Gas Myelography and Percutaneous Puncture in the Diagnosis of Spinal Cord Cysts.

Abstract

HomeRadiologyVol. 89, No. 4 PreviousNext Announcements and Book Reviews - Book ReviewsGas Myelography and Percutaneous Puncture in the Diagnosis of Spinal Cord Cysts.Published Online:Oct 1 1967https://doi.org/10.1148/89.4.755bMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractBy Gunnar Westberg. Acta radiol., Suppl. 252. Paper, Sw. Kr. 30:-. Pp. 67, with 39 figures. Stockholm, Sweden, Acta radiol., 1966.Although gas meylography was first introduced in the U.S.A., there is little doubt that the Swedish Neuroradiologic School under the leadership of Erik Lindgren has perfected this diagnostic technic. As is true for other radiological fields, the Swedish pre-eminence has come about because of different factors. In the opinion of this reviewer, however, the centralization of the clinical material represents the most important circumstance. Between 1937 and 1963, 3,200 gas myelographic procedures were performed in the roentgen department at the Sera-fimerlasarettet, a figure which hardly can be matched in any other center in the world. Many of these procedures were carried out by relatively few radiologists, this fact obviously allowing the accumulation of a high degree of experience and skill by the investigators. Successive refinements have thus been produced: Lindgren established the basic technic; Oden demonstrated the value of tomography for better visualization of the normal and pathologic spinal cord, and now Westberg, in this Supplementum of Acta radiologica, presents clear evidence that the gas myelographic diagnosis of the cystic nature of spinal cord expanding lesions is possible in a large number of cases.The observation that the size of the cord in a patient with an intramedullary cyst varied with positioning during gas myelography spurred Westberg to review the gas myelograms on file and to modify the myelographic technic to most suitably put in evidence fluid fluctuation phenomena in cystic cord lesions. Percutaneous puncture of the cysts, when such diagnosis is made at myelography, represents a further development. The modification of the gas meylographic technic proposed and tested in 125 cases by Westberg in the Neuroradiologic Department of the Karolinska Sjukhuset takes maximum advantage of the intrathecal gas-fluid reciprocal distribution with the different positioning of the patient on a tilting table. By elevating and lowering the head and feet of the patient it is possible to obtain optimal filling with gas of the various sections of the spinal subarachnoid space and thus to examine the entire spinal cord. Two very appealing features of the modified Westberg technic are the use of the lumbar puncture alone (many investigators are reluctant to carry out a suboccipital puncture) and the fact that gas pressures higher than 20 mm Hg are not necessary as in other recently suggested gas-myelographic methods. Tomography is used extensively, and maximum reliance is based on the lateral views of the cord as in the other technics of negative contrast myelograms.Article HistoryPublished in print: Oct 1967 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 89, No. 4 Metrics Altmetric Score PDF download