The current role of CT myelography and myelography in neurosurgical practice

Abstract

S. Naderi Marmara University Hospital, Department of Neurosurgery, Altunizade, Istanbul, Turkey V. K. H. Sonntag ( ) Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA Mailing address: 1 c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, AZ 85013-4496, USA Tel.: (602) 406-3593 Fax: (602) 406-4104 e-mail: neuropub@mha.chw.edu The correct diagnosis of spinal disease with nerve root and/or spinal cord compression depends on the precise correlation between neurological findings and accurate radiographic imaging studies. To evaluate the exact clinical value of any diagnostic modality, one must know its sensitivity (reflection of false negatives) and specificity (reflection of false positives). For many years myelography, computed tomography (CT), and CT myelography have been the modalities of choice for evaluation of spinal disease. Today at many institutions magnetic resonance (MR) imaging has replaced myelography, CT myelography, and to some extent, CT for diagnosis of the spinal disorder. MR imaging has the advantages of multiplanar display and lack of ionizing radiation. It can provide sequences that reveal information, such as amount of hydration, about the spinal cord, the nerve root, and the disc itself. However, MR imaging, like CT, has significant false positive and false negative rates. To our knowledge, the main drawback of MR imaging is its insensitivity in detecting detailed anatomy of the bony narrowing at the neural foramen and lateral recess. The occurrence of false positives and false negatives necessitates the usage of complementary or supplementary diagnostic modalities such as CT, CT myelography, and myelography. This article reviews four reports that compare MR imaging with some of these other imaging modalities and is intended to inform neurosurgeons about the current role of CT myelography and myelography in neurosurgical cases. Introduction