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PubMed1975

Amipaque myelography. The side effects compared with Dimer X.

In a comparative study between Dimer X and Amipaque (metrizamide) for lumbar myelography it was found that there is a little higher frequency of monor, but unimportant side effects after Amipaque. Amipaque has also been used for thoracocervical myelography with excellent results and without greater discomfort than after myelography in the lumbar region. A new puncture technique was used for the eximation of the cervical region alone: lateral puncture on the neck between the laminae of C1 and C2 under TV control. In more than 75 reinvestigations no arachnoid changes were observed.

Adult↗
PubMed1993

Electrophysiological and cognitive effects of lumbar myelography with iopamidol: comparison with diagnostic lumbar puncture.

To assess the influence of contrast medium on cortical function, we studied 20 patients undergoing lumbar myelography with iopamidol and 10 patients undergoing diagnostic lumbar puncture (controls). The examinations performed before and 6 and 24 h after myelography (or lumbar puncture) included a neuropsychological battery and an electrophysiological evaluation. In the patients cranial CT was performed thrice to assess passage of contrast medium from the cerebrospinal fluid into the brain. Neither patients nor controls had significantly different scores on neuropsychological testing after the diagnostic examinations. A transient slowing of basal EEG activity could be detected in 2 patients and 3 controls 6 h after the lumbar puncture. In 3 patients CT showed a transient increase in density of the brain. None of the parameters studied was significantly affected by myelography with iopamidol. CT findings support the hypothesis of early clearance of iopamidol from brain tissue, explaining its low neurotoxicity.

Adult↗
PubMed1991

Theory and practice: how much contrast for myelography?

A questionnaire sent to members of the British Society of Neuroradiologists revealed that the majority of practitioners will, when necessary, inject more than 3 g of iodine during myelography with iohexol or iopamidol. The 3 g limit recommended by the contrast medium manufacturers is not based upon scientific studies involving these media, and it is the experience of British neuroradiologists that larger amounts of modern contrast agents can be used without an increase in post myelography complications. There is, therefore, a need for a controlled trial to assess the question of the most appropriate dose of contrast medium in myelography.

England↗
PubMed1991

Combined use of spin-echo and gradient-echo MR-imaging in cervical disk disease. Comparison with myelography and intraoperative findings.

In a prospective study we compared the diagnostic value of combined gradient-echo (GE) and spin-echo (SE) MR imaging with cervical myelography in 30 patients with clinical signs and symptoms of cervical radiculopathy and/or myelopathy due to disk disease. Only patients who subsequently underwent surgery (anterior interbody approach) were included. By means of MRI the clinically relevant segment was identified in all cases, by means of myelography in all but two patients. Using both spin-echo (SE) and gradient-echo (GE) techniques it was possible to differentiate between bone tissue and disk material by MR in all but one. It is concluded that MRI-especially gradient-echo imaging is a viable alternative to cervical myelography and can be considered as an initial diagnostic procedure for suspected cervical disk disease.

Adult↗
PubMed1990

Magnetic resonance imaging, computed tomography, and myelography in the diagnosis of recurrent lumbar disc herniation.

Thirteen patients with recurrent symptoms after lumbar discectomy were evaluated. All the patients were enrolled in the study on the basis of clinical symptoms and signs only. The patients were examined with MRI, CT, and myelography in order to compare a) the clinical findings with the imaging investigations, b) the predictive value of the different investigations, and c) the clinical and investigative results with the operative findings. All patients were operated upon according to the clinical findings, and the surgical results were used as the final diagnosis. In six patients a new disc herniation was detected. In the remaining cases surgery revealed either scar tissue or nothing to explain the recurrence of the symptoms. The three imaging modalities were analysed by receiver operating characteristic (ROC) curves. The areas under the ROC curves were 0.68 for MRI, 0.83 for CT, and 0.43 for myelography. The difference in areas between CT and myelography was significant (p less than 0.05). The results indicate that CT has the highest predictive value for demonstrating the recurrence of a lumbar disc herniation.

Adult↗
PubMed1992

[Improved interpretation of intra-operative myelography in dorsal spinal instrumentation].

Intraoperative assessment of the spinal canal during dorsal instrumentation for vertebral fractures which narrow the canal is facilitated by myelography. However, the flow of contrast medium around a displaced fragment may result in an erroneous interpretation of canal patency. By performing myelography prior to instrumentation and reduction of the fracture, a chance in myelography-findings after reduction can clearly be caused only by successful repositioning of the displaced fragment. The possibility of an incorrect interpretation of the investigation can thus be reduced.

Fracture Fixation, Internal↗
PubMed1989

Current status of myelography in the evaluation of the thoracic spinal cord.

