CT SCAN MYELOGRAPHY (DELDC) at Dr. Essa Lab

CT SCAN MYELOGRAPHY (DELDC) at Dr. Essa Lab

CT SCAN MYELOGRAPHY (DELDC) is a highly specialized, advanced diagnostic imaging procedure performed at Dr. Essa Lab to evaluate the spinal cord, nerve roots, and the subarachnoid space. This examination combines the high-resolution imaging capabilities of computed tomography (CT) with the administration of a contrast medium directly into the spinal canal. By utilizing state-of-the-art multi-slice CT scanners, Dr. Essa Lab provides exceptionally detailed cross-sectional images of the spine, allowing neuroradiologists and clinicians to diagnose complex spinal pathologies with high precision. The term ‘DELDC’ signifies the clinical standards and diagnostic excellence maintained at Dr. Essa Laboratory and Diagnostic Centre, a premier healthcare institution in Karachi, Pakistan, renowned for its commitment to diagnostic accuracy and patient care.

The procedure works by introducing a water-soluble, non-ionic contrast agent into the subarachnoid space—the fluid-filled area surrounding the spinal cord and nerve roots—typically via a lumbar puncture under fluoroscopic guidance. Once the contrast medium is distributed throughout the spinal canal, it outlines the neural structures, making them highly visible on the subsequent CT scan. This technique is particularly valuable for evaluating the delicate anatomy of the cervical, thoracic, and lumbar spine. It provides critical diagnostic value in cases where magnetic resonance imaging (MRI) is contraindicated, inconclusive, or unavailable. The detailed visualization of bone-to-soft-tissue interfaces makes CT myelography an indispensable tool for surgical planning and complex neurological evaluations.

The clinical importance of CT SCAN MYELOGRAPHY (DELDC) lies in its ability to detect subtle abnormalities within the spinal canal that may be missed by conventional imaging modalities. By clearly delineating the boundaries of the spinal cord and exiting nerve roots, this test helps physicians identify the exact source of nerve compression, spinal stenosis, or cerebrospinal fluid (CSF) leaks. The benefits of undergoing this procedure at Dr. Essa Lab include access to highly trained medical specialists, advanced imaging technology, and a sterile, safe clinical environment. Common clinical indications for this examination include severe back or neck pain radiating to the limbs, progressive muscle weakness, numbness, tingling, suspected spinal canal narrowing, herniated discs, spinal tumors, and post-operative evaluation of spinal fusion or instrumentation.

Clinical Procedure: What to Expect

Patient Preparation

Proper patient preparation is essential to ensure the safety, efficacy, and comfort of the CT SCAN MYELOGRAPHY (DELDC) procedure. Patients are advised to adhere strictly to the following guidelines prior to their appointment at Dr. Essa Lab:

• Fasting Requirements: Patients should fast (no solid food) for at least 4 hours prior to the procedure. Clear liquids are permitted and highly encouraged to maintain optimal hydration.
• Hydration: Drink plenty of water the day before and the morning of the test. Good hydration helps dilute the contrast medium and reduces the risk of post-procedure headaches.
• Medication Review: Inform the clinical staff of all current medications. Certain drugs, particularly blood thinners (anticoagulants such as warfarin, clopidogrel, or aspirin) and certain antidepressants or antipsychotics that lower the seizure threshold, may need to be temporarily discontinued under the guidance of the prescribing physician.
• Kidney Function Test: A recent blood test showing serum creatinine levels may be required, especially for patients with a history of kidney disease, diabetes, or hypertension, to ensure the safe clearance of contrast media.
• Allergy History: Notify the radiologist of any known allergies, particularly to iodine, contrast media, or local anesthetics.
• Comfortable Clothing: Wear loose, comfortable clothing. You will be asked to change into a sterile patient gown before the procedure begins.
• Arranging Transportation: Because a lumbar puncture is performed, patients must arrange for a responsible adult to drive them home after the procedure. Driving is not permitted for 24 hours post-test.

During the Procedure

The CT SCAN MYELOGRAPHY (DELDC) is a two-step procedure consisting of a contrast injection under fluoroscopic guidance followed by a high-resolution CT scan. At Dr. Essa Lab, the entire process is conducted under strict sterile conditions to ensure patient safety.

First, the patient is positioned on the fluoroscopy table, typically lying prone (on the stomach) or on their side with the knees drawn up. The radiologist cleans the injection site (usually the lower back) with an antiseptic solution and applies sterile drapes. A local anesthetic is injected to numb the skin and deeper tissues, minimizing discomfort. Using real-time X-ray guidance (fluoroscopy), the radiologist carefully inserts a fine spinal needle into the subarachnoid space. A small sample of cerebrospinal fluid (CSF) may be collected for laboratory analysis if clinically indicated.

