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MRI vs Myelogram

      Re: MRI vs Myelogram

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Posted by CCF NEUROSURGERY MD on September 19, 1997 at 10:35:39:

In Reply to: MRI vs Myelogram posted by Keith Stabler on September 18, 1997 at 15:21:00:

: I have had a 4 year history of cervical pain with radiculopathy, paresthesia into both arms and subscapular pain.  This has been treated as muscle strain until recently when X-ray revealed some ossification.  An MRi without contrast was performed and revealed moderate to severe herniated nucleus pulposus at both C4-5 and C5-6, with foraminal impingement and cord compression.  Additionally, there was a mild bulge at C3-4.  My neurosurgeon ordered a myelogram and CT.  This came back indicating a normal C-spine with a mild bulge at C5-6.  Based upon the myelogram and CT, my neurosurgeon said I was fine.
  Which of these imaging techniques are more reliable?  
Dear Keith,
MRI and CT myelogram give similar information, but one may be used in
preference to another in certain situations.  They may also be used
together, as in your case.
MRI is superior in delineating soft tissues, as in disc herniation.  It is
also excellent in evaluating the amount of compression there is on the
spinal cord, also a soft tissue.  The nerve roots at each level can be
followed out the foramina, where they are often compressed.  MRI also grants
the ability to reconstruct images in different 3D planes.  The resolution
of soft tissues with MRI is superior to any other imaging modality.
CT is better at imaging bony structures and is not as good as MRI in
delineating soft tissues.  It is currently only available in the axial plane.
Of note, a CT is quicker to perform, and can be done with reasonable resolution
when a patient has metal instrumentation in place.  
A myelogram is done by injecting dye into the thecal sac followed by plain
x-rays of the spine.  Compression on nerve roots or the spinal cord itself
can be seen as abnormal inpouchings on the thecal sac.  Imagine the thecal
sac as a balloon filled with water surrounding the spinal cord.  After dye
is injected, it is easy to see whether something is pressing on and distorting
the normal anatomy.  When combined with a post-myelogram CT, this is a highly
effective diagnostic tool.
It is up to your surgeon to determine whether the pathology he sees on
CT and MRI warrants surgical intervention.  
Good luck.

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