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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↗
PubMed2003

Evaluation of magnetic resonance myelography in the investigation of cervical spondylotic radiculopathy.

The objective of this study was to prospectively evaluate the accuracy of MR myelography for the demonstration of foraminal nerve root impingement in cervical spondylotic radiculopathy. 40 patients with cervical spondylotic radiculopathy were imaged with conventional MRI and with MR myelography. The diagnostic accuracy of these imaging strategies for the demonstration of exit foraminal stenosis was calculated relative to a gold standard of the combination of conventional MRI and MR myelography. Conventional MRI had a sensitivity of 88.9%, specificity of 99.1%, and diagnostic accuracy of 94.5% for the demonstration of exit foraminal disease (p<0.001). MR myelography alone had a sensitivity of 84.4%, a specificity of 90.1%, and diagnostic accuracy of 88% (p<0.001). However, the addition of MR myelography increased the diagnostic yield of the MR examination for the detection of foraminal stenotic disease. MR myelography is a useful adjunct to conventional MRI in the investigation of cervical spondylotic radiculopathy.

Adult↗
PubMed1989

Side effects after ambulatory lumbar iohexol myelography.

Side effect incidences after ambulatory (22G needle and two h bed rest) and after non-ambulatory (22 and 20G needles and 20 h bed rest) lumbar iohexol myelography have been estimated and compared. Headache incidence was significantly greater in ambulatory (50%, n = 107) as compared to non-ambulatory myelography (26%, n = 58). Headaches in the ambulatory group tended to be of shorter duration and the difference between severe headaches in ambulatory and non-ambulatory groups was not significant. Serious adverse reactions did not occur and none of the ambulatory patients required readmission because of side effects. The headache was predominantly postural and occurred significantly earlier in the ambulatory group. Headache incidence was significantly greater after 20G needle myelography (44%, n = 97) as compared to 22G needle iohexol myelography (26%, n = 58). The results supports the hypothesis that CSF leakage is a major cause of headache after lumbar iohexol myelography.

Adult↗
PubMed1984

Psychopathometric demonstration and quantification of mental disturbances following myelography with metrizamide and iopamidol.

Groups each consisting of ten patients underwent lumbar and cervical myelography with metrizamide and iopamidol, together with a control group of ten patients who underwent lumbar punctures only. These groups were studied with a psychopathometric test procedure in order to demonstrate and quantify mental disturbances. It was shown that in contrast to myelography with iopamidol, mild mental disturbances are common after myelography with metrizamide. The severity of the mental disturbances after myelography with metrizamide was dependent on the quantity of contrast medium which diffused into the intracranial space after myelography, suggesting a dose-related neurotoxic effect of this substance. Such a correlation was not found with iopamidol.

Adolescent↗
PubMed1988

Myelography with iohexol (Omnipaque); a clinical report with special reference to the adverse effects.

One thousand myelographies (370 cervical, 77 thoracic and 553 lumbar examinations) with iohexol (Omnipaque) were performed in 922 patients. No convulsions were seen. Transient hallucinations were reported in one patient. Headache occurred in 38%. The highest frequency of headache (52%) was reported following cervical myelography with lumbar puncture technique, placing the patient horizontally after the examination. The lowest frequency (20%) occurred following cervical myelography with the C1-C2 puncture technique, placing the patient in bed with the head end elevated 20 degrees. Lumbar myelography was performed on an out-patient basis in 243 patients. The frequency of headache was slightly higher (49%) in this group than in the other lumbar myelography patients (34-44%), but no serious complications were seen.

Adolescent↗
PubMed1997

Magnetic resonance myelography (MRM) as a spinal examination technique.

PURPOSE: Conventional myelography involves side effects and complications due to puncture of CSF space and injection of contrast medium. On the other hand, MR-myelography (MRM) is a new noninvasive method requiring neither puncture nor contrast medium and causing no side effects. The diagnostic value and accuracy of MRM was evaluated in comparison with conventional myelography. MATERIALS AND METHODS: In this prospective comparative study, 41 patients (17 male, 24 female, mean age 42 years) with radicular symptoms underwent conventional lumbar myelography and were also submitted to MRM. Evaluation was performed in a blind manner by two independent examiners. RESULTS: The specificity and sensitivity of the methods are identical. MRM shows 35 cases of thecal indentation with amputation of a nerve root sheath and 6 cases of spinal stenosis. The results of conventional myelography and MRM were surgically confirmed in 38 patients. CONCLUSIONS: Both methods have the same diagnostic accuracy, but MRM requires neither puncture nor contrast medium nor x-rays.

