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PubMed1984

Psychic changes following myelography with metrizamide and iohexol. A comparative investigation with psychologic tests.

Based upon the results of repeated psychologic tests, psychic impairment following myelography has been studied in 60 patients. Thirty of these had lumbar myelography with metrizamide and 30 with iohexol. Psychic impairment was noted in both groups, although with a higher frequency and much more marked in the group which had metrizamide myelography. For this type of examination iohexol is thus to be recommended.

Cognition Disorders↗
PubMed1983

Clinical trial of iohexol for lumbar myelography.

Iohexol containing 180 mg I/ml was used in 80 patients for myelography by lumbar injection. By using an adequate volume, between 10 and 20 ml, satisfactory films were obtained in all cases. Minor adverse effects occurred in 12 patients (15%) and were more frequent in women than men; they were headache (5), nausea (3), vomiting (2), back or limb pain (5), and skin rash (1) and were of minor degree in 10 cases, moderate in the other two and lasted more than 24 h in only one case. There was no change in vital signs or neurological examination related to the studies. No patient suffered difficulty with concentration, personality change or seizures. Electroencephalograms performed on 21 patients before and during the 24 h after iohexol showed no seizure or focal activity or any significant change. Repeat lumbar punctures were performed on ten patients during the 24 h following myelography. One of these, a patient with symptoms due to disc prolapse, whose CSF was abnormal prior to the myelogram, showed a slightly increased cellular response. There was no significant change in any other case. Iohexol is a very satisfactory contrast medium for myelography and compares favourably with other non-ionic contrast media.

Adolescent↗
PubMed1988

A comparative study of magnetic resonance imaging and computed tomography-assisted myelography in spinal dysraphism.

Thirty-seven patients with a wide spectrum of spinal dysraphic lesions were studied by both magnetic resonance imaging (MRI) and myelography complemented by computed tomography (CT). Magnetic resonance imaging proved to be superior for tissue characterization, overall anatomical definition, topographical relationships of the cranio-cervical junction and demonstration of the presence and extent of hydrosyringomyelia. Demonstration by CT myelography of fine neural structures such as the filum terminale and nerve roots remains the superior technique; however, with constantly improving spatial resolution and thinner-slice imaging, MRI will become increasingly competitive in this respect. The osseous component of these lesions was best demonstrated by CT myelography. A high incidence of associated syrinx (8/15 cases) was found in the diastematomyelia group, with an overall incidence of 15 cases in all the dysraphic patients studied. The use of both T1- and T2-weighted sequences is required for tissue characterization. Whilst both imaging modalities proved complementary in the investigation of spinal dysraphism, we suggest that, with its superior tissue characterization and anatomical display of these lesions. MRI should be the primary imaging technique. Avoidance of an invasive procedure and use of ionizing radiation confers additional benefits upon MRI. The relative ease and shorter examination time of MRI makes this technique ideal for pre- and post-operative monitoring and assessment.

Adolescent↗
PubMed2004

Usefulness of myelography with multiple views in diagnosis of circumferential location of disc material in dogs with thoracolumbar intervertebral disc herniation.

The usefulness of myelography with multiple views (lateral, ventrodorsal, left and right oblique view) in the diagnosis of the exact circumferential location of herniated disc material around the spinal cord in 80 dogs diagnosed with thoracolumbar intervertebral disc herniation at surgery was assessed by comparison of clinical and surgical findings. The circumferential location of the compressing mass was diagnosed in 94% of dogs on myelography. The oblique view was of more benefit than the ventrodorsal view in diagnosing the circumferential distribution of the compressing mass. Only the oblique view contributed to a diagnosis of lateralization of the compressing mass in 45% of dogs. Fourteen percent of dogs had clinical lateralization contralateral to myelographic lateralization. The myelographic localization agreed with the surgical localization in 97% of dogs with regard to the exact location of herniated disc material. The presence of clinical lateralization contralateral to myelographic lateralization and a high proportion of agreement of myelographic and surgical localization documents that myelography with multiple views is useful and essential to accurately determine the circumferential location of disc material around the spinal cord.

