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PubMed2003

Evaluation of myelography and computed tomography in clinically diagnosed patients of lumbar disc herniation.

Forty patients with dinical diagnosis of lumbar disc herniation were evaluated with myelography and CT scan. Myelography diagnosed lumbar disc hemiation at 59 levels in 40 patients, while CT diagnosed disc hemiation at 64 levels. Lumbar disc hemiation was confirmed peroperatively in 30 out of 40 patients at 48 levels. Myelography correctly diagnosed 43 levels out of 48 levels and thus had a sensitivity of 89.6 per cent. CT diagnosed all the 48 levels correctly with a sensitivity of 100 per cent. Thus CT is super to conventional myelography in the diagnosis of lumbar disc herniation. However, conventional myelography supplements CT examination by limiting the number of scans to the level of interest and thus reduces radiation exposure.

Adult↗
PubMed2004

Myelography in spinal disorders--experience of 1400 cases.

OBJECTIVE: To evaluate the diagnostic importance of myelography in spinal disorders, in correlation with clinical presentation of the patients. METHODS: Patients selected for myelography had presented with history of various spinal disorders such as low backache, neurogenic claudication, paraparesis or paraplegia, quadriparesis or quadriplegia, trauma to spinal region and infective spondylitis. Patients excluded were those with history of allergies to iodinated contrast agents, seizures coagulopathy and pregnant women. Contrast agent was water soluble non ionic agent--lohexol. Spinal Needles used were of 20,22 and 25 gauge. X-Ray machine with tiltable table was used for myelography. RESULTS: There were 1400 patients of whom 935 were males and 465 females with male to female ratio of 2.1. Age range was 8 to 65 years. Spinal disorders diagnosed on myelography were lumbar disc prolapse 866 (60%) cases, lumbar canal stenosis 113 (8%), thoracic disc protrusions 15 (1%), infective spondylitis 53 (4%) cases, spinal tumors 36 (2.5%), spinal dysraphism 28 (2%) and traumatic spine in 85 (6%) cases. Free flow of contrast agent with no block was found in 149 (10.64%) cases. These were subjected for MRI scan which revealed significant pathological lesion of surgical importance in 23 cases (1.64%) only. CONCLUSION: Myelography is the least expensive valuable diagnostic test in spinal disorders specially in lumbar disc prolapses and lumbar canal stenosis.

Adolescent↗
PubMed1989

[Ambulatory myelography using iohexol (Omnipaque): methods and results].

Outpatient myelography with iohexol (Omnipaque) was performed in 150 patients. Side effects were noted in 28 patients (19%), with only 3 (2%) major complaints. It concerned 2 patients with severe and prolonged headache and one patient with seizures. Side effects were not more frequent in outpatient myelography than in reported series of hospitalized patients. The frequency of side effects was significantly lower with the use of iohexol than in comparable studies with metrizamide. Headache was the most frequent side effect, followed by an increase or exacerbation of ischiatiform pain, nausea and vomiting. Side effects were slightly more frequent in cervical myelography than in lumbar myelography and were not related to underlying pathology. It is concluded that outpatient myelography is feasable for as far as iohexol is used and patient surveillance is carefully organized.

Adult↗
PubMed1989

[Ambulatory radiculography (lumbar myelography) with iohexol].

Iohexol lumbar myelography was performed in 133 consecutive patients remitted to a private radiological institute on an outpatient basis. Adverse reactions were recorded during the first week after myelography. The data were collected through a questionnaire returned by the patients. The results showed that half (48%) of all patients had no side effects. Some more than one third (41%) of all patients had only mild or moderate side effects from the ambulatory myelography. Of all patients 11% experienced headache or other bothersome symptoms for more than three days following myelography. In this material there was no difference in side effects between women and men. About half of the patients was punctured with a 22 gauge spinal needle and the others with a 25 gauge needle. There was no significant difference in side effects related to needle size. Iohexol lumbar myelography can safely be performed without hospitalization of the patient.

Adult↗
PubMed1989

[Efficacy of CT omnipaque myelography in the demonstration of intraspinal space-occupying diseases (report of 77 cases)].

