Neuro X-ray methods of research - Causes, Symptoms and Treatment .MF .
No matter how perfect was the topical diagnosis of diseases of the nervous system, no matter how vast experience possessed any clinician anatomical diagnosis verification is desirable and often essential.For the choice of treatment, especially when it comes to neurosurgical operations need clear understanding of the nature, the exact location and size of the pathological process, its relation to surrounding brain structures, and others. The answers to these questions provide X-ray methods of investigation, providing visualization of the pathological process.Some of these research methods, such as pneumoencephalography and ventriculography with air, which appeared at the beginning of the XX century, is now hardly used, replaced by a more informative and safe methods, such as a computer and the brain and spinal cord MRI.
Skull has a complex anatomical structure, therefore, in addition to the review of images in direct and lateral projections, make special sighting shots.Craniography can re
For topical diagnosis is important to identify local radiographs of bone changes due to the influence of intracranial pathologic process (hyperostosis, Uzury, increased development of vascular furrows, etc.).. Typical local changes sella for tumors of the pituitary gland, the expansion of the internal auditory canal when neuromas VIII cranial nerve, expanding and modifying the edges of the optic nerve holes in gliomas and other
When X-ray can detect common signs of hydrocephalus: changing the shape of the skull, increasing its size,flattening the base, increased vascular pattern set of bones.Identify common changes in the skull caused by prolonged increased intracranial pressure: secondary changes sella, shortening and porosity his back, the porosity of the front and rear inclined processes, the expansion of the entrance to the saddle and dredging, the change in bone structure arch in the form of so-called digital impressions, differences cleftcranial sutures.
spine X-ray study is usually performed in the lateral and frontal projection.If you want to make sighting radiographs and pictures in special projections.Spondylography reveals abnormal curvature of the spine (kyphosis, scoliosis, rotation axis), vertebral anomalies development.It is the main method of diagnosis of traumatic injuries of the spine, nonspecific and specific (tuberculosis) his defeats.
X-rays can detect different manifestations of vertebral osteochondrosis:. Narrowing of intervertebral spaces, the change of the vertebral bodies, posterolateral osteophytes, unkovertebralny arthrosis, etc. This is important to establish the size of the spinal canal, especially its sagittal diameter.Possible detection of unstable spinal segment, displacement of the vertebrae (spondylolisthesis).
spondylography reveals changes in tumors of the spinal cord and its roots: the expansion of the intervertebral foramen with spinal roots neuromas, destruction bifida with extramedullary tumors, local expansion of the spinal canal.Revealed as the destruction of the vertebral body with metastatic tumors.
Rentgenocontrast study of cerebrospinal fluid pathways.Contrast agents used in X-ray examination of the brain and spinal cord cerebrospinal fluid spaces can be different.Water-soluble substances (CONGO, dimer-X, AMIPAK), easily mixing with cerebrospinal fluid, provide good opacification (like casts of the brain ventricles and the subarachnoid space), but it may not always be clearly identified level of occlusion.For these purposes it is better to use heavy contrast agents, the relative density is greater than 1.0 (mayodil, yodfendilat).
contrast to liquor ways you can use gas - air, oxygen, helium.
Rentgenocontrast study of the brain ventricles is mainly used in the differential diagnosis of occlusal and open (communicating) hydrocephalus.The study begins with a puncture anterior or posterior horn of the lateral ventricle.When ventriculography with mayodilom puncture lateral ventricle anterior horn produced in the position of a patient lying down and injected contrast agent (1.5-2.0 mL) in a sitting position;head slightly tilted forward, and in the opposite direction.In the absence of blockade of cerebrospinal fluid pathways heavy contrast agent penetrates through the interventricular holes in the III ventricle, midbrain aqueduct, IV of the ventricle, a large tank, and the spinal canal.Delay creates an obstruction contrast medium which is measured by X-ray of the skull, made in two projections.Ventriculography should not be performed for tumors, hematomas, abscesses, parasitic cysts cerebral hemispheres, as it worsens the condition of patients, giving scant information.
X-ray study of the ventricles and the subarachnoid space by introducing air into the subarachnoid space in the position of the patient sitting through a lumbar puncture.This procedure is possible in two ways significantly different from each other: from the breeding and without removal of cerebrospinal fluid.Pneumoencephalography In the first method, trying to achieve a good filling of the ventricles and the subarachnoid space, introduce large amounts of air (60-80 mL or more), and not to cause a significant increase in intracranial pressure, cerebrospinal fluid parallel output.When pneumoencephalography without removal of cerebrospinal fluid air is introduced in a small amount (not exceeding 20-25 ml) slowly and strictly directed to the proposed localization of the pathological process.If there is a need for the introduction of air into the base of the brain subarachnoid space (in the tank), during the manipulation of the patient's head throws back the most back.Plain radiography and tomography of the skull in two projections is carried out in the patient's sitting position.This method is called pnevmotsisternografiey respectively.Although ventrikulo- pneumoencephalography and allow to clarify the nature and location of a number of pathological processes (tumors, consequences of traumatic brain injury, vascular and inflammatory diseases), they are not practically used in recent years because they are invasive and yield to its informational content of computer and magnetic resonance imaging.