Animals↗
PubMed1979

CT metrizamide myelography for intraspinal and paraspinal neoplasms in infants and children.

Computed tomography (CT) metrizamide myelography is an accurate and satisfactory method for examining the spinal cord in infants and children with suspected intraspinal neoplasms. It was performed in 13 infants and children and in one adult with intra- and paraspinal neoplasms. CT metrizamide myelography in paraspinal masses provides the total geography of the mass; that is, possible intraspinal extension, as well as the paraspinal portion itself. As such, it is superior to conventional myelography.

Adolescent↗
PubMed1982

Neuropsychologic reactions and other side effects after metrizamide myelography.

One hundred patients were questioned after metrizamide myelography about the side effects of the examination. The number and type of side effects were tabulated and correlated with investigated region (e.g., cervical, lumbar) and with use of medication (e.g., analgesics, diuretics). The number of side effects, particularly neuropsychologic, were higher than previously reported. The most common side effects were minor meningeal irritations (headache, nausea, dizziness, and vomiting) and were regarded by the patients as inconsequential. All side effects became apparent during the first 24 hr after myelography and all were transitory. The side effects, being minor, should not limit the use of metrizamide for myelography. However, those caring for patients who have undergone the study should be aware of the possible side effects.

Adult↗
PubMed1986

Neurologic complications in diabetics after metrizamide lumbar myelography.

Recognized risk factors for metrizamide myelography are seizure disorder, seizure-threshold-lowering drugs, dehydration, and possibly age. After observing serious neurologic complications in diabetic patients after routine metrizamide myelography, a retrospective study was conducted to determine if diabetes should be considered another independent and important risk factor. Forty-one diabetic patients who had lumbar metrizamide myelograms were compared with a control group of 110 nondiabetic patients. A significantly higher incidence was found of severe vomiting (15% vs. 3%, p less than 0.01) and neurologic complications (20% vs. 2%, p less than 0.001) in the diabetic population. Neurologic complications included one case each of seizure, severe encephalopathy, auditory and visual hallucinations, and prolonged somnolence and four cases of confusion-anxiety. Four of the diabetic patients had major transient elevations of blood pressure. These findings suggest that diabetics are a high-risk population for metrizamide myelography. The dose of metrizamide should be minimized, whenever possible. The new nonionic myelographic agents may prove to be safer in this population, but caution and careful follow-up should be exercised in the initial trials with these patients.

Aged↗
PubMed1986

Cognitive and affective changes after myelography: a comparison of metrizamide and iohexol.

A battery of brief cognitive tests and a mood scale were administered to 42 patients before and after cervical myelography with either metrizamide (20 patients) or iohexol (22 patients). The patients receiving metrizamide experienced a deterioration in mood after myelography and a relatively greater decline in cognitive test performance than did those receiving iohexol. These two side effects tended to occur together in the metrizamide group, suggesting a common underlying cause; but there was no correlation between changes in mood and cognitive function after myelography with iohexol. These results suggest that metrizamide has a greater neurotoxic effect than iohexol.

Adult↗
PubMed1988

Comparison of MR and CT myelography in imaging the cervical and thoracic spine.

MR imaging and CT myelography were compared in a retrospective study of 38 patients with suspected lesions of the cervical and thoracic spinal canal and cord. Twenty-eight abnormal cases were found, including spondylosis (9), tumors (8), intramedullary cavities (3), arachnoiditis (3), disk-space-centered infection or osteomyelitis (2), nonneoplastic cord swelling (2), and CSF-borne metastasis (1). MR was equal or superior to CT myelography in depicting cases of cord enlargement, cord compression, and cord atrophy, providing better tissue characterization, no shoulder artifact, and no limitation caused by CSF block. CT myelography was superior to MR in depicting cases of spondylosis and arachnoiditis. It showed superior spatial resolution, which was most pronounced when comparing axial images and hence particularly superior in detecting the lateral extent of disk herniation. Use of surface coils and thin imaging sections is essential for accurate and complete MR evaluation of the cervical and thoracic spine.