The value of omnipaque myelography and CT myelography in 77 cases of intraspinal space-occupying lesions (51 extramedullary and 26 intramedullary confirmed by operation) was reviewed. In 69 cases the preoperative diagnosis was accurate, but not in the other 8 cases. It is not advisable according to the authors' experience to have both myelography and postmyelography CT scan done for all intraspinal space-occupying lesions. For most of the extramedullary tumors, myelography alone proved to be adequate. For intramedullary lesions the information obtained from myelography was inconclusive and postmyelography CT scan as a supplementary procedure was necessary.

Adolescent↗
PubMed1987

[Two cases of cervical disc disease with intramedullary pathological changes, which are responsible for their neurological syndromes, on delayed CT myelography].

We report two cases of cervical disc disease with myelopathy classified as of motor system syndrome type showing small contrast accumulation within the spinal cord on delayed CT myelography. In our two cases, high density spots on delayed CT myelography were bilaterally localized within the spinal cord, and believed represent pathological changes of the spinal cord, such as collection of microcavities or cystic necrosis. In case 1, the high density areas seemed to be localized in the anterior horn and corticospinal tract, and in case 2, they seemed to be localized in the corticospinal tract. The patient in case 1 produced signs and symptoms resembling motor neurone disease and lesion could not be differentiated from the latter. Delayed CT myelography showed that the cause of the upper limb amyotrophy was attributed to an anterior horn disorder and that of pyramidal tract sign to a corticospinal tract disorder. Therefore, we could differentiate the lesion from motor neurone disease on delayed CT myelography in case 1. In conclusion, we emphasize that delayed CT myelography can demonstrate the intramedullary pathological changes in the cervical disc disease and is useful in distinguishing between cervical disc disease simulating motor neurone disease and the latter.

Cervical Vertebrae↗
PubMed1987

[Diagnosis of a cystic lesion in the spinal cord--studies on delayed CT myelography and MRI].

UNLABELLED: The collection of contrast medium within the spinal cord on delayed CT myelography generally indicates the presence of syringomyelia. We report the cases of cystic myelopathy with intramedullary contrast accumulation on delayed CT myelography. The purpose of this report is to compare MRI with delayed CT myelogram and to discuss the pathogenesis of the intramedullary contrast accumulation on delayed CT myelography. METHODS AND MATERIALS: Thirty patients with intramedullary contrast accumulation on delayed CT myelography were studied with High Resolution Computed Tomography (Siemens Somatom II) and Magnetic Resonance Imaging (MRI) (0.15T imager, Toshiba MRT 15A). MRI were routinely obtained in both axial plane and sagittal plane. Short spin-echo sequences (30 msec TE, 500 msec TR) were used. This series included 6 cases of cervical disc disease, 5 cases of Chiari malformation, 4 cases of lipomeningocele, 4 cases of adhesive arachnoiditis, 2 cases of thoracolumbar spondylosis, 2 cases of trauma, one case of spinal arachnoid cyst, one case of spinal epidural cyst, and 5 cases of idiopathic type. RESULTS: 1) In 17 out of the 30 patients (57%), the region corresponding to the region of contrast medium collection, which was visualized on delayed CT myelography, was seen as an area of the low signal intensity on MRI. In 11 cases out of 17, the syrinx cavity was confirmed at surgery. 2) In 13 cases, delayed CT myelogram showed collection of intramedullary contrast medium, but MRI failed to reveal an area of low signal intensity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Clinical and electroencephalographic signs of side effects in patients after myelography using "amipaque"].

The authors present the results of own investigations on the occurrence of side effects following myelography with the contrast medium Amipaque administered usually by the lumbar route. Sixty patients aged 21-65 years with various diseases of the spinal cord and cauda equina were studied. Clinical and myelographic investigations were performed before and after myelography. In 6 out of 60 cases (10%) transient neurological disturbances developed including epileptic seizures, speech disturbances of the type of aphasia and dysartria, visual disturbances and twitching of lower extremities. Other symptoms and signs included: headaches, vomiting, collapse. One patient with cardiorespiratory failure died hours after myelography with evidence of increased symptoms of cardiorespiratory failure. EEG changes appeared after myelography in 2/3 of cases and persisted for up to 12 days. The authors call attention to the high proportion of neurological complications and EEG changes which must be taken into account when indications to myelography are considered. Particular caution is necessary in cases with coexistent cardiorespiratory failure.

Adult↗
PubMed1985

[Cervical myelography and x-ray computed tomography in arm paralysis of traumatic origin].

