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The radiological diagnosis of meningiomas, the impact of EMI scanning.

A review of the impact of computerized axial tomography on the radiological diagnosis of meningiomas is presented. Seventy-one intracranial and eight orbital cases have been examined by this new method using the 160 X 160 matrix. The diagnostic accuracy of the method is compared with established neuroradiological methods of examination (plain X rays, angiography, pneumography and isotope scanning). The new non-invasive method is undoubtedly the most accurate diagnostic tool yet available. It provided a specific diagnosis of meningioma in 77% of the intracranial cases without contrast enhancement and diagnosed the presence of tumour in a further 19% giving an overall tumour diagnosis of 96%. There were three false negatives (4%). After intravenous injection of contrast medium specific diagnosis of meningioma was made in a further six cases raising the specific diagnostic rate to 86%. Specific identification of intra-orbital meningiomas is more difficult though the presence of retro-orbital tumour was correctly diagnosed in all eight cases examined (100%). In none of our cases was a false positive diagnosis of tumour made. However, there are areas where a specific diagnosis of meningioma can only be made as part of a wider differential diagnosis. Apart from the orbit these include the suprasellar area, the cerebello-pontine angle, and the intraventricular regions. Occasionally also supratentorial gliomas or secondaries can simulate meningiomas.

Angiography↗

Dimer X in hysterosalpingography.

The incidence of abdominal pain during hysterosalpingography was assessed from replies to postal questionnaires completed by 42 patients receiving Diaginol Viscous and 23 patients receiving Dimer X: the questionnaires were analysed using a double-blind technique. In the Diaginol Viscous group, 58.5% of patients experienced moderate or severe pain during the injection as compared with an incidence of only 19% in the group receiving Dimer X. In three of tha patients receiving Diaginol Viscous, there was brief loss of consciousness. Radiographic quality was satisfactory with both contrast media. After effects of hysterosalpingography were relatively common and included: lower abdominal pain; vaginal bleeding; temporary difficulty in walking; menstrual disturbances in subsequent periods. No correlation could be demonstrated between the type of medium used and the incidence of these after effects.

Clinical Trials as Topic↗

The effect of osmotic diuresis on urinary iodine concentration using contrast media of differing osmolality.

The urinary iodine concentrations of a monomer (sodium iothalamate), a dimer (sodium iocarmate) and a non-ionic compound (metrizamide) have been compared in dogs with varying levels of solute excretion. All the animals were undergoing maximal antidiuresis. In dogs with normal solute excretion, metrizamide and iocarmate produced higher urinary iodine concentrations than iothalamate. There was no significant difference between metrizamide and iocarmate. With increasing levels of solute excretion, the differences between the compounds were reduced. These findings suggest that contrast media of reduced osmolality are unlikely to have a special place in advanced renal failure.

Animals↗

Kidney distension during IV urography in normal rats and in rats with artificial unilateral renal artery stenosis.

Acute changes in kidney size during IV urography were studied in normal rats and in rats with artificial unilateral renal artery stenosis. In normal rats, IV bolus injection of sodium iothalamate (400 mg I/ml), 1.5 ml/kg body weight, produced an increase in area of the renal silhouette by an average maximum of 12.7% after 60 seconds. In nine out of ten rats which developed hypertension after left sided renal artery clamping, renal distension was either small or absent on the stenosed side, while the contralateral right kidney showed normal distension during IV urography. Two out of three rats, which remained normotensive after renal arterial clamping, showed normal distension of both kidneys. These results confirm earlier observations in man that the acute changes in size of the kidney during IV urography can be used as an aid in the urographic screening of hypertensive patients for significant renal arterial stenosis. In all rats with arterial clamp and hypertension, the stenosed kidney was smaller than its contralateral mate. An index between the size of the non-stenosed and the stenosed kidneys greater than 1.15 was only seen in these particular rats.

Animals↗

Contrast dose for enhancement of computed tomograms of the brain.

This study shows that contrast enhancement of cerebral lesions can be adequately achieved with a bolus injection of 60 ml of sodium iothalamate 70%. While the infusion of a larger dose of contrast agent increases quantitatively the level of enhancement of a variety of lesions, this method of examination does not appear to provide any more useful diagnostic information, and it introduces added and unnecessary inconvenience, cost and potential hazard.

Brain↗

Adverse reactions to urographic contrast medium. Rapid versus slow injection rate.

Adverse reactions following very rapid (ten seconds) and slow (two minutes) i.v. bolus injection of meglumine ioxitalamate (380 mg I/ml, 1.5 ml/kg bodyweight) for urography were compared. Except for warmth and a mild transient headache, rapid injection caused no higher incidence of adverse reactions. The rapid injection provides a high quality nephrogram. It may be hazardous in patients with pre-existing heart disease.

Adolescent↗

A randomized blind trial of Iopamidol and meglumine calcium metrizoate (Triosil 280, Isopaque Cerebral) in cerebral angiography.

A randomized blind trial of iopamidol and meglumine calcium metrizoate (Triosil 280, Isopaque Cerebral) for cerebral angiography was performed in 20 patients. The Iopamidol was better tolerated and caused significantly less discomfort in patients than metrizoate. There was no difference in the quality of the radiographs. A further 13 patients also received Iopamidol for cerebral angiography with similar results. No adverse effects were observed in any of the patients. Our evidence suggests that Iopamidol has significant advantages over currently available contrast media for cerebral angiography.

Cerebral Angiography↗

A comparative trial of sodium meglumine ioxaglate (Hexabrix) and iopamidol (Niopam) for cerebral angiography.

We have carried out a randomized blind trial comparing iopamidol (Niopam) and sodium meglumine ioxaglate (Hexabrix) in cerebral angiography in 50 patients. There was no significant difference in the degree of pain or movement produced by the contrast media. The degree of heat felt was slightly greater with iopamidol than with ioxaglate. Both were very well tolerated by patients, producing only a mild or moderate sensation of heat, and in only a few instances slight pain during the injections. No difference in radiographic quality was observed. We conclude that both media are a significant advance over the conventional ionic media and the choice between them will be determined by factors of neurotoxicity, ease of use and cost.

Carotid Arteries↗

Isomeric purity and supersaturation of iopamidol.

We have found that iopamidol 370 mg I/ml solutions may be greatly supersaturated and iopamidol 300 mg I/ml solutions slightly supersaturated at 4 degrees C and at 25 degrees C. The solubility and degree of supersaturation probably depend on the isomeric purity of the preparation. Some possible implications are discussed.

Contrast Media↗

Contrast agent induced thrombophlebitis following leg phlebography: iopamidol versus meglumine iothalamate.

A comparison was made of the incidence of venous thrombophlebitis resulting from the use of a high-osmolality contrast medium (Conray 60%, meglumine iothalamate), and a low-osmolality contrast medium (Niopam 61%, iopamidol). In 20 patients Conray was injected into one leg and Niopam into the other. The incidence of thrombophlebitis was then determined using the iodine-125 fibrinogen uptake test in a prospective, randomised, double-blind study. There was significantly less thrombophlebitis with Niopam than with Conray and it is concluded that Niopam is a safer contrast medium for phlebography.

Adult↗