Arachnoiditis↗
PubMed2002

Risk factors associated with development of seizures after use of iohexol for myelography in dogs: 182 cases (1998).

OBJECTIVE: To determine prevalence of seizures after use of iohexol for myelography and identify associated risk factors in dogs. DESIGN: Retrospective study. ANIMALS: 182 dogs that received iohexol for myelography in 1998. PROCEDURE: Medical records were reviewed for age, breed, sex, weight, dose and total volume of iohexol, injection site, number of injections, lesion type and location, total duration of anesthesia, duration from time of iohexol injection to recovery, presence and number of seizures, and whether surgery followed the myelogram. RESULTS: 39 (21.4%) dogs had at least 1 generalized seizure during or after myelography. Injection site was strongly associated with prevalence of seizures, and risk of seizure was significantly higher after cerebellomedullary injections, compared with lumbar injections. Mean total volume of iohexol administered to dogs that had seizures was significantly higher, compared with that administered to dogs that did not have seizures, although dosage did not differ between groups. Weight was significantly correlated with risk of seizure, and dogs that weighed > 20 kg (44 lb) had higher prevalence of seizures than dogs that weighed < 20 kg. CONCLUSIONS AND CLINICAL RELEVANCE: It is preferential to administer iohexol via the L5-6 intervertebral space to minimize the risk of seizures. Higher prevalence of seizures in large dogs, compared with smaller dogs, may be caused by administration of larger total volumes of contrast agent per volume of CSF.

Animals↗
PubMed1991

Iopamidol myelography: morbidity in patients with previous intolerance to iodine derivatives.

The records of 1005 patients who underwent iopamidol myelography between January and September, 1988, were reviewed. In this group, 50 patients had histories suggestive of untoward sequelae associated with iodine intake, contact, or administration. The charts of these patients were carefully reviewed, and none of them had any reactions or sequelae suggestive of toxicity or an allergic response after iopamidol myelography. It is concluded that, even in patients with a previous history suggestive of intolerance to iodine administration, iopamidol myelography is generally a safe procedure.

Adolescent↗
PubMed2000

Diagnosis of spontaneous intracranial hypotension by using magnetic resonance myelography. Case report.

The authors describe a case of spontaneous intracranial hypotension in which the leakage site was determined by using magnetic resonance (MR) myelography. This technique demonstrated the route of cerebrospinal fluid (CSF) leakage, whereas other methods failed to show direct evidence of leakage. Magnetic resonance myelography is a noninvasive method that is highly sensitive in detecting CSF leakage. This is the first report in which a site of CSF leakage was detected using MR myelography.

Adult↗
PubMed1994

Lumbar herniated disk disease: comparison of MRI, myelography, and post-myelographic CT scan with surgical findings.

One hundred eighty patients with suspected lumbar disk disease were evaluated preoperatively with magnetic resonance imaging (MRI), myelography, and post-myelogram computerized tomography (CT) scan. Sixty patients underwent surgery on 102 disk levels, allowing for anatomic confirmation of the diagnosis. Eight negative explorations were performed. The correlation between preoperative interpretations of each test and the observed surgical findings was analyzed statistically. Based on this analysis, MRI accurately predicted the operative findings in 98 of 102 disk levels (96%), while the accuracy of myelography (81%) and post-myelogram CT scan (57%) was significantly less. When myelography and CT scan were utilized jointly, the accuracy was 84%, a significant improvement over either test alone, as a diagnostic modality. There was only one false positive MRI study in the evaluation of lumbar herniated disk. The results of this study reflect that MRI is a clinically superior diagnostic test in the evaluation of patients with suspected lumbar disk herniation, and that it should be the diagnostic study of choice when available. Its noninvasive nature, multiplanar capabilities, and the lack of ionizing radiation are particularly desirable for patient and physician.

