References

Individual subsection authors: Plain film analysis, Darryn Shaff and Todd L. Siegal; computed tomography, Beverly L. Hershey; magnetic resonance imaging, Scott H. Faro and Robert A, Koenigsberg; magnetic resonance imaging of the spine, Scott H. Faro and Robert A. Koenigsberg; magnetic resonance angiography, Scott H. Faro and Feroze Mohamed; myelography, Todd L. Siegal; neuroangiography, Robert A. Koenigsberg and Scott H. Faro; ultrasonography, Robert A. Koenigsberg; positron emission tomography and single photon emission computed tomography, Scott H. Faro and Robert A. Koenigsberg.

Imaging of the nervous system encompasses a wide variety of modalities that have undergone rapid evolution in the past few decades. Plain film analysis of the skull and spine, although still employed, is not routine in the initial investigation of patients with neurological signs and symptoms. Computed tomography (CT), developed in the 1970s, remains a common radiographic technique, particularly for the acutely traumatized patient. Magnetic resonance imaging (MRI), which came into widespread clinical usage in the 1980s, has supplanted CT for evaluation of many suspected pathological processes of the brain and spine. Depending on availability, MRI is often the initial study ordered, particularly in an outpatient setting. MRI continues to be a rapidly evolving field, encompassing techniques such as magnetic resonance angiography (MRA) and spectroscopy. Myelography, introduced in the early 1900s, has been replaced to varying degrees by MRI owing to the noninvasive nature of the latter. Myelography is still regarded as useful in visualizing the intradural nerve roots and is performed in selected cases, particularly when MRI is contraindicated. Throughout the century, myelography has evolved into a much safer examination, owing to development of contrast agents with dramatically reduced neurotoxicity. Angiography, introduced in 1927, remains the gold standard for evaluation of neurovascular disease. Interventional neuroradiology, a field that has evolved in the past two decades, offers patients therapy through angiographic techniques. Ultrasonography is most useful in the evaluation of the neonatal brain and spine as well as extracranial vascular disease. Transcranial Doppler (TCD) studies are useful in selected patients for assessing intracranial vascular disease. Ultrasonography has also been employed in the operative setting. Positron emission tomography (PET) and single photon emission computed tomography

403

TABLE 23-1 -- NEUROIMAGING APPLICAT

ONS IN DIAGNOSIS AND THERAPY

Technique

Diffuse or Multifocal Cerebral

Focal Cerebral

Subcortical

Brain Stem

Spinal Cord

Plain film

Neoplasm Metabolic Congenital

Neoplasm

Not useful

Neoplasm

Degenerative

CT

Hemorrhage

Hemorrhage

Hemorrhage

Hemorrhage

Hemorrhage

Calcification

Calcification

Calcification

Calcification

Calcification

Infarct

Infarct

Infarct

Infarct

Neoplasm

Neoplasm

Neoplasm

Neoplasm

Neoplasm

Inflammation

Inflammation

Inflammation

Inflammation

Inflammation

Vascular

Vascular

Vascular

Vascular

MR

Neoplasm

Neoplasm

Neoplasm

Neoplasm

Neoplasm

Inflammation

Inflammation

Inflammation

Inflammatory

Inflammatory

Hemorrhage

Hemorrhage

Hemorrhage

Hemorrhage

Hemorrhage

Vascular

Vascular

Vascular

Vascular

Vascular

White matter disease

White matter disease

White matter disease

White matter disease

White matter disease

Congenital

Congenital

Infarct

Infarct

Infarct

Infarct

Infarct

Myelography

Not useful

Not useful

Not useful

Neoplasm

Hematoma

Inflammatory

Vascular

Congenital

Angiography

Mass effect

AVM tumor

AVM tumor

AVM tumor

AVM

Vasculopathy

Aneurysm

Aneurysm

Aneurvsm

Atheroselerosis

Atheroselerosis

Atheroselerosis

Atheroselerosis

Ultrasonography

Hemorrhage

Hemorrhage

Hemorrhage

Congenital

Congenital

(Neonatal)

(Neonatal)

(Neonatal)

Neoplasm

Neoplasm

Congenital

Congenital

Congenital

Neoplasm

Neoplasm

Neoplasm

Infection

Infection

Vascular

Vascular

PET/SPECT

Vascular

Vascular

Vascular

Not useful

Not useful

Neoplasm

Neoplasm

Neoplasm

Infection

Infection

Infection

Degenerative

Degenerative

Degenerative

Trauma

Trauma

Trauma

(SPECT) are nuclear medicine techniques that offer physiological information (Iable.23-1) .

Individual subsection authors: Plain film analysis, Darryn Shaff and Todd L. Siegal; computed tomography, Beverly L. Hershey; magnetic resonance imaging, Scott H. Faro and Robert A. Koenigsberg; magnetic resonance imaging of the spine, Scott H. Faro and Robert A. Koenigsberg; magnetic resonance angiography, Scott H. Faro and Feroze Mohamed; myelography, Todd L. Siegal; neuroangiography, Robert A. Koenigsberg and Scott H. Faro; ultrasonography, Robert A. Koenigsberg; positron emission tomography and single photon emission computed tomography, Scott H. Faro and Robert A. Koenigsberg.

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