myelography.

A cystogram is similar to a VCUG except that the voiding portion is deleted. The bladder is emptied through the catheter. Cystography is used primarily to rule out a perforated or ruptured bladder, to check the integrity of the bladder post-operatively, or to evaluate urinary incontinence.

Indications:

1. Suspected tumor of the spinal column.



2. Various congenital anomalies.



3. Evaluation of complicated fracture of the spine.



4. Neck instability after trauma.

Contraindications:

Any contraindication to lumbar puncture such as raised intracranial pressure secondary to an intracranial mass lesion, if a myelogram is being performed. Contraindications to myelogram, meds, etc

Preparation:

1. The patient should be well-hydrated but should not have had solid foods for at least four hours prior to the examination



2. Appropriate sedation.

Complications:

1. Complications of lumbar puncture.



2. Contrast reaction (extremely rare with non-ionic contrast agents).

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CEREBRAL INTERVENTIONAL RADIOLOGY

 

Description:

The femoral artery is catheterized using modified Seldinger technique and the catheter is then advanced into the appropriate carotid or vertebral artery and contrast material is injected, followed by rapid filming.

Indications:

1. Further work up of lesions found on MRI or CT, particularly to study the vascularity of the lesion prior to surgery.



2. Intrinsic vascular disease (arteritis, arteriosclerotic disease, FMD, Takayasu’s Disease, etc.).



3. Study of vascular lesions in the brain and neck (arteriovenous malformation, aneurysm, pseudoaneurysm, dissection and glomus tumor).



4. Extraaxial lesions (meningioma).



5. Evaluation of arteriosclerotic disease in the great vessels of the neck.



6. Recurrent epistaxis.



7. Objective pulsatile tinnitus.

Contraindications:

1. Contrast allergy – requires preparation.



2. Severe renal disease (relative contraindication).



3. Severe hypertension (relative contraindication).

Preparations:

1. Signed consent form required.



2. No solid food in PO after midnight on the night of the study; patient should be well hydrated.



3. Appropriate premedication.

Complications:

1. Stroke.



2. Death.



3. Contrast reaction.



4. Renal failure from contrast material.



5. Arterial dissection.



6. Thrombosis of femoral artery.



7. Groin hematoma/hemorrhage.

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SPINAL INTERVENTAIONAL RADIOLOGY

 

Description:

This is quite similar to that of cerebral IR; however, each spinal artery is catheterized and injected.

Indications

1. Spinal cord AVMs, spinal dural fistulas.
   
   
2. Vascular malformations.
   
   

Contraindications and Preparation:

See Cerebral IR. Signed consent form required.

Complications:

The major risk of this procedure, in addition to those of cerebral IR, is para- or quadraplegia secondary to spinal cord infarction.

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INTERVENTIONAL NEURORADIOLOGY

 

Description:

A femoral artery is punctured and a catheter is placed via the Seldinger technique. The catheter is then advanced into the appropriate vessel and various materials may be used for embolization, including polyvinyl alcohol, cyanoacrylate, detachable balloons or coils.

Indications:

1. Carotid cavernous fistula.
   
   
2. Vertebral venous fistula.
   
   
3. Arteriovenous malformation
   
   
4. Extradural aneurysm.
   
   
5. Various intracranial tumors.
   
   
6. Epistaxis not responsive to usual therapy.
   
   
7. Superselective chemotherapy infusions.
   
   
8. Intracranial aneurysm.
   
   
9. Stroke.

Contraindications:

See Cerebral IR.

Preparations:

See Cerebral IR. Consult neuroradiology service.

Complications:

The complications are essentially those described in Cerebral IR; however, the risk of these complications varies depending on the procedure.

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MYELOGRAPHY

 

Description:

A lumbar or lateral cervical C1-2 puncture is performed and contrast material is injected. The choice of contrast material is non-ionic. Spot filming of the areas of interest is performed. This study is usually followed by CT.