Next, a non-ionic, water-soluble contrast agent is slowly injected through the needle. The patient may feel a mild sensation of pressure or warmth during the injection. Once the contrast is introduced, the needle is removed, and the patient is gently rolled or tilted on the table to facilitate the flow of contrast around the spinal cord and nerve roots. The patient is then transferred to the adjacent CT scanner. During the CT scan, the patient lies still on the motorized table as it moves through the gantry. High-speed, multi-slice imaging is performed, capturing detailed cross-sectional views of the target spinal regions. The entire procedure typically takes between 45 to 60 minutes. After the scan, the patient is monitored in a recovery area for a few hours with their head slightly elevated to prevent the contrast from migrating toward the brain.

When is a CT SCAN MYELOGRAPHY (DELDC) Performed?

Evaluating Spinal Canal Stenosis

Spinal canal stenosis is a degenerative condition characterized by the narrowing of the bony canal that houses the spinal cord and nerve roots. This narrowing is often caused by osteoarthritis, ligament hypertrophy, or disc degeneration. Patients typically present with symptoms of neurogenic claudication, which includes lower back pain, bilateral leg pain, numbness, and weakness that worsens with walking or standing and improves with bending forward. Physicians request a CT SCAN MYELOGRAPHY (DELDC) to precisely map the degree of canal narrowing and identify the specific levels of spinal cord or cauda equina compression, which is crucial for planning decompressive spinal surgery.

Investigating Herniated Discs and Radiculopathy

When an intervertebral disc herniates, its inner gel-like core protrudes through the outer fibrous ring, potentially compressing adjacent spinal nerve roots. This leads to radiculopathy, commonly known as sciatica when it affects the lumbar spine, presenting as sharp, shooting pain, tingling, and sensory loss radiating down an arm or leg. A CT myelogram is performed to visualize the exact site of disc herniation and determine how severely the protruding disc material is compressing or displacing the nerve roots. This detailed visualization assists orthopedic and neurosurgical specialists in deciding between conservative management and surgical intervention.

Detecting Cerebrospinal Fluid (CSF) Leaks

Cerebrospinal fluid (CSF) leaks occur when there is a tear or hole in the dura mater, the outermost protective membrane surrounding the brain and spinal cord. This leads to a loss of CSF volume and pressure, resulting in a classic orthostatic headache (a severe headache that worsens when upright and improves when lying flat), along with nausea, tinnitus, and neck stiffness. CT myelography is widely considered the gold standard diagnostic test for localizing CSF leaks. By injecting contrast into the subarachnoid space and performing high-resolution CT imaging, radiologists can pinpoint the exact site of contrast extravasation, guiding targeted treatments such as an epidural blood patch or surgical repair.

Assessing Spinal Cord Tumors and Masses

Tumors within or adjacent to the spinal canal can arise from the spinal cord itself (intramedullary), the meninges (intradural-extramedullary), or the surrounding bones and tissues (extradural). These masses can compress the spinal cord, leading to progressive neurological deficits, localized back pain, loss of sensation, and bowel or bladder dysfunction. A CT SCAN MYELOGRAPHY (DELDC) is indicated to evaluate the relationship between the tumor and the spinal cord, delineate the extent of the mass, and assess the degree of subarachnoid space obstruction. This information is vital for oncologists and neurosurgeons to plan biopsies, surgical resections, or radiation therapy.

Evaluating Patients with Contraindications to MRI

While magnetic resonance imaging (MRI) is often the primary modality for spinal imaging, many patients cannot undergo an MRI due to absolute contraindications. These include the presence of cardiac pacemakers, implantable cardioverter-defibrillators (ICDs), cochlear implants, certain metallic aneurysm clips, or retained metallic foreign bodies. Additionally, patients with severe claustrophobia or those who exceed the weight limits of standard MRI machines may find the procedure impossible. In such cases, CT SCAN MYELOGRAPHY (DELDC) serves as the premier alternative, providing high-resolution, contrast-enhanced diagnostic details of the spinal canal and neural structures without the risks associated with strong magnetic fields.

What Does a CT SCAN MYELOGRAPHY (DELDC) Detect?

The CT SCAN MYELOGRAPHY (DELDC) is an exceptionally sensitive diagnostic tool capable of detecting a wide range of structural and pathological abnormalities within the spinal column. The high-contrast resolution provided by the intrathecal contrast medium allows for the identification of the following clinical findings:

• Central spinal canal stenosis (narrowing of the spinal canal).
• Foraminal stenosis (narrowing of the passages where nerve roots exit).
• Lateral recess stenosis causing nerve root impingement.
• Herniated intervertebral discs (protrusions, extrusions, and sequestrations).
• Osteophyte formation (bone spurs) compressing neural elements.
• Hypertrophy of the ligamentum flavum contributing to canal narrowing.
• Facet joint arthropathy and osteoarthritic changes.
• Spondylolisthesis (slippage of one vertebra over another) and its impact on the spinal canal.
• Cerebrospinal fluid (CSF) leaks and dural tears.
• Arachnoiditis (inflammation and scarring of the arachnoid membrane).
• Clumping or thickening of the cauda equina nerve roots.
• Intradural-extramedullary tumors such as meningiomas and schwannomas.
• Intramedullary tumors including ependymomas and astrocytomas.
• Extradural metastatic lesions compressing the dural sac.
• Perineural or Tarlov cysts within the sacral or lumbar regions.
• Spinal dural arteriovenous fistulas (AVFs) and abnormal vascular patterns.
• Syrinx formation (syringomyelia) within the spinal cord.
• Spinal cord atrophy or myelomalacia (softening of the spinal cord).
• Post-surgical epidural fibrosis or scar tissue compressing nerve roots.
• Epidural lipomatosis (excessive fat accumulation in the epidural space).
• Spinal trauma, including vertebral fractures and bone fragments in the canal.
• Atlantoaxial subluxation or instability in the upper cervical spine.
• Congenital spinal anomalies such as tethered cord syndrome or spina bifida occulta.
• Arachnoid webs or cysts causing focal spinal cord compression.
• Epidural hematomas or abscesses compressing neural structures.

Turnaround Time and Report Access at Dr. Essa Lab

At Dr. Essa Lab, we understand that timely diagnostic results are crucial for effective clinical decision-making and patient peace of mind. The imaging data acquired during your CT SCAN MYELOGRAPHY (DELDC) is processed immediately using advanced post-processing workstations. A team of highly qualified, board-certified neuroradiologists carefully reviews the cross-sectional CT images, fluoroscopic contrast distribution, and clinical history to formulate a comprehensive diagnostic report.

The finalized medical report and high-resolution imaging films are typically available within 24 to 48 hours after the completion of the procedure. Dr. Essa Lab provides multiple convenient options for accessing your results. Patients can pick up their physical reports and imaging films directly from the diagnostic center where the test was performed. Additionally, reports can be accessed securely online through the official Dr. Essa Lab patient portal. This digital access allows patients and their referring physicians to view, download, and share the diagnostic findings instantly, facilitating prompt medical consultation and treatment planning.

CT SCAN MYELOGRAPHY (DELDC) Findings Overview

Structure / Parameter Evaluated	Normal Findings	Possible Abnormal Findings
Spinal Cord	Normal caliber, central position, and uniform signal intensity without evidence of compression or displacement.	Spinal cord compression, displacement, focal atrophy, myelomalacia, or intrinsic masses.
Subarachnoid Space	Uniform patency and symmetric distribution of contrast medium without filling defects.	Narrowing, complete block of contrast flow, filling defects (masses, discs), or contrast extravasation (CSF leak).
Nerve Roots / Cauda Equina	Symmetric exit through neural foramina, normal caliber, and free of compression or displacement.	Nerve root impingement, displacement, thickening, or clumping indicative of arachnoiditis.
Intervertebral Discs	Normal disc height, intact posterior margins, and no protrusion into the spinal canal or neural foramina.	Disc herniation, protrusion, extrusion, or severe disc space narrowing with osteophyte formation.
Bony Spinal Canal	Normal sagittal diameter, smooth vertebral margins, and well-maintained facet joints.	Spinal canal stenosis, osteophytic spurs, facet joint hypertrophy, or spondylolisthesis.
Meninges (Dura Mater)	Intact dural sac with smooth contours and no abnormal contrast leakage or thickening.	Dural tear, CSF leak, meningeal thickening, or dural-based masses (e.g., meningioma).
Epidural Space	Normal distribution of epidural fat, free of abnormal fluid collections, masses, or tissue.	Epidural abscess, hematoma, lipomatosis, or tumor infiltration compressing the dural sac.

Note: Diagnostic findings should always be interpreted by a qualified healthcare professional together with the patient’s symptoms, medical history, physical examination, laboratory investigations, previous imaging studies, and other relevant clinical information. Additional investigations or specialist consultation may be recommended depending on the findings.

Why Choose Dr. Essa Lab for CT SCAN MYELOGRAPHY (DELDC)?

Choosing the right diagnostic facility is paramount for specialized procedures like CT myelography. Dr. Essa Lab is a trusted name in diagnostic healthcare, offering several key advantages:

• Experienced Healthcare Professionals: Our team includes highly trained radiologic technologists and board-certified neuroradiologists specializing in spinal imaging.
• Patient-Focused Care: We prioritize patient comfort, safety, and clear communication throughout the entire diagnostic process.
• Quality Diagnostic Services: Dr. Essa Lab is committed to maintaining the highest standards of diagnostic accuracy and clinical excellence.
• Professional Reporting: Detailed, precise, and clinically relevant reports are generated promptly to assist your referring physician.
• Modern Diagnostic Approach: We utilize advanced multi-slice CT scanners and fluoroscopy systems to ensure high-resolution imaging.
• Comfortable Environment: Our clinical facilities are designed to provide a clean, safe, and welcoming environment for all patients.
• Convenient Location: With multiple branches across Karachi, Pakistan, accessing premier diagnostic services is highly convenient.
• Commitment to Accurate Diagnosis: We adhere to strict quality control protocols to deliver reliable results that you and your doctor can trust.