The myelographic features in 35 patients with clinical thoracic spinal cord disease and normal plain radiographs were reviewed to re-evaluate the role of pre-operative myelography since the advent of computed tomography and magnetic resonance. The most frequent lesions were meningioma (9 cases), prolapsed intervertebral disc (9 cases), and metastases (8 cases). The extent and anatomical location of the lesion was demonstrated in all 19 patients without myelographic block. In 16 cases with complete block, the anatomical location was demonstrated in 14, and the extent of the lesion in four, using cervical puncture in two and CT myelography in one. Myelography remains a valuable method of assessment of the thoracic spinal cord and canal and is sufficient to allow the preoperative planning of surgical management in the absence of complete block. Additional investigation by computed tomography or magnetic resonance imaging is advised in the presence of complete block or an intramedullary lesion.

Adult↗
PubMed2001

[Radiotherapy planning for paraspinal tumors with CT-myelography].

BACKGROUND AND AIM: Artifacts due to metal implants are an important problem in diagnostic radiology and radiotherapy planning in tumors such as chordoma of the spine. A strict differentiation between target and radiosensitive structures e.g. spinal cord is absolutely essential for high-dose radiotherapy. Up to now CT and MRI techniques have provided only limited image quality in such situations. We introduce an approach to facilitate segmentation by using the technique of CT-myelography for radiation treatment. PATIENT AND METHOD: A 48-year-old woman with multiple inoperable relapses of a chordoma in the lumbar spine and extensive metal instrumentation in this area was given to radiotherapy using IMRT-technique (intensity modulated). MRI- and CT-planning images did not allow differentiation between myelon, cauda equina, dural sac and tumor. In this situation we performed a CT-myelography with the patient in treatment position. RESULT: CT-myelographic images enabled precise differentiation between myelon, cauda equina and intraspinal tumor. A substantial improvement of the segmentation of the spinal cord was obtained. There was no compression of the dural sac along the spine. This information provided the basis for a precise radiotherapy planning in IMRT-technique. CONCLUSION: In situations where CT- and MRI-techniques are not able to generate precise images which allow differentiation between tumor, myelon and cauda equina because of metal artifacts, CT-myelography is a promising technique which may help the diagnostic radiologist and radiation oncologist in planning radiotherapy.

Humans↗
PubMed2006

[Multislice computed tomographic myelography].

While magnetic resonance imaging (MRI) is the first line modality in depicting intramedullary spinal lesions, computed tomographic (CT) myelography has gained renewed attention due to the introduction of multislice scanning (MS-CT). Compared with conventional CT, MS-CT permits rapid, high-resolution imaging of various spinal pathologies with extended scan length. Although soft tissue contrast is inferior to that with MRI, MS-CT myelography performs best in detailed assessment of osseous pathologies, 3D imaging of orthopedic and anesthesiologic implants, and showing dural leakage and causes of CSF circulation impairment. Whenever MRI is not available or contraindicated, MS-CT myelography is the method of choice for evaluating spinal lesions.

Anatomy, Cross-Sectional↗
PubMed2005

Intracranial hypotension due to leakage of cerebrospinal fluid: could myelography be a therapeutic option?

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid leakage. We report of a 29-year-old woman with typical symptoms in whom initial cranial MRI and CT were normal . A clinical diagnosis of SIH, but the symptoms did not resolve with conservative therapy or a lumbar epidural blood patch. Repeat MRI revealed (indirect) findings consistent with SIH but failed to directly demonstrate a cerebrospinal fluid fistula. Subsequent CT myelography revealed leakage of contrast medium into the epidural space bilaterally along the nerve roots at C3-7. Following the myelography the patient reported dramatic clinical improvement with complete resolution of symptoms. The adhesive quality of the myelographic contrast medium might have precipitated closure of the meningeal tears. Myelography may be not only of diagnostic value but also therapeutic in SIH.

Adult↗
PubMed2000

Intracranial haemorrhage following lumbar myelography: case report and review of the literature.

We describe a subacute intracranial subdural haematoma following lumbar myelography. This rare but potentially life-threatening complication has been reported both after lumbar myelography and following lumbar puncture for spinal anaesthesia. We review 16 previously reported cases of intracranial haemorrhage following lumbar myelography, and discuss the pathogenesis. In all reported cases post-puncture headache was the leading symptom and should therefore be regarded as a warning sign.

Cerebral Angiography↗
PubMed1998

Imaging of spinal intradural arachnoid cysts: MRI, myelography and CT.

Imaging studies in eight patients with surgically-confirmed spinal arachnoid cysts were analyzed retrospectively. All patients had preoperative MRI of the spine and seven preoperative myelography with postmyelographic CT. In all cases the correct diagnosis could be made preoperatively on the basis solely of MRI. The diagnosis could also be established from myelography and postmyelographic CT in six of the seven cases. In one case myelography and CT simply demonstrated an intradural extramedullary mass.

Adult↗
PubMed1986

Spinal metastases of cerebral glioblastoma: the value of computed tomographic metrizamide myelography in the diagnosis.

