High-dose i.v. contrast in CT scanning of the postoperative lumbar spine.

Evaluation of the postoperative lumbar spine is sometimes difficult because of obliteration of epidural fat by hypertrophic scarring. We examined 70 patients using a high-dose intravenous contrast technique in an attempt to distinguish hypertrophic scarring from herniated disk. The CT interpretation was confirmed in all 17 patients who had follow-up operations. Thirteen had herniated disk material associated with scar and four had hypertrophic scarring only. The latter four patients underwent reoperation because of concomitant foraminal or spinal canal stenosis seen on CT. Twelve of the herniated disks had the expected appearance of a nonenhancing mass surrounded by a rim of enhancing scar tissue. In the 13th patient, homogeneous enhancement of the herniated disk was seen. It is thought that chronically herniated disks, such as this one, may incite enough surrounding scar to give the CT appearance of an enhancing disk. Finally, marginal enhancement in the anulus fibrosus region was seen in over 90% of disk spaces examined. Although an anatomical explanation cannot be given at present, this phenomenon is thought to represent a normal finding.

Radiological techniques in the examination of patients with headaches.

It can be said that in the majority of headache patients who have a long typical history, a negative neurologic examination, and a noncontributory general physical examination, radiologic studies will probably not give further pertinent information. Nevertheless, in a sufficient number of these patients, the noninvasive and essentially atraumatic procedures of plain skull radiography, computed tomography, and (as indicated) echoencephalography and radionuclide brain scanning will provide a considerable amount of information pertinent to the clinical problem. Hospitalization for angiography and, on occasion, pneumoencephalography or other special procedures, will then become indicated for those patients in whom an abnormality is found in these screening procedures.

Demonstration of acute post-viral myelitis with magnetic resonance imaging.

Post-infectious transverse myelitis is an important clinical entity in childhood, but the diagnosis is difficult to confirm by conventional radiologic investigations. We report a patient with acute, cervical, post-infectious transverse myelitis whose diagnosis had been established by the distribution and evolution of lesions on serial magnetic resonance imaging (MRI). Autopsy results confirmed the diagnosis of post-infectious transverse myelitis and the presence of MRI-identified lesions. To our knowledge, this patient is the first child reported with MRI findings in post-infectious transverse myelitis and suggests that MRI may be valuable in the diagnosis and management of children with this syndrome.

The sylvian cistern on computed tomography scanning.

The sylvian cistern is an important landmark in neuroradiology. It can be directly evaluated with computed tomographic (CT) scanning, especially in patients with some degree of cerebral atrophy or when enlarged by masses or fluid accumulations.