The Specialized World of Neuroradiology

Neuroradiology is a medical field that involves diagnostic imaging of the human nervous system. Particular attention is focused on the head, neck and spine. A subspecialty of general radiology, neuroradiology uses many of the same imaging tools, such as computerized tomography (CT), magnetic resonance imaging (MRI) and ultrasound.

Training in this field generally requires physicians to spend their residencies in diagnostic radiology, with at least four months spent in neuroradiology. A dedicated fellowship of one to two years follows; in some schools, the second year allows even greater specialization, such as focusing exclusively on the spine or on pediatric conditions.

A further subspecialty, called interventional neuroradiology, requires another year or two of training. Residencies in neurosurgery or neurology can also lead to this fellowship, which involves endovascular procedures. These somewhat invasive techniques are used to diagnose and treat lesions of the central nervous system, head or neck, such as vascular malformations, tumors, stroke or aneurysms. Two diagnostic procedures used in this subspecialty include neuroangiography and myelography.

Neuroangiography is used to examine and treat blood vessels in the areas associated with this subspecialty. The neuroradiology specialist injects a local anesthetic in the patient's groin area before inserting a catheter into a blood vessel there and guiding it to the affected vessels. Injection of a contrast dye helps to enhance the radiographic images then taken. Once the procedure is complete, the patient must lie flat and still for up to six hours. Patients may be observed for a longer period, if necessary, before being released.

Myelography is a diagnostic tool used to discover spinal conditions such as tumors, narrowing of the spinal canal and herniated discs. Patients lie on their stomachs and are secured with straps. Given the sensitivity of the spine and the invasive nature of the procedure, the straps are necessary to help keep the patient immobilized. The neuroradiology specialist numbs a small area of the neck or back with local anesthetic before using X-ray guidance to place a small needle into the patient's spinal fluid. An injection of contrast dye through the needle highlights the nerves and the spinal cord for the X-ray images. The table may be tilted to move the dye within the fluid for some images; the straps hold the patient in place. A CT scan often follows the X-rays to provide additional diagnostic information. After the myelography is complete, patients must remain reclined for up to two hours to minimize the risk of a spinal headache. Following discharge, patients need at least eight hours of bed rest with the head slightly elevated.

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