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PubMedDate not supplied

Conventional and CT metrizamide myelography in Arnold-Chiari I malformation and syringomyelia.

Four normal controls and 26 cases of Arnold-Chiari I malformations and/or syringomyelia were reviewed. The pathologic cases included five isolated Arnold-Chiari I malformations, nine communicating syringomyelia, five idiopathic syringomyelia, four posttraumatic syringomyelia, one syringomyelia with hemangioblastoma, and two postshunt syringomyelia. The objectives of this study were to compare the accuracy of conventional metrizamide myelography with CT metrizamide myelography and to study indirectly the hydrodynamics of CSF flow in syringomyelia by comparing the sequential enhancement patterns of the spinal cords and cord cavities in the different groups of patients. Twenty-five patients underwent conventional metrizamide myelography immediately before CT metrizamide myelography, and one patient underwent CT metrizamide myelography only. Scans were obtained 1-2 hr, 4-8 hr, and 12-24 hr after injection of metrizamide, but not all patients were scanned during all three intervals. CT metrizamide myelography was found to be more sensitive than conventional metrizamide myelography in the diagnosis of both Arnold-Chiari I malformation and syringomyelia. Performing just an immediate and a delayed scan was found to be more cost-effective than doing all three scans. Contrary to previous reports, it was found that delayed (12-24 hr) scans demonstrated more syrinx cavities than intermediate ones. In studying the sequential enhancement patterns of the spinal cords and cord cavities, some interesting trends were observed that tend to support the theories of Aboulker and of Ball and Dayan of transneural passage of CSF into cord cavities in syringomyelia.

Adult↗
PubMed1982

[Experimental and clinical studies on the diagnostic value of CT-myelography using a water-soluble contrast medium, metrizamide].

UNLABELLED: A basic and clinical study on the diagnostic value of computed tomographic myelography (CTM) with metrizamide was performed using the GE. CT/T. X-2. A basic study: using the fourth lumbar spine taken from a fresh cadaver and the phantom containing a test tube filled with metrizamide, the optimum window level (W. L.) and window width (W. W.) of the spinal CT and the optimum metrizamide concentration for the CTM were investigated. A clinical study: the relation between the concentration and volume of metrizamide and the timing for performing the CTM after intrathecal injection of metrizamide were examined, then CTM was performed in 82 cases with spinal and spinal cord disorders and 4 cases with normal spinal cords. RESULTS: 1) Observing the spinal CT and CTM, the optimum W. L. is 50-150 and W. W. is 1,000. 2) The optimum metrizamide concentration of the subarachnoid space for CTM is 6-12 mgI/ml and its CT number is 150-300. This concentration is difficult to recognize in the conventional myelography. 3) It was confirmed that there were two methods to obtain the optimum concentration. One is the CTM after conventional myelography by lumbar puncture; at the cervical or thoracic level CT is performed 1-2 hours after metrizamide myelography with 230-250 mgI/ml and 7-10 ml, and at the lumbar level CT is performed 3-6 hours after myelography with 190-200 mgI/ml and 6-7 ml. The other is the CTM without conventional myelography; at each level, metrizamide with 100 mgI/ml is injected by lumbar puncture and CT is performed 15-40 minutes after injection of 10-15 ml for the cervical or thoracic level, and 3-5 ml for the lumbar level. The CTM obtained under these conditions provides the accurate information about intraspinal canal lesions and, therefore, it is very useful not only for the diagnosis of the lesion but also for the selection of the approach when a surgical treatment is indicated.

Adolescent↗
PubMed1984

Iohexol compared to metrizamide in cervical and thoracic myelography. A randomized double blind parallel study.

A randomized double blind study with iohexol (Omnipaque) and metrizamide (Amipaque) in cervical myelography was performed in 50 patients, 29 with iohexol and 21 with metrizamide. The myelographies were performed either with lumbar or with C1-C2 puncture in about equal groups, using 300 mg I/ml and 240 mg I/ml of the contrast media respectively. The image quality was equal with both contrast media, excellent in about 4/5 and good in 1/5 of the examinations. Subjective side effects were twice as frequent with metrizamide as with iohexol. The most frequent side effect was headache, occurring in 34% with iohexol and in 67% with metrizamide. Altogether 24% or the patients had EEG changes after iohexol as compared to 47% after metrizamide. All EEG changes were slight dysrythmia-except in three patients with spike activity after metrizamide. These were the only ones with mental reactions as well. It can be concluded that in this trial iohexol was better suited for cervical myelography than metrizamide.

