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In emergency cases and traumatic head cases, CT scanning has completely changed the diagnostic method and angiography can in most cases be avoided. Not only can a proper diagnosis be set concerning intracranial bleedings or hematomas of different kinds but also additional information which earlier with help of angiography were not available can now be diagnosed. The article discusses the principles for using CT scanning as a diagnostic method in traumatic and emergency patients and discusses also the limitations and benefits with this method compared with angiography.

Metrizamide (Amipaque) is a new water-soluble contrast agent for use in the intrathecal space. Extensive animal and clinical studies have demonstrated its low toxicity. The advantages to the use of metrizamide include the fact that it is miscible with cerebrospinal fluid and can fill narrow spaces, is sufficiently radiopaque to outline delicate structures within the central nervous system, is completely resorbed from the subarachnoid space, and, to date, has not been implicated in the formation of adhesive arachnoiditis. Application of metrizamide to the evaluation of neurologically diseased patients has included myelography, intracranial cisternography, and ventriculography, as well as various techniques in conjunction with computerized tomography. These various uses of metrizamide are discussed together with some indications and advantages. Metrizamide has now replaced Pantopaque and gas as the most commonly used intrathecal contrast agent at the University of Texas Health Science Center at Dallas.

The blood-brain barrier seems to be an important factor in drug access to malignant brain tumors. Successful experimental reversible disruption of the blood-brain barrier in animals provided the basis for a clinical evaluation of osmotic disruption in five patients with primary and metastatic malignant brain tumors. Good to excellent blood-brain barrier disruption was achieved in four patients with a single nontransient complication, a superficial wound infection at the burr hole site in the first patient. Reversible, transient osmotic barrier disruption was achieved 15 times in five patients without additional toxicity. Computed tomography and radionuclide brain imaging were shown to be useful noninvasive monitors of the adequacy and extent of barrier disruption. These studies also provide further evidence that the barrier is at least partially intact in human tumors because in one patient a metastsis was seen only after barrier disruption.

Interpretation of the angiographic findings in posterior fossa angiography can be improved by a simple angiotomographic device which gives a midline tomography of the posterior fossa. Especially the vessels around the brain stem and close to the midline can be well seen and this is especially helpful with lesions in the brain stem and the anterior part of the posterior fossa. A few examples are given of midline angiotomography which demonstrates the advantages of this technique.

• Computed tomographic (CT) scans were prospectively obtained on 68 patients with previously untreated stages III and IV squamous cell carcinoma of the oral and pharyngeal cavity. We report herein the results of CT evaluation of primary disease arising in these sites, improvements in contrast-enhancement techniques, and CT assessment of the patient's condition after radiation or chemotherapy treatment. (Arch Otolaryngol1982;108:688-692)