Neuroradiology back to the future: spine imaging

Although radiography of the spine began shortly after Roentgen's discovery in 1895, there was little written in the medical literature about spine imaging until nearly 25 years later with the development of myelography, first by using air and then a variety of positive contrast agents. The history of spine imaging before CT and MR imaging is, in large part, a history of the development of contrast agents for intrathecal use. The advent of CT and, more important, MR imaging revolutionized spine imaging. The spinal cord and its surrounding structures could now be noninvasively visualized in great detail. In situations in which myelography is still necessary, advances in contrast agents have made the procedure less painful with fewer side effects. In this historical review, we will trace the evolution of spine imaging that has led to less invasive techniques for the evaluation of the spine and its contents and has resulted in more rapid, more specific diagnosis, therapy, and improved outcomes.

Neuroradiology back to the future: brain imaging

The beginning of neuroradiology can be traced to the early 1900s with the use of skull radiographs. Ventriculography and pneumoencephalography were introduced in 1918 and 1919, respectively, and carotid angiography, in 1927. Technical advances were made in these procedures during the next 40 years that lead to improved diagnosis of intracranial pathology. Yet, they remained invasive procedures that were often uncomfortable and associated with significant morbidity. The introduction of CT in 1971 revolutionized neuroradiology. Ventriculography and pneumoencephalography were rendered obsolete. The imaging revolution continued with the advent of MR imaging in the early 1980s. Noninvasive angiographic techniques have curtailed the use of conventional angiography, and physiologic imaging gives us a window into the function of the brain. In this historical review, we will trace the origin and evolution of the advances that have led to the quicker, less invasive diagnosis and resulted in more rapid therapy and improved outcomes.

Raupp: 50 years of neuroradiology

OBJECTIVE

Evaluate the laboral and intellectual contributions of a founder of Brazilian Neuroradiology to the development of specialty.

METHOD

Interviews were conducted with Dr. Raupp and contemporary doctors. Then we made a literature review with the Raupp search term aiming to identify those papers which included major changes in the diagnostic and therapeutic neurosurgical.

RESULTS

The colleagues consulted were unanimous in recognizing the work of avant-garde and the importance of Dr. Raupp to the development of neuroradiological methods, especially in the pre-computed tomography fase.

CONCLUSION

The work of Dr. Raupp was fundamental for the consolidation of Brazilian Neuroradiological School over the past five decades. He developed diagnostic and therapeutic techniques in congruence with the practices of the specialty on the global stage and he promoted education through medical residency programs.

[J.K.A. Wertheim Salomonson (1864-1922): nerves, currents and X-rays]

Wertheim Salomonson was the first specialist for nervous diseases at the University of Amsterdam. He was based in the department of internal medicine of the 'Binnengasthuis'. Through his keen interest in physics he introduced the medical community in The Netherlands firstly to the use of electricity in the diagnosis and treatment of neurological disease and subsequently to the application of X-rays. His clinical expertise was greatest in disorders of muscle and the peripheral nervous system.

Neuroimaging: a story of physicians and basic scientists

Until just a few decades ago, it was very difficult to detect, non invasively, physiological signals from the brain. However, the discoveries in physics, the evolution of information technology, and the invention of non-invasive biomedical technologies in the last decades of the twentieth century transformed this scenario and created numerous opportunities for studying the brain in living subjects. The authors trace the extraordinary evolution of brain imaging techniques (magnetic resonance imaging, emission tomography, and ?functional neuroimaging?) in the second part of the twentieth century. Not only have these methods had a remarkable clinical impact, they have also been outstanding research tools in the field of the neurosciences. In their most recent applications, they are employed in the quest to uncover the neuronal substrate of the human mind.

Evolution of diagnostic neuroradiology from 1904 to 1999

Neuroradiology began in the early 1900s soon after Roentgen discovered x rays, with the use of skull radiographs to evaluate brain tumors. This was followed by the development of ventriculography in 1918, pneumoencephalography in 1919, and arteriography in 1927. In the beginning, air studies were the primary modality, but this technique was supplanted by angiography in the 1950s and 1960s. The first full-time neuroradiologist in the United States was Cornelius G. Dyke at the New York Neurological Institute in 1930. Neuroradiology took a firm hold as a specialty in the early 1960s when Dr Juan M. Taveras brought together fourteen neuroradiologists from the United States and Canada to establish the nucleus of what was to become the American Society of Neuroradiology, or ASNR. This society's initial goals were to perform research and to advance knowledge within the specialty. Neuroradiologists initially were able to diagnose vascular disease, infections, tumors, trauma, and alterations in cerebrospinal fluid flow, because the brain structure was invisible. Neuroradiology was forever changed with computed tomography (CT) because the brain structure became visible. Soon thereafter, magnetic resonance (MR) imaging was developed, and it not only provided anatomic but also made possible vascular and physiologic functional imaging.

[Point of view of the radioneurologist]

Since the 1970s, neuroradiology has benefited from significant advances and has become less and less invasive. SALT group (Saint-Anne-Lariboisière-Tenon), created in 1986, treats and follows patients presenting with arteriovenous malformation with surgery, embolization and/or radiosurgery. Treatment failures and complications are analyzed in order to better define indications and improve techniques of treatment which benefit from advances in equipment and software, as well as in radiobiology and genetics.

The history of Swedish neuroradiology

The history of Swedish neuroradiology is reviewed.

[Neuroradiology--past and future]

After the discovery of X-rays by Roentgen exactly 100 years ago, neurosurgeons and neurologists have been promoting an imaging diagnosis of the central nervous system around the turn of the century with methods like pneumencephalography and angiography. With the induction of computed tomography and magnetic resonance imaging (MRI) in the last two decades, seemingly simple examination methods became available which led to a temporary separation of neuroradiology from its parent fields. Further development of MRI with methods that allow to measure brain perfusion and to visualize brain function has led this diagnostic modality back to its origin, neurology: adequate evaluation of such multimodality imaging is only possible in the context of all neurosciences. On the other hand, interventional neuroradiology with endovascular procedures in the brain has evolved to an operative field that is only feasible in close cooperation with neurosurgery. This also applies to MRI, where the 'open magnets' require close cooperation between neuroradiologist and neurosurgeon to perform image guided procedures online.