Adult↗
PubMed1976

Studies on metrizamide-protein interactions.

1. The apparent density of catalase after isopycnic centrifugation in metrizamide gradients is dependent on the metrizamide concentration into which the enzyme is dissolved at the beginning of the centrifugation. 2. This different behaviour of the enzyme in metrizamide gradients is due to the formation of a metrizamide-protein complex which is more dense than the uncomplexed catalase. 3. A bimodal distribution of the catalase, with additional heavy bands, was only observed in metrizamide gradients in light water, where rather high metrizamide concentrations are needed even for a banding of the uncomplexed enzyme. 4. The half-life of the metrizamide-protein complex is less than 5 min. This was shown by spectroscopical measurements and band sedimentation analysis in an analytical ultracentrifuge.

Binding Sites↗
PubMed1986

CT of extraarachnoid metrizamide instillation.

Because CT of spinal extraarachnoid metrizamide collections may be misleading, we reviewed the postmetrizamide CT scans of 425 patients in order to characterize the appearance of subdural or epidural metrizamide. Eight patients were found to have extraarachnoid metrizamide contrast collections. In all patients, both the subarachnoid space and the extraarachnoid collection were opacified with metrizamide. In seven patients, a subdural collection of metrizamide created a mass upon the opacified subarachnoid space. Three of these subdural collections were less dense than the opacified subarachnoid compartment and simulated soft-tissue disease, including tumor and an arteriovenous malformation. The hypodense collections are probably a result of leakage of metrizamide and cerebrospinal fluid through the spinal needle defect. CT clues for diagnosing these potentially misleading subdural collections include preservation of the normal dural and epidural interface, identification of small islands of metrizamide within a suspected soft-tissue "mass," the presence of concomitant epidural contrast material collections, and the absence of adjacent vertebral-body destruction.

Epidural Space↗
PubMed1977

Adverse effects of water-soluble contrast media in myelography, cisternography and ventriculography. A review with special reference to metrizamide.

The adverse effects following lumbar myelography and ventriculography with meglumine iothalamate (Conray Meglumin), meglumine iocarmate (Dimer-X, Bis-Conray) and metrizamide (Amipaque), and after thoracic and cervical myelography and cisternography with metrizamide are reviewed. In addition to the published material information given to Nyegaard & Co. from several hospitals participating in clinical trials with metrizamide is also reported. The frequency of minor adverse effects (headache, nausea, vomiting) seems to be about the same with all the three water-soluble contrast media. Convulsions, either localized to the lower part of the body or generalized, may be a problem with meglumine iothalamate and meglumine iocarmate, while the epileptogenic effect is markedly lower with metrizamide. With a technique directed towards preventing contrast medium of high concentration from passing intracranially, the frequency of serious adverse effects may be kept at a very low level. Late adverse effects (adhesive arachnoiditis) occurring after all other water-soluble contrast media are a very minor problem after metrizamide. Serious complications have not been recorded following ventriculography and cisternography with metrizamide. Metrizamide is considered to be the water-soluble contrast medium best suited for use in the subarachnoid space and cerebral ventricles.

Cerebral Ventriculography↗
PubMedDate not supplied

Metrizamide in experimental urography. V. Renal excretion mechanism of a non-ionic contrast medium in rabbit and cat.