Adult↗
PubMed1990

Early diagnosis of spinal epidural metastases using out-patient computed tomographic myelography.

Twenty patients with known malignancies, back pain, abnormal roentgenograms of the spine, and normal neurological examinations were evaluated by outpatient computed tomographic (CT) myelography to determine the presence and extent of epidural tumor. Spinal CT following the intrathecal administration of low doses of water soluble contrast agents provided high quality diagnostic information. Three patients experienced adverse effects from this procedure which were mild and easily managed in the outpatient setting. Epidural tumor was identified in 15 of 20 (75%) patients. Patients were followed for 9-27 months following myelography. The 14 patients with epidural tumor treated with local radiation experienced pain relief and only one of these patients developed signs or symptoms of recurrent epidural tumor in the treated site. This study documents the high incidence of epidural tumor in selected patients without neurological deficits and the excellent palliative results of non-emergent, carefully planned radiation therapy. It also demonstrates that high resolution CT myelography can be performed safely in an outpatient setting in patients at high risk for epidural tumor. Outpatient myelography facilitates the early diagnosis of epidural tumor and provides needed information on the extent of the tumor for radiation treatment planning while conserving health care resources. For these reasons, outpatient CT myelography should be considered in selected patients with cancer who are at high risk for epidural metastases.

Adult↗
PubMed1977

Is positive-contrast myelography of value in acute cervical spinal cord injury?

Positive-contrast myelography in 30 patients with acute cervical spinal cord injury has not provided any information of clinical value. Reference to the literature does not provide a definite set of indications for myelography in acute spinal cord injury. An attempt has therefore been made to evaluate the indications for this procedure. The potential hazards of myelography in patients with acute spinal cord injury are discussed. Specific contra-indications are described. Difficulties in the radiological interpretation of the usual myelographic appearances in spinal cord injury are mentioned. The advantages of negative-contrast myelography are briefly described. It is concluded that there is a very limited indication for positive-contrast myelography in acute spinal cord injury.

Humans↗
PubMed1979

[Computer tomography of the cervical spinal canal following intrathecal enhancement: cervical CT myelography. Studies on technic and the initial results (author' transl)].

Computer tomography of the cervical spinal canal was carried out in 54 patients after the intrathecal injection of metrizamide (CT myelography). In 43 patients this was done after conventional myelography, in eleven it was the primary examination. In 32 patients the examination proved normal and in 22 abnormal. Correlation between the CT findings and conventional myelography was excellent. Quite small intraspinal structures both normal and abnormal, could be demonstrated. CT myelography is particularly valuable for determining the special relationships within the vertebral canal. The procedure can supplement and confirm conventional myelography, for instance round the foramen magnum. Under certain circumstances it may be regarded as the method of choice, since it is simpler for the patient and less likely to produce complications due to the contrast medium.

Adolescent↗
PubMed1983

The value of CT after total block on myelography. Experience with 25 patients.

Twenty-five patients having a total block on conventional myelography underwent spinal CT. The myelographic and CT findings were compared to surgical findings. The commonest cause of the block was a tumour in 14 cases. In four cases a herniated disc was found, and in three cases the block was caused by degenerative spinal stenosis. Localization of the lesion was more reliably estimated by CT than by conventional myelography. Both the size and localization may be inadequately demonstrated by myelography; in seven cases there was a discrepancy between the myelographic and surgical findings. The intradural lesions were precisely localized on conventional myelography, if the examination was performed through both the lumbar and cervical routes. With extradural lesions there was a significant discrepancy between the myelographic and surgical findings in some cases. Correlation between surgical and CT findings was good, and paraspinal extension of the lesion was also seen on CT. A CT examination is recommended to complement myelography, particularly for the localization of extradural processes. CT also gave additional qualitative information about the lesions, calcifications and cysts being demonstrated by CT only. Destructive, erosive, or degenerative bone changes were better seen with CT.

Diagnosis, Differential↗
PubMed1993

The role of nonionic myelography in the diagnosis of lumbar disc herniation.

