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Sagittal T2
Mass lesions in spinal canal are classified as epidural, intradural and intramedullary.
Techniques for demonstration includes Xray Myelography, CT Myelography and MR
Myelography. At present times MR Myelography is ideal and investigation of choice.
The different patterns on MR Myelography by which a lesion may be partly elucidated,
whether it is intramedullary, intradural or epidural is as follow.
In above case, lesion is at the center of spinal canal, completely occupying the spinal canal
with obliteration of Csf spaces, making an acute angle on either side on MR Myelo. The
pattern resembles to B but it can not be intramedullary lesion as cord has already ended above
the level of lesion. So its intradural and extramedullary. Above patterns are applicable only at
the level of cord.
MR Myelography
Magnetic Resonance Myelography is studying the spinal canal and subarachnoid space by
high-resolution MRI, a sequence in which strong T2 weighting is used to provide high
contrast between the 'dark' spinal cord and the surrounding 'bright' Csf space.
MR myelography is an additional sequence, has become part of an entire MR examination
and virtually replaced the traditional X-ray myelography which used contrast with radiation
exposure. It was a procedure, to be done under aseptic precaution. Lumbar puncture was done
first for intrathecal injection of iodinated contrast followed by x ray shoots in AP and Lateral
view. Overall its was a time consuming procedure.
MR Myelo on the contrary requires no intrathecal contrast, its a T2 weighted fast spin echo
pulse sequence. Due to its strong T2 weighting it uses its inherent contrast. No radiation
exposure. No risk and complications of lumbar puncture. Its a Fast sequence it
hardly takes couple of seconds.
Posted by Dr Balaji Anvekar at 3:27 pm