Results of cervical myelography by the lumbar approach were compared with those of CT scan imaging after subarachnoid metrizamide by the lumbar route, in 16 patients operated upon for post-traumatic cervical spine lesions. Examination in each patient included the last four cervical and first thoracic roots on the injured side, making a total of 80 roots. Lesions detected by myelography and CT scanning are described, comparison of semiologic data with gross findings at operation showing poorer diagnostic accuracy for myelography (86%) than for myelography and a CT scan combined (97%). Sensitivity of the former varied between 70 and 90%, depending on whether doubtful forms were classed as normal or pathologic, but was lower than that of the CT scan (96%). This also applied to specificity (90% as against 96%) and diagnostic accuracy (86% to 90% as against 97%). Combining myelography with a CT scan after subarachnoid contrast injection provides complementary very precise data allowing improved therapeutic results.

Adolescent↗
PubMed1984

A comparison of CT scanning and myelography in the diagnosis of lumbar disc herniation.

Computerized tomographic (CT) scanning of the fourth and fifth lumbar disc spaces with the GE CT/T8800 scanner followed by metrizamide myelography was obtained for 134 consecutive patients with suspected lumbar disc disease. There was an overall concordance rate of 85% between CT scanning and myelography. In those 52 patients treated by surgery, concordance between the CT and the myelogram was similar at 86.5%. Myelography and surgical findings were in agreement in 94.2% of cases, while CT findings and surgical finding agreed in 92.3% of cases. The authors' data indicate that the CT scan is as accurate as myelography in the diagnosis of lumbar disc disease. When the CT scan interpretation is supported by clinical findings, the myelogram may be eliminated in the preoperative patient. Myelography may be reserved for equivocal cases.

Adolescent↗
PubMedDate not supplied

Metrizamide myelography and postmyelographic computed tomography: comparative adequacy in the cervical spine.

Metrizamide myelography and postmyelographic computed tomography (CT) were evaluated for relative efficacy when correlated with operative findings in a series of 30 patients. Fifty-seven levels were operated on in the 30 patients with 27 patients diagnosed as having diffuse cervical stenosis, hyperostotic spondylosis, or herniated nucleus pulposus. Metrizamide myelography and CT metrizamide myelography were equally useful in providing preoperative diagnostic information at 44 of 57 levels. Both radiographic techniques agreed with the degree of canal and neural forman stenosis found operatively at more than 80% of levels. This study indicates that either metrizamide myelography or CT myelography alone is sufficient, and that both should be performed only if one fails to answer the clinical question or if syringomyelia or cord tumors are suspected.

Adult↗
PubMed1984

A study of computer-assisted tomography. II. Comparison of metrizamide myelography and computed tomography in the diagnosis of herniated lumbar disc and spinal stenosis.

One hundred twenty-two patients with surgically confirmed pathology consisting of either herniated lumbar disc, spinal stenosis, or both were included in this investigation. For each of these patients, preoperative metrizamide myelography and computerized tomography were performed. Each myelogram and CT scan was read blindly so that the neuroradiologist interpreting the study had no knowledge of the patient's surgical pathology, clinical examination, nor any knowledge of the interpretation of the other preoperative test. A painstaking attempt was made to describe precisely both the exact nature of the preoperative myelogram and CT scan interpretations. The correlations between the preoperative interpretation of each test and the observed surgical findings then were analyzed statistically. Based upon this analysis, myelography was found to be more accurate than computed tomography in the diagnosis of herniated lumbar disc (83% vs. 72%). In the diagnosis of spinal stenosis, myelography was slightly more accurate than computed tomography (93% vs. 89%). Based upon the results of this study, the authors conclude that metrizamide myelography is more accurate than computed tomography in the diagnosis of both herniated lumbar disc and spinal stenosis and remains the diagnostic study of choice for these conditions. Furthermore, metrizamide myelography gives the added advantage of visualizing the thoracolumbar junction and, thus, affords the opportunity to diagnose occult spinal tumors.

False Negative Reactions↗
PubMedDate not supplied

Metrizamide myelography and epidural venography. Their role in the diagnosis of lumbar disc herniation and spinal stenosis.