RATIONALE AND OBJECTIVES: The accuracy and safety of nonionic myelography, unenhanced computed tomography (CT), and magnetic resonance (MR) in the diagnosis of lumbar disc herniation are reviewed. The comparative costs of these tests are also considered. METHODS: The accuracy of imaging tests that diagnose disc herniations was established by conducting a Medline search between 1985 and 1992. The morbidity associated with these tests are less formally established from selected articles. Finally, the mediocre reimbursement rates of these tests are reviewed. RESULTS AND CONCLUSIONS: The evolution of nonionic contrast media from the first to the second generation has been accompanied by a notable decrease in adverse reactions. Although nonionic myelograms are now better tolerated by patients, noninvasive imaging with CT and MR imaging has become as accurate as or more accurate than lumbar myelography, and should replace it as a screening test. Computed tomography may have advantages over MR imaging when issues of availability and cost are considered. In contrast to lumbar myelography, CT myelography may continue to be a useful method for clarifying ambiguous results of noninvasive tests. The morbidity associated with CT myelography can be minimized by using low doses of a nonionic agent, keeping the patient well hydrated, and using a small lumbar puncture needle. The incidence of adverse reactions can be expected to decrease further as new nonionic dimers become clinically available.

Contrast Media↗
PubMed1999

Comparison of computed tomography myelography and magnetic resonance imaging in the evaluation of cervical spondylotic myelopathy and radiculopathy.

STUDY DESIGN: A cross-sectional retrospective radiologic study. OBJECTIVES: To establish concordance rates between interpretations of computed tomography myelography and magnetic resonance imaging in patients with degenerative cervical spine disease. SUMMARY OF BACKGROUND DATA: Observed discrepancies in interpretation of computed tomography myelography and magnetic resonance imaging question the reliability of comparisons between these two methods. METHODS: This study blindly and randomly evaluated cervical computed tomography myelography and magnetic resonance imaging in 20 patients referred for clinically diagnosed cervical spondylotic radiculopathy, myelopathy, or both. The discovertebral joints, facet joints, lateral recesses, cord size, spinal canal, and neural foramina also were evaluated with graded scales. All results were subjected to the kappa statistic for strength of agreement. RESULTS: Agreement for interpretation of the discovertebral junction occurred in 144 of 240 sites (60%), indicating only moderately good intermethod concordance (kappa = 0.44). Intermethod agreement on the characterization of facet joint disease was only moderately good (143 of 160 sites; 89.4%; kappa = 0.52), and on characterization of lateral recess disease was poor (125 of 160 sites; 78.1%; kappa = 0.20). On degree of spinal canal compromise, there was agreement within one grade in 199 of 240 sites (82.9%; kappa = 0.42). Intermethod agreement on neural foraminal encroachment and cord size was only moderately good (kappa = 0.42 and 0.46, respectively). Computed tomography myelography tended to upgrade the spinal canal narrowing and neural foraminal encroachment. CONCLUSIONS: For most parameters of interpretation, the degree of concordance between computed tomography myelography and magnetic resonance imaging is only moderately good, with discrepancies noted especially in the differentiation of disc and bony pathology. These methods should be viewed as complementary studies.

Adult↗
PubMed1978

Risk factors in complications of aqueous myelography.

The adverse reactions from aqueous myelography in 88 primates were reviewed to determine what factors increase the risk of complications. Seventy-four iocarmate (Dimeray) myelograms were obtained on 41 animals, and 90 metrizamide (Amipaque) myelograms were obtained on 47 animals. The risk of seizures and death from iocarmate myelography was higher than from metrizamide myelography. In animals that had previous myelograms or showed evidence of arachnoiditis, the risk of complications from aqueous myelography was higher. Additional precautions may be indicated if aqueous myelography is performed in patients with arachnoiditis.

Animals↗
PubMedDate not supplied

Cervical myelography in dogs using iohexol.

Iohexol, a non-ionic water-soluble radiographic contrast medium, was used for cervical myelography in dogs (10-17 kg). The animals remained clinically normal following myelography, with no evidence of seizures. At 10 days after myelography there was a slight, but significant (p less than 0.05) increase in neutrophils in the cerebrospinal fluid; these cell numbers had returned to normal by the time of necropsy at 60 days after myelography. This investigation suggests that iohexol may be suitable for clinical myelography in the dog.

Animals↗
PubMed1984

Guidelines for cervical myelography: lumbar versus cervical puncture technique.