Indications:

1. Work-up of disc disease and back pain, and cervical, thoracic, or lumbar radiculopathy in patients who cannot undergo MRI.
   
   
2. Evaluation of congenital spinal anomalies.

Contraindications:

1. Drug allergy (relative; pantopaque has been reported to cause allergic reactions, non-ionics have not).
   
   
2. Severe renal disease (relative; non-ionic).
   
   
3. Phenothiazine, tricyclic anti-depressants, and MAO inhibitors (non-ionic), will decrease the seizure threshold.
   
   

Preparation:

1. Plain films of spine appropriate to the examination.
   
   
2. No solid food after midnight; patient should be well-hydrated.
   
   
3. Steroid prep if allergic to I.V. contrast.
   
   
4. Signed consent form required.

Complications:

1. Complications of lumbar puncture (spinal headache).
   
   
2. Lumbar radiculopathy.
   
   
3. Nausea & vomiting (non-ionics; treat with Emetecon, add in fluids first).
   
   
4. Uncommon for non-ionics: chemical meningitis, encephalopathy, and seizure.
   
   

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ANGIOGRAPHIC COMPUTED TOMOGRAPHY (CTA)

 

Description:

Multiple axial cuts of the neck and head obtained using helical technology, starting at the level of the common carotid arteries up to the vertex of the calvarium. The acquisition is time based on the arrival of a bolus of intravenously administrated contrast material to the artery(ies) of interest. This is followed by processing of images using standard algorithms such as maximum intensity projections, shaded surface display, and volume rendering to improve visualization of arteries.

Indications:

1. Carotid artery disease such as arteriosclerosis and dissection.
   
   
2. Study of vascular abnormalities such as aneurysm and arteriovenous malformation.
   
   
3. Study of vasospasm.

Preparation:

See Cranial Computerized Tomography

Complications:

1. Contrast reaction.
   
   
2. Contrast extravsation at the site of intravenous injection.

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VENOGRAPHIC COMPUTED TOMOGRAPHY (CTV)

 

Description:

Multiple axian cuts of the neck and head obtained using helical technology, starting at the level of the common carotid arteries up to the vertex of the calvarium. The acquisition is time based on the arrival of a bolus of intravenously administrated contrast material to the vein(s) of interest. This is followed by processing of images using standard algorithms such as maximum intensity projections, shaded surface display, and volume rendering to improve visualization of arteries.

Indications:

1. Venous and dural sinus thrombosis, occlusion, or stenosis.
   
   
2. Study of vascular abnormalities such as arteriovenous dural fistula.

Contraindications:

Uncorrectable Bleeding Disorder. This is a relative contraindication as the coagulation parameters can be corrected in most patients to allow placement of a PCN.

Preparation:

See Cranial Computerized Tomography

Complications:

1. Contrast reaction
   
   
2. Contrast extravasation at the site of intravenous injection.
   
   

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VERTEBROPLASTY/KYPHOPLASTY

 

Description:

Under imaging guidance, a needle is introduced into the vertebral body using transpedicular or lateral approach. Cement or balloon are introduced into a compressed vertebral body to help alleviate spinal pain, stabilize the compressed vertebral body, and possibly restore its height.

Indications:

1. Alleviation of pain secondary to vertebral body compression fractures due to osteoporosis, primary tumor, or metastatic disease.
   
   
2. Alleviation of kyphotic deformity secondary to vertebral body compression fractures.

Preparation:

1. Plain films and MRI of the spine appropriate for the examination.
   
   
2. No solid food after midnight; patient should be well hydrated.
   
   
3. Steroid prep if allergic to contrast agent.
   
   
4. Signed consent form required.

Complications:

1. Leakage of cement into the epidural space.
   
   
2. Leakage of cement into the paraspinal veins with secondary pulmonary embolism.
   
   
3. Pedicular fracture.
   
   
4. Contrast reaction.

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