introduction of contrast medium into the subarachnoid space of the spinal cord, followed by X-ray of the spine gives an opportunity to clarify the nature and localization of the pathological process.Myelography is indicated for spinal tumors, hernias of intervertebral discs, chronic spinal arachnoiditis and other pathological processes, limiting the lumen of the spinal canal.
myelography There are upward and downward, depending on the type and relative density of contrast agent.When descending myelography with the introduction of a large tank mayodila produce suboccipital puncture, remove 2-3 ml of cerebrospinal fluid and inject an equal amount mayodila.X-rays are produced in the patient sitting or lying on the table with the raised head end.When you block the subarachnoid space of the spinal cord stops contrast of pathological focus ( "rider" sign).
When ascending myelography contrast dye is injected through a lumbar puncture.X-ray examination, the spine is performed at a lowered head end of the table.The lower boundary of liquor obstacles can be detected.
as contrast agents can be used air (airmyelography) and a radioactive noble gas - xenon (isotope myelography).In the latter case, distribution of xenon in the subarachnoid space is determined by a highly sensitive radiostsintillyatsionnogo counter.
the presence of magnetic resonance imaging evidence for myelography limited.
Rentgenocontrast study of the blood vessels.
contrast agent is introduced into the main vessels of the head and make a fast serial shot at the X-ray machines of special design.Angiographic methods can be divided into direct, under which puncture is performed carotid or vertebral arteries, and catheterization, when a contrast agent is injected into the main vessels of the head by means of catheterization through the femoral, axillary or brachial artery.Cerebral angiography allows you to specify the nature and localization of the pathological process and is used in the diagnosis of brain tumors, malformations of the cardiovascular system (aneurysms arterial and arteriovenous, arteriovenous fistula), some forms of stroke to clarify the indications for surgery, as well as to monitor the results of a number of surgical procedures.
Angiography is important for the study of collateral circulation and cerebral blood flow velocity determination.Distinguish arterial, capillary and venous phases of contrast medium passage for the vessels of the brain.Normally, the contrast leaves the vascular bed of the brain for 8-9 seconds, but the sudden increased intracranial pressure caused by swelling, hematoma, hydrocephalus, cerebral edema, cerebral circulation time can be extended up to 15-20 seconds.At the extreme of intracranial hypertension and brain death occurs stop cerebral circulation - the contrast agent does not enter the brain vessels.The acceleration of cerebral blood flow seen with arteriovenous anastomoses and aneurysms.
Spinal angiography is also performed by catheterization of the arteries, krovosnabzhayushih spinal cord at different levels.The need for this complex and time-consuming research appears in suspected arteriovenous malformations of the spinal cord and in some spinal tumors.
any radiological examination must be justified, ie it must be carried out under strict indications.The main argument should be the need to obtain important diagnostic information.When the same information content preference should be given to those studies that do not involve exposure to the patient, or are accompanied by less irradiation.With extreme caution suitable for screening (preventive) beam research.Testing X-ray examinations are not conducted for pregnant women and children up to 14 years.Radiographic studies related to the exposure of sexual organs (intestines study, kidney, lumbar spine, pelvis, and others.), Women of childbearing age are recommended for the first week after menstruation.Restricting the use of X-ray examinations during pregnancy due to the potential risk of adverse effects of additional radiation on fetal development.Although the vast majority of medical procedures using X-rays, are not subjected to the developing child to critical exposure and significant risk, in some cases, there may be a slight chance of negative influence of X-ray radiation to the fetus.The risk of the X-ray examination depends on the gestational age and the type of the procedure.In studies of the head, limbs, chest using a special protective aprons for pregnant women, as a rule, the child is not exposed to direct radiation and, consequently, the survey procedure is virtually safe for him.Only in rare cases, during pregnancy there is a need to carry out X-ray examination of the abdomen or pelvis, but even in such a situation, the doctor may prescribe a special kind of examination or, if possible, to limit the number of surveys and the area of irradiation.Due to the fact that an overwhelming number of radiological examinations carried out in pregnant women for health reasons (the need to avoid pneumonia or tuberculosis), the risk of data research for the mother and the unborn child is always incomparably lower than the possible harm that can bring them to the rejection of the survey.Procedures using a conventional X-rays (plain x-ray, fluoroscopy, computed tomography) are safe for nursing mothers.X-rays do not affect the composition of breast milk.In the case of nursing mothers are a danger only X-ray examination, which involves injecting radioactive substances.Before this survey breastfeeding mothers need to inform doctors about lactation, since some drugs can get into the milk.In order to avoid the effects of radioactive substances on the child's body, doctors are likely to advise mothers to briefly interrupt the feeding, depending on the type and quantity of the radioactive substance.As in the case of pregnant women, X-ray examination of children is carried out for health reasons and the risk is almost always lower than the possible risk of the disease, about which the survey is conducted.