Intravenous (IV) gadolinium-based contrast agents are not routinely used in the setting of scoliosis, except in those instances when tumor or infection is a consideration. CT Multiplanar and 3-D reconstruction CT of the bony spine can help in selected cases for presurgical planning. In addition, the volumetric CT data can be used for surgical navigation [16,17]. CT may also be used to characterize and define the extent of the lesion, such as with the nidus of an osteoid osteoma. CT can be rapidly acquired, and low-dose protocols have been developed and implemented [18]. IV iodine-based contrast is almost never warranted in the perioperative setting, the exception being when tumor or infection is suspected and MRI with contrast cannot be obtained because of a contraindication. Bone Scan Tc-99m methyl diphosphonate (MDP) bone scintigraphy has been advocated in the specific setting of painful scoliosis and is particularly sensitive in cases with primary bone tumors, such as osteoid osteoma or osteoblastoma, spondylolysis, and infection. However, generalized pain is common in scoliosis, occurring in up to a third of idiopathic cases, and radiography often demonstrates the etiology in those individuals with an underlying bone abnormality [19]. Bone scintigraphy findings are usually not specific. Therefore, after initial evaluation with radiography, MRI is generally the second-line imaging modality even in the setting where a primary bone tumor, such as osteoid osteoma, is a consideration [20]. Discussion of Procedures by Variant Variant 1: Child. Congenital scoliosis. Initial imaging. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information, including prior imaging.
Scoliosis Child. Intravenous (IV) gadolinium-based contrast agents are not routinely used in the setting of scoliosis, except in those instances when tumor or infection is a consideration. CT Multiplanar and 3-D reconstruction CT of the bony spine can help in selected cases for presurgical planning. In addition, the volumetric CT data can be used for surgical navigation [16,17]. CT may also be used to characterize and define the extent of the lesion, such as with the nidus of an osteoid osteoma. CT can be rapidly acquired, and low-dose protocols have been developed and implemented [18]. IV iodine-based contrast is almost never warranted in the perioperative setting, the exception being when tumor or infection is suspected and MRI with contrast cannot be obtained because of a contraindication. Bone Scan Tc-99m methyl diphosphonate (MDP) bone scintigraphy has been advocated in the specific setting of painful scoliosis and is particularly sensitive in cases with primary bone tumors, such as osteoid osteoma or osteoblastoma, spondylolysis, and infection. However, generalized pain is common in scoliosis, occurring in up to a third of idiopathic cases, and radiography often demonstrates the etiology in those individuals with an underlying bone abnormality [19]. Bone scintigraphy findings are usually not specific. Therefore, after initial evaluation with radiography, MRI is generally the second-line imaging modality even in the setting where a primary bone tumor, such as osteoid osteoma, is a consideration [20]. Discussion of Procedures by Variant Variant 1: Child. Congenital scoliosis. Initial imaging. The body regions covered in this clinical scenario are the cervical, thoracic, and lumbar spine. These body regions might be evaluated separately or in combination as guided by physical examination findings, patient history, and other available information, including prior imaging.