Norman E. Leeds

Computerized tomography in the diagnosis of sellar and parasellar lesions

Multiple thin or overlapping cuts have been found necessary to examine this region properly, since the volume is small and filled with important anatomic structures. The suprasellar cistern defines the area to be evaluated in patients suspected of having lesions in the sellar or parasellar regions. In the routine nonsellar examination of the brain, three or four cuts are made with the patient’s head angled 20” or 25” to Reid base line. The first cut is through the base of the skull at the level of the sphenoid sinus, and subsequent cuts are made at 2.5~cm intervals. During these routine studies, only one or two slices actually demonstrate the suprasellar region. In a review of 100 consecutive cases performed in this routine manner, the suprasellar cistern was visualized on at least one cut in only 85% of cases, and even this cut was often unsatisfactory because of normal asymmetry and rotation of the head. For adequate visualization of the suprasellar

Tolerance of iohexol, iopamidol, and metrizamide in lumbar myelography.

Iohexol and iopamidol, two new nonionic contrast media, have been extensively studied in comparison with metrizamide for lumbar myelography. Review of the literature with statistical analysis indicates both agents are superior to metrizamide in terms of number of patients with adverse reactions (p less than 0.001). Preliminary data suggest, but do not prove, that use of iohexol may result in fewer side effects than iopamidol.

Computed tomography guidance for skeletal biopsy

Computed tomographic (CT) guided biopsy and abscess drainage of multiple organ systems have been well described. Reports of spinal and skeletal applications have been less common. This study describes the use of CT guidance in the biopsy of various skeletal lesions in 46 patients. Forty-one patients had skinny needle aspirations (18 or 22 gauge) and 23 patients had trephine core biopsies. Sites of the lesions included: thoracic spine-15 patients, lumbosacral spine-17 patients, bony pelvis-6 patients, rib-2 patients, and long bones-6 patients. Fast scanners capable of rapid image reconstruction have overcome many constraints. With CT guidance, the physician who performs the procedure receives virtually no ionizing radiation. The exact location of the needle tip is accurately visualized in relation to the lesion being biopsied and to the vital organs.

Extraspinal abnormalities identified on lumbar spine CT

SummaryRetrospective review of 1517 lumbar CT examinations revealed extraspinal pathology in 22 (1.45%). Retroperitoneal tumors and lymphadenopathy as well as vascular, urinary tract and gynecologic abnormalities were identified. This study demonstrates the need to carefully evaluate the visualized portions of the abdomen and pelvis on all lumbar spine CT examinations even when the patients symptomatology is suggestive of spinal abnormalities.