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Neuroradiology

E2913. A Resident-Friendly Algorithmic Approach to Preforming and Interpreting Myelography of the Spine

Segovis C,  Schroeder J,  Sachs J,  West T,  Zapadka M. Wake Forest Baptist Medical Center, Winston Salem, NC

Address correspondence to C. Segovis (cegovis@wakehealth.edu)

Background Information: Although MRI is generally the primary imaging modality of choice for detailed anatomic evaluation of degenerative spine disease, myelography continues to play an important role in the interpretation of spine disease in both the acute and nonacute setting, particularly in cases when MRI may be contraindicated. Also, referring surgeons may still use myelography for surgical decision making. Myelography can be intimidating to residents because of both the procedural and diagnostic requirement, and potential limited exposure to the technique. The purpose of this exhibit is to present a concise, algorithmic approach for the performance and interpretation of myelography that is applicable to learners at all levels.

Educational Goals/Teaching Points: We present an algorithmic approach for the performance and interpretation of myelography applicable to learners at all levels. This exhibit reviews the preprocedure evaluation including contrast agents and injection level selection, methods for accessing the thecal sac for injection of intrathecal contrast, protocols for myelography including CT myelography and MR myelography, and interpretation of images. Post-procedural complications are also discussed.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Participants will receive a focused review of relevant anatomy with preprocedure protocol including patient consent, preprocedure examination, contrast selection, and selecting an injection level. A discussion of postprocedural complications is offered. Viewers will learn about image acquisition including a review of radiographic, CT protocols, and MR protocols and imaging interpretation with examples of normal and relevant abnormal findings.

Conclusion: Although MRI is generally the primary imaging modality of choice for detailed anatomic evaluation of degenerative spine disease, myelography continues to play a significant role in the evaluation of spine pathology in both the acute and nonacute setting. The exhibit presents a concise, algorithmic approach for the performance and interpretation of myelography that is applicable to learners at all levels.