The excretion mechanisms of the non-ionic contrast medium, metrizamide, and the ionic, sodium diatrizoate, are compared to investigate the potential usefulness of metrizamide in clinical urography. A mixture of 125I-labeled metrizamide and 131I-labeled diatrizoate was injected intravenously to rabbits or cats. Urine, bile and blood were analyzed for their concentration of iodine. From these concentrations the renal and total clearance was calculated. In the rabbit the excretion of metrizamide was also compared with that of 3H-inulin with or without influence of p-aminohippurate or probenecid. The earlier reported relatively low urinary iodine concentrations after intravenous injection to rabbits of low doses were explained by the following findings: In the rabbit the volume of distribution, the renal clearance and the total clearance of metrizamide were smaller than those measured for diatrizoate and inulin. The biological half-life in serum measured 30-150 min after injection was the same for all three compounds. No indication of tubular secretion was found. The excretion mechanism of the contrast media exhibits species differences as no differences between metrizamide and diatrizoate in the parameters mentioned above could be measured in the cat.

Aminohippuric Acids↗
PubMedDate not supplied

The effect of iohexol on glucose metabolism compared with metrizamide.

In a previous in vitro study we demonstrated reduced CO2 production in rat hippocampal tissue when metrizamide was added. This metabolic depression is believed to be a result of the 2-deoxy-D-glucose (2-DG) portion of the metrizamide molecule since 2-DG is a known competitive inhibitor of glucose metabolism. This competitive inhibition probably occurs at the cell membrane since it has never been shown that metrizamide penetrates neural cells. Further the inhibition is most likely related to competition for the membrane glucose carrier. A new nonionic contrast medium, iohexol, does not contain a 2-DG component and if the hypothesis for the metabolic inhibition is valid we should not expect metabolic inhibition with iohexol. This hypothesis was tested using the rat hippocampus model previously used for metrizamide. We compared iohexol with metrizamide in isotonic concentrations and also examined the effect of hypertonicity. These experiments did not demonstrate inhibition of CO2 production with iohexol at near physiologic osmolalities, however, there was a marked depressive effect with increasing osmolality. This effect from hypertonicity is, however, probably of less importance in vivo where water will rapidly diffuse toward the hypertonic areas. The apparent lack of interference of the iohexol molecule on glucose metabolism should therefore make iohexol a more suitable contrast medium, for subarachnoid investigations than metrizamide.

Animals↗
PubMedDate not supplied

Lumbar myelography with iohexol and metrizamide. A comparative multicenter prospective study.

Diagnostic quality and adverse reactions associated with metrizamide and iohexol as contrast agents for lumbar myelography were compared in a prospective randomized double-blind study in 350 patients at seven centers. Both contrast media were administered in comparable volumes at a concentration of 180 mg I/ml. Overall quality of radiographic visualization was graded as "good" or "excellent" in 95% of 175 metrizamide studies and in 98% of 175 iohexol myelograms. Ninety-three patients examined with metrizamide (53%) and 130 patients studied with iohexol (74%) experienced no discomfort during or after myelography. The incidence of postmyelographic headache was 38% with metrizamide and 21% with iohexol. Nausea and vomiting were also more common with metrizamide. Five patients examined with metrizamide (3%) experienced transient confusion and disorientation after lumbar myelography. No such reactions were observed after iohexol myelography.

Adult↗
PubMed1986

Penetration of subarachnoid contrast medium into rabbit spinal cord. Comparison between metrizamide and iohexol.

The penetration into rabbit spinal cord of two nonionic contrast media, iohexol and metrizamide, and a reference tracer, technetium DTPA, were compared. The spinal subarachnoid space was perfused for 4 hours with a CSF solution to which technetium DTPA and either iohexol or metrizamide had been added. The contrast media and technetium DTPA concentrations reached a plateau level in CSF outflow within 80 minutes. The contrast media concentrations in CSF were higher than the technetium DTPA (P less than .001). In the cord tissue, technetium DTPA reached higher concentrations than the contrast media (P less than .001), and iohexol reached higher concentrations relative to technetium DTPA than metrizamide (P less than .001). The mean contrast media distribution volumes in the thoracic cord were 13% (iohexol) and 12% (metrizamide). The smaller distribution volume observed for metrizamide could be related to the larger effective size of "associated" metrizamide molecules or an interference with diffusion perhaps related to binding to glucose carriers.

Animals↗
PubMed1992

Lung tumor incidence after intrabronchial administration of the nonionic contrast agent metrizamide.