Cervical myelography may be performed with non-ionic contrast media either by direct cervical puncture or by lumbar puncture with run-up of the contrast medium. In this prospective study of 300 cervical myelograms using iopamidol (130 by direct puncture and 170 by lumbar puncture), we have shown that the run-up technique causes no more side effects than direct puncture technique and films of equivalent diagnostic quality are obtained. A sub-group of 80 patients had EEG examinations before and after myelography, plus a lateral skull film taken at the end of the myelogram to assess the amount of contrast medium that had entered the skull. More EEG abnormalities were found in those patients examined by direct puncture and significantly more contrast medium had entered the skull in this group. Run-up myelography therefore results in less intracranial spill and so less potential for cortical irritation. In view of the EEG abnormalities, anticonvulsant premedication is discussed, and we now give phenytoin to all patients having cervical myelography with iopamidol. We consider that cervical myelography can be adequately and more safely performed by lumbar puncture technique but, to optimise patient safety, should be performed by a radiologist experienced in neuroradiology.

Anticonvulsants↗
PubMed1987

Computed tomographic myelography in the investigation of childhood scoliosis and spinal dysraphism.

The combined investigations of positive contrast myelography and computed tomographic (CT) myelography were performed on 53 consecutive children. Thirty-eight (72%) of these investigations were performed as a routine pre-operative procedure to identify occult spinal dysraphism in patients with childhood scoliosis; the remainder were because of the "orthopaedic syndrome", cervical radiculopathy, back pain and patients with clinical findings to suggest spinal dysraphism. In the 20 patients (38%) with idiopathic scoliosis, there was no case of spinal dysraphism and CT myelography provided no additional information to the myelogram. In the seven patients with spinal dysraphism the plain radiographic abnormalities identified were lumbar vertebral abnormalities (five), thoracic vertebral abnormalities (one), and sacral agenesis (one). Diastematomyelia was found in four patients, a low tethered cord and lipoma in two patients and a large lipoma in one patient. In all of these cases the myelogram indicated the intraspinal abnormalities; however, CT myelography provided more precise anatomical detail. We conclude that CT myelography is not indicated in the initial preoperative assessment of idiopathic scoliosis but should be reserved for patients with congenital or complicated scoliosis where the association with dysraphism is well recognised.

Adolescent↗
PubMed2005

Comparison of the predictive value of myelography, computed tomography and MRI on the treadmill test in lumbar spinal stenosis.

To date, there have been no prospective, objective studies comparing the accuracy of the MRI, myelo-CT and myelography. The purpose of this study is to compare the diagnostic and predictive values of MRIs, myelo-CTs, and myelographies. Myelographies with dynamic motion views, myelo-CTs, MRIs and exercise treadmill tests were performed in 35 cases. The narrowest AP diameter of the dural sac was measured by myelography. At the pathologic level, dural cross-sectional area (D-CSA) was calculated in the MRI and Myelo-CT. The time to the first symptoms (TAF) and the total ambulation time (TAT) were measured during the exercise treadmill test and used as the standard in the comparison of correlation between radiographic parameters and walking capacity. The mean D-CSA by CT was 58.3 mm(2) and 47.6 mm(2) by MRI. All radiographic parameters such as AP diameters and D-CSA have no correlation to TAF or TAT (p > 0.05). Our data showed no statistically significant differences in the correlation of the patients' walking capacity to the severity of stenosis as assessed by myelography, myelo-CT and MRI.

Aged↗
PubMed2002

[Myelography, can it be performed as an outpatient procedure?].

The modern contrast agents used today in myelography cause far fewer complications than earlier. This development has opened up the prospect of undertaking myelography as an outpatient procedure. The complications that can occur after the myelography are, for the great majority known, benign, and disappear within a few days, mainly headache. The frequency of minor complications can be minimised by the use of a smaller gauge and/or a rounded needle tip. When the procedure is done by experienced personnel with non-toxic antiseptic preparation, the complications seem to be similar in frequency, magnitude, and type to a simple diagnostic spinal tap. Positioning of the patients after the examination does not affect the frequency or seriousness of the complications. Our study of the patients' attitude towards outpatient myelography shows great satisfaction with the procedure. We therefore conclude that there is no added risk in performing outpatient myelography; the only noticeable complication is headache, which seldom needs intervention, and there are considerable benefits for both patients and hospital in an outpatient procedure.

Ambulatory Care↗