Neuroradiology And Ultrasound

Miscellaneous

Intraoperative ultrasound (IOUS) may be used as a guide in both brain and spinal surgery. In the spine, ultrasound may be used to guide the approach to a tumor, reducing the extent of the laminectomy and dural opening. With intramedullary tumors, the extent of the posterior myelotomy can be defined, together with the presence of syringomyelic cavities and deep tumor extension [25]. In some cases there may be pointers to a histological diagnosis and, where indicated, ultrasonic-guided aspiration and biopsy can be performed. Similarly, IOUS is well able to localize and define the margins of both superficial and deep intracranial tumors, and can subsequently accurately determine the extent of resection.

Finally, IOUS may be of use in the evaluation of both the brain and spinal cord in trauma patients. Localization of hematomas, bone fragments and foreign bodies is possible and ultrasound may subsequently provide dynamic guidance to facilitate their removal.

Conclusions

The future of neuroradiology will see further development of MRI so that it becomes the central, and often only, diagnostic tool needed. MRA and CTA will replace diagnostic angiography. Functional and physiological data will be routinely available although newer techniques, such as magnetoencephalography, may have a limited role in complementing MRI. CT scanning will remain important and even myelogra-phy will have a limited role. The neuro-radiologist will remain central, being the interface between the application and interpretation of these sophisticated technologies and the clinical problems of the patient.

Self-assessment

□ What are the features of a subdural empyema on a CT scan?

□ What are the MRI appearances of an acute parenchymal hematoma?

□ What are the common hemorrhagic tumors of the brain and what are their characteristic features on MRI?

□ What are the complications of cerebral angiography?

□ A patient presenting with subarachnoid hemorrhage is found to have multiple aneurysms. How do you decide which has bled?

References

1. Osborn AG. Diagnostic neuroradiology. St Louis: Mosby Year Book, 1994.

2. Atlas SW. Magnetic resonance imaging of the brain and spine, 3rd edition, Philadelphia; Lippincott-Williams-Wilkins, 2002.

3. Rankine JJ, Gill KP, Hutchinson CE, Ross ERS, Williamson JB. The therapeutic impact of lumbar spine MRI on patients with low back and leg pain. Clin Radiol 1998;53:688-93.

4. Hounsfield GN. Computerised transverse axial scanning (tomography). Part I. Description of system. Br J Radiol 1973;46:1016-22.

5. Osborn AG. Intracranial haemorrhage. In: Osborn AG, editor. Diagnostic neuroradiology. St Louis: Mosby Year Book, 1994; 154-98.

6. Katayama H, Yamaguchi, Kozuku T et al. Adverse reactions to ionic and non-ionic contrast media: a report from the Japanese Committee on the safety of contrast media. Radiology 1990;175:621.

7. Vieco PT. CT Angiography of the intracranial circulation. Neuroimaging Clin N Am 1998;8(3):577-92.

8. Schild HH. MRI made easy. Berlin/Bergkamen: Schering AG, 1990.

9. Connelly A, Jackson GD, Frackowiak RSJ, Belliveau JW, Vargha-Khadem F, Dadian DG. Functional mapping of activated human primary cortex with a clinical MR imaging system. Radiology 188: 125, 1993.

10. Castillo M, Kwock L, Scatliff J, Mukherji SK. Proton MR spectroscopy in neoplastic and non-neoplastic brain disorders. Magn Reson Imaging Clin N Am 1998; 6(1): 1-21.

11. Moriarty TM, Kikinis R, Jolesz FA, Black PM, Alexander E. Magnetic resonance imaging therapy: intraoperative MR imaging. Neurosurg Clin N Am 1996;7(2):323-31.

12. Le Bihan D. Diffusion and perfusion magnetic resonance imaging. New York: Raven Press, 1995.

13. Sato Y, Yuh WTC, Smith WL et al. Head injury in child abuse. Evaluation with MR imaging. Radiology 1989; 173:653-57.

14. Broderick JP, Adams HP, Barson W et al. Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 1999;30:905-15.

15. Zhu XL, Chan MS, Poon WS Spontaneous intracranial hemorrhage: which patients need diagnostic cerebral angiography? A prospective study of 206 cases and review of the literature. Stroke 1997;28:1406-9.

16. Lenthall RK, Dean JR, Bartlett JR, Jeffree MA Intrapitu-itary fluid levels following hemorrhage: MRI appearances in 13 cases. Neuroradiology 1999;41: 167-70.

17. Shellock FG, Kanal E. Magnetic resonance bioeffects, safety and for MR imaging safety and patient management. In: Patient management, 2nd edn. Philadelphia: Lippincott-Raven, 1996.

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