RATIONALE AND OBJECTIVES: Metrizamide has been used for examination of the gastrointestinal tract and tracheobronchial tree of infants. Contrast agents may enter the lungs during such examinations. The current study was undertaken to determine whether there would be any later pulmonary effects when metrizamide was administered to the lungs of weanling mice. METHODS: One hundred fifty mice (18-21 days old), divided into groups, received either 75 microL of metrizamide, using the manufacturer's diluent (190 mg iodine [I]/mL), or saline solution administered to the lungs by injection into the trachea. The mice were observed for the duration of their lives. Moribund animals were killed. At death, all animals underwent necropsy. The lungs were fixed in formalin, and histologic sections were examined for pathologic changes. RESULTS: The incidence of lung tumors was increased (P less than .05) in the lungs of mice receiving metrizamide compared with those receiving saline. Eighteen percent of the lung tumors in the metrizamide-treated mice were lymphomas, a histologic type not found in the saline-treated controls. CONCLUSIONS: A hypothesis proposing that metrizamide may be an initiator of carcinogenic transformation rather than a carcinogen was developed.

Adenocarcinoma↗
PubMed1984

Lumbar myelography with iohexol and metrizamide: a comparative multicenter prospective study.

Diagnostic quality of radiographs and adverse reactions associated with the use of metrizamide and iohexol as contrast agents in lumbar myelography were compared in a prospective randomized double blind study in 350 patients at seven centers. The contrast media were administered in comparable volumes at a concentration of 180 mg I per ml. Overall quality of radiographic visualization was graded good or excellent in 95% of 175 metrizamide studies and in 98% of 175 iohexol studies. Ninety-three patients examined using metrizamide (53%) and 130 patients examined using iohexol (74%) experienced no discomfort during or after myelography. Postmyelographic headache was associated with 38% of metrizamide examinations and 21% of iohexol examinations. Nausea and vomiting were also more common with metrizamide. Five patients examined using metrizamide (3%) experienced transient confusion and disorientation following lumbar myelography. No such reactions were observed following iohexol myelography.

Adolescent↗
PubMed1984

Iopamidol and metrizamide for myelography: prospective double-blind clinical trial.

In a comparative randomized double-blind study, 73 patients underwent myelography using iopamidol (36 patients) or metrizamide (37 patients) as contrast medium. The overall diagnostic adequacy of iopamidol myelography was found to be comparable to that of metrizamide myelography. The incidence of examinations graded as superior (64%) or adequate (36%) with iopamidol was equivalent to that with metrizamide (57% superior, 43% adequate). Adverse reactions after iopamidol myelography were fewer, less severe, and generally of shorter duration than those associated with metrizamide. In the iopamidol group, adverse reactions occurred in nine (25%) patients, all of whom experienced mild or moderate headache, one with nausea, vomiting, and fatigue. In the metrizamide group, adverse reactions occurred in 17 (46%) patients, all of whom experienced mild or moderate headache, six with nausea and vomiting and four with back and leg pain. Of nine individuals who underwent myelography using 300 mg 1/ml metrizamide injected via lateral C1-C2 puncture, three experienced a toxic encephalopathy with confusion, dysphasia, headache, nausea, and vomiting, and a fourth individual suffered severe nausea, vomiting, fever, and irregular pulse. Encephalopathy was not observed in any of the 11 patients in whom myelography was performed via lateral C1-C2 puncture with a similar concentration of iopamidol. No seizures were encountered, and no clinically significant changes in laboratory studies were observed with either contrast medium.

Clinical Trials as Topic↗
PubMedDate not supplied

Iohexol vs. metrizamide: study of efficacy and morbidity in cervical myelography.

A double-blind study was conducted in 60 patients undergoing either cervical or more complete myelography via C1-C2 puncture. Patients received either iohexol or metrizamide at a 300 mg l/ml concentration. The contrast media were equally efficacious in the production of high-quality radiographs and CT scans. However, the incidence of adverse reactions differed markedly. Of patients receiving metrizamide, 68% had some type of adverse reaction, whereas only 26% receiving iohexol had symptoms. The incidence of headache (metrizamide, 34%; iohexol, 26%) was not statistically different, but the quality of the headache differed: half of the metrizamide headaches were moderate or severe, whereas all iohexol headaches were mild. Nausea (31%) and vomiting (28%) were common with metrizamide but unusual (3% nausea) with iohexol. Of the metrizamide patients, 21% had overt psychologic changes that did not occur in the iohexol group.