Adult↗
PubMed1984

Intracranial subdural haematoma after metrizamide myelography.

Headaches for a short period after metrizamide myelography are common. It is unusual for these headaches to persist beyond four days. The case of a patient whose headache dated from the time of myelography and in whom an intracranial subdural haematoma developed after myelography is presented, to draw attention to this rare complication.

Adult↗
PubMed2005

[Speech disturbance following myelography with iohexol: a case report].

Iohexol (Omnipaque) is a non-ionic contrast media for neuroradiology, which causes the neurological complications on rare occasions. A 63-year-old, righthanded female suffered from dysphemia 12 hours after myelography with iohexol via lumbar puncture. The initial cerebral computed tomography scan revealed the generalized contrast media uptake into the cisterns, which was typical to the finding after intrathecal iohexol injection. Although the cerebral magnetic resonance (MR) imaging 7 days after attack also demonstrated no abnormal finding, the electrical encephalogram revealed the sporadic sharp wave activity. Her nonfluent speech deficit had recovered gradually, however, the neurogenic stuttering was still remained. Some literatures previously reported the cases with speech deficits as complications of metrizamide myelography, whereas, a case manifesting as speech disturbance following myelography with iohexol has been not reported. Metrizamide is also a non-ionic agent and had a lower incidence of speech disturbance, which is supposed to be associated with a focal superficial neurotoxic reaction of the cerebrum. Therefore, our unfortunate case suggests that iohexol could rarely cause speech disturbance such as metrizamide.

Brain↗
PubMed2005

Iopamidol myelography-induced seizures.

Iopamidol, a water-soluble contrast agent, has been rarely associated with seizures. We describe a case of generalized tonic-clonic seizure after cervical myelography with iopamidol in a previously healthy young man. In patients presenting with seizures, a history of recent myelography should be considered as an etiology. Iopamidol myelography may be associated with a risk of seizures. Clinicians need to be aware of this complication and inform their patients about such risk.

Contrast Media↗
PubMed1991

Central nervous system reactions to cervical myelography.

In a double blind prospective study of side effects to cervical myelography 38 patients were evaluated with neurologic examination, electroencephalography (EEG), brainstem evoked response (BER), somatosensory evoked responses (SSER), and continuous reaction times prior to and at 6 h and 24 h after myelography with either metrizamide or iohexol. A difference in the incidence of side effects (for example headache, dizziness, nausea, and neck pain) to the two different contrast media indicated that the inconveniences related to myelography were not only due to the spinal puncture. A contrast medium effect on the central nervous system varying from one agent to another was present. A high frequency of EEG deteriorations among patients with adverse clinical reactions and on only discrete affection upon BER indicated the reaction to be located to the cerebral cortex. Weakened tendon reflexes and reduced strength in the upper extremities were probably caused by blockade in the motor roots as SSER were normal indicating no affection of the sensory pathways. This hypothesis is in agreement with the fact that the patients were in the prone position in the first phase of the investigation causing the highest concentration of contrast medium around the motor roots and the anterior part of the spinal cord. Difference in metabolic effect may explain differences in side effects of metrizamide and iohexol.

Adult↗
PubMed1991

MRI and myelography in the diagnosis of lumbar canal stenosis and disc herniation. A comparative study.

We studied the diagnostic accuracy of magnetic resonance imaging (MRI) and the possibility of its substitution for myelography in 78 patients with lumbar canal stenosis and/or disc herniation, who had myelography and MRI examination. The diagnostic results of the two methods were compared respectively with those of operation, showing no statistical significance (coincidence rate 88.5% vs 92.3%, P greater than 0.05). We conclude that MRI could clearly reveal the pathological changes and anatomical relations of lumbar structures without invasive and radioactive damages, and that with the improvement of operative technique, better understanding of images, and reduction of cost, MRI is likely to replace myelography in the future.

Adult↗