Spinal metastases from cerebral glioblastoma via the cerebrospinal pathway are rarely detected when the primary tumors are under apparent control. The authors report two adult patients with cerebral glioblastoma who developed spinal symptoms referable to spinal seeding without neurological and computed tomographic findings of the recurrence of the primary tumors. Computed tomographic metrizamide myelography clearly revealed minute deposits of perispinal metastatic tumors that could not be detected by conventional myelography. Even perispinal mass lesions so minute that they are revealed only by computed tomographic metrizamide myelography can invade the spinal cord and cause clinical symptoms.

Adult↗
PubMed1984

Outpatient low-dose computed tomography metrizamide myelography and evaluation of lumbar disk disease.

Outpatient low-dose computed tomography metrizamide myelography (CTMM) for the evaluation of lumbar disk disease is described in 55 patients. Ten individuals (group 1) were studied using 3.5 ml of 150 mg I/ml (525 mg I total) of metrizamide. Forty-five additional patients (group 2) were examined with 5 ml of 110 mg I/ml (550 mg I total) concentration of metrizamide. Group 2 experienced less post-procedure headache (6.6%) and nausea (2.2%) than did group 1 (30% and 10%, respectively). Group 2 demonstrated a lowered rate of headache (p less than .01) and showed a trend to less nausea (p less than .09) than a recently published study describing full-dose lumbar myelography. In addition, CTMM in group 2 produced more uniform mixing of metrizamide than in group 1. Overall, low-dose CTMM increased accuracy and reduced morbidity, patient cost, and inconvenience as compared with routine full-dose lumbar myelography.

Adult↗
PubMedDate not supplied

Pseudolesion with nonionic contrast myelography.

Water soluble contrast myelography has been associated with a variety of complications. The inadvertant injection of air into the thecal sac may produce an apparent extramedullary, intradural defect on myelography. Post myelography CT examination should be used to confirm the presence of such a pseudolesion.

Air↗
PubMed1991

The influence of needle size and other factors on the incidence of adverse effects caused by myelography.

A randomized prospective trial of 26 G versus 22 G spinal needles was performed in 284 consecutive patients referred for myelography, during which contrast medium was introduced by lumbar puncture. Use of the fine (26 G) gauge needle resulted in a significant decrease in moderately or severely painful needle placements and moderate, severe or postural headaches following myelography. The incidence of other side effects was not significantly influenced by needle size. The incidence of headaches and other side effects was significantly higher in female patients. Back pain, the commonest side effect, was significantly more common in patients who had normal lumbar myelograms than in those in whom lumbar root compression was demonstrated. The incidence of neck stiffness was significantly higher following cervicothoracic myelograms than lumbar myelograms but there was no significant difference in the incidence of other side effects. The use of 4.5 g instead of 3.0 g of iodine resulted in no increase in symptoms. The experience of the operator had no significant effect on the incidence of side effects. Some side effects of myelography appear to be due mainly to cerebrospinal fluid leakage at the site of puncture and are strongly influenced by psychological factors.

Adolescent↗
PubMed1997

Inadvertent intraoperative myelography with Hypaque: case report and discussion.

BACKGROUND: Myelography is routinely performed safely using nonionic water-soluble radiographic contrast media. However, inadvertent introduction of ionic contrast media into the thecal space can result in a syndrome of spasms and convulsions, which can lead to death if not recognized and dealt with in a timely manner. METHODS: We report a case of inadvertent use of the ionic diatrizoate meglumine, an ionic contrast agent, instead of a nonionic contrast agent during intraoperative myelography. RESULTS: The patient developed a sterotypical syndrome of ascending myoclonic spasms, resulting in rhabdomyolysis. Treatment included elevation of the head, removal of cerebrospinal fluid, administration of anticonvulsants, diuresis and sedation, and neuromuscular blockade. The patient recovered well, and there were no long-term sequelae. CONCLUSIONS: Intrathecal introduction of ionic contrast media and the resultant syndrome must be recognized promptly and treated with aggressive medical management to address rhabdomyolysis and seizures. Ionic contrast media should be stored and marked in such a way as to avoid inadvertent use in myelography.

Aged↗
PubMed1985

Pitfalls of incomplete myelography with thoracic spinal lesions.

This paper describes four patients with thoracic spinal lesions in whom the initial clinical presentation was highlighted by complaints in the lower back and lower extremities, in the absence of thoracic spinal or radicular symptoms. Initial myelography, confined to the lumbar region, failed to reveal a cause for the patients' symptoms. Subsequently, diagnostic consideration of a thoracic spinal lesion prompted repeat myelography of the thoracic region which demonstrated a relevant lesion in each case. It is important to visualize the thoracic cord when myelography is performed for the investigation of pain or neurological symptoms in the lower back or lower extremities.

Aged↗