Adult↗
PubMed1980

[Reduced cardiotoxicity of contrast media in angiocardiography. Comparative clinical study using diatrizoate with added calcium or metrizamide (author's transl)].

Cardiodepressive side effects of angiocardiography can be reduced by using non-ionic metrizamide (Amipaque) or adding calcium to diatrizoate (Urografin 76%). In 15 patients with coronary artery disease undergoing heart catheterization, we compared cardiac side effects of coronary angiography and left ventricular angiography using metrizamide and diatrizoate with and without additional calcium (11.3 mmol/l) as contrast media under randomized conditions. In selective intracoronary injection with diatrizoate alone, peak left ventricular pressure and contractility (dP/dtmax) showed a fall of 30 +/- 11% and 31 +/- 15% (n = 33 injections). Using diatrizoate with added calcium (11.3 mmol/l), the fall was only 23 +/- 12% and 20 +/- 10% respectively (n = 31 injections). With metrizamide (n = 32 injections) cardiac side effects are even less and the decrease in pressure and contractility only 13 +/- 10% and 7 +/- 7% respectively, which its highly significant (p less than 0.0001) compared with the effect of diatrizoate. The heartrate slowing, not essentially altered by calcium addition, was minimal using non-ionic metrizamide. In left ventricular angiography, the pressure fall in the late phase after injection of diatrizoate, caused by decrease peripheral vascular resistance (vasodilation), was lacking when injecting metrizamide (p less than 0.001). Metrizamide has even less cardiodepressive side effects than diatrizoate with additional calcium when used in angiocardiography and seems to be suitable particularly for the evaluation of high risk patients.

Adult↗
PubMed1982

The histologic effect of intraventricular injection of metrizamide.

A patient with sudden apoplexy and coma was found to have hydrocephalus on computed tomographic scan, and metrizamide was instilled into the ventricles. Subsequent autopsy disclosed a brainstem infarct secondary to a primary dissecting aneurysm of the basilar artery, and a histologic picture of encephalitis in the walls of the lateral and third ventricles. Metrizamide may cause pathologic changes that must be recognized for the correct interpretation by the pathologist of tissue sections previously exposed to metrizamide. In the present case, the changes were seen 11 days after exposure of the tissue to metrizamide, consonant with the time course of similar changes observed in animals. The localization of the cellular infiltrates to the Virchow-Robin spaces corroborates evidence from the literature that metrizamide enters brain parenchyma via these spaces.

Adult↗
PubMed1983

Complications of metrizamide myelography.

Adverse neurobehavioral reactions have not been emphasized as a complication of metrizamide myelography. We encountered six such reactions in approximately 250 metrizamide myelograms. All reactions followed either cervical myelography or panmyelography via lumbar puncture. We also treated a single case of tonic-clonic seizure after intracranial spill of metrizamide in a patient without a history of seizure disorder, and a case of myoclonus following a thoracic metrizamide myelogram that showed a highgrade block. Metrizamide should not be used if an intrathecal block is suspected, or if the location to be studied makes intracranial spill difficult to avoid.

Adult↗
PubMed1981

The toxicity of the non-ionic water-soluble contrast media iohexol and metrizamide (Amipaque) in selective vertebral angiography. An experimental study in rabbits.

Selective left vertebral angiography was carried out in 25 rabbits comparing the toxic effects of iohexol and metrizamide (Amipaque). The iodine concentration for iohexol was 280 and 350 mg/ml and for metrizamide 350 mg/ml. Short general convulsions were seen in many of the animals with iohexol in the concentration of 350 mg iodine/ml. Cardiovascular reactions were seen with both contrast media, but were more marked with iohexol than with metrizamide in the concentration of 350 mg iodine/ml. Both iohexol and metrizamide are far less toxic than the ionic contrast medium metrizoate, but metrizamide seems to be less toxic than iohexol in vertebral angiography.

Animals↗