This study compares lumbar epidural venography with metrizamide (Amipaque) myelography as diagnostic modalities in the evaluation of lumbar disc herniation and spinal stenosis. The accuracy of epidural venography and metrizamide myelography was evaluated in 30 surgically confirmed cases of lumbar disc herniation and spinal stenosis to determine their relative diagnostic values. Sensitivities of epidural venography and metrizamide myelography were 83% and 97%, respectively, while the specificities were 88% and 100%, respectively. The conclusions of this study were: (1) The accuracy of metrizamide myelography exceeds that of epidural venography in the diagnosis of lumbar disc herniation and spinal stenosis. (2) Metrizamide myelography is indicated as the primary contrast technique in lumbar disc herniation and spinal stenosis. (3) Epidural venography is indicated as a secondary contrast technique in patients with a congenitally short or tapered dural sac.

Adult↗
PubMed1995

[Intracranial distribution of iohexol and iotrolan after cervical myelography].

Twenty-eight consecutive patients undergoing cervical myelography were examined with either iohexol (14) or iotrolan (14). Just before the myelography a cranial CT was performed and control CT (3-5 slices) examinations were performed three, six, 24 and 48 hours afterwards. In all 28 patients CT showed intracranial contrast medium distribution after cervical myelography. The contrast medium distributed mainly in the subarachnoid space, first to the basal cisterns and the insular fissures, and to the 4th ventricle. The densities in the subarachnoid spaces were significantly higher after iotrolan than iohexol in the basal cisterns three and six hours after myelography, and in the 4th ventricle. The subcortical density was still increasing 48 hours after iotrolanmyelography while the subcortical density reached the maximum 24 hours after iohexolmyelography. Following cervical myelography the contrast media iohexol and iotrolan distribute intracranially and iotrolan seems to be eliminated more slowly than iohexol.

Adult↗
PubMed1996

Myelography with Omnipaque (Iohexol) using basic radiographic facilities: the main adverse effects.

OBJECTIVE: Documentation of main adverse effects, their magnitudes and relationship to contrast concentrations in patients subjected to myelography under basic radiographic facilities. Use of the acquired data for better patient management in the future. DESIGN: In a prospective double blind study consecutive admitted neurological patients of age range seven to 77 years were subjected to myelography with different concentrations of Omnipaque (300* cervical, 240* thoracic and 180* lumbar) under limited radiographic facilities by radiologists (cases). Thirty admitted patients of about the same age range with justified medical problems were subjected to diagnostic lumbar puncture by different physicians (controls). The main adverse effects were assessed in both groups (subjects) by a neuro-physician unaware of subject status. Patients primarily admitted to the hospital with headache, dizziness, nausea, vomiting and convulsions and subjected to lumbar puncture were excluded from the study. SETTING: Cases and controls were derived from patients referred from variable regional hospitals scattered throughout the country. SUBJECTS: 110 consecutive neurological cases referred to the Radiology Department for myelography between December 1989 and January 1991. Thirty consecutive qualifying diagnostic lumbar puncture patients managed at the same period. MAIN OUTCOME MEASURES: Development of symptoms including headache, dizziness, nausea, vomiting and convulsions and evaluation of their magnitude subjectively quantitated from mild (+) and moderate (+2) (tolerable) to severe (+3), (intolerable) among the cases and controls. RESULTS: Overall, symptoms in all magnitudes (mild to severe) occurred in 63.6pc of cases compared to 36.7pc of controls (p < 0.05). Concentrations of 300 and 180 were more associated with the effects (p = 0.017 and 0.016 respectively) while the 240 concentration was relatively safe causing no more adverse effects than a diagnostic lumbar puncture (p = 0.137). In severe magnitudes (intolerable) the same effects occurred in 20.9pc of cases compared to 6.7pc of controls (p < 0.05); differences in contrast concentrations did not significantly feature (p = 0.59: Omnipaque 300; p = 0.063: Omnipaque 240 and p = 0.061; Omnipaque 180). CONCLUSION: Even with limited radiographic facilities, myelography with Omnipaque 240 is relatively safe; being associated with no more adverse effects than a medical diagnostic lumbar puncture; thus the contrast concentration of choice for myelography under sub-optical radiographic set up. With the 180 and 300 concentrations, the procedure is associated with tolerable adverse effects not significantly differing from those arising from the same procedure performed under ideal radiodiagnostic establishments.

Adolescent↗
PubMed2003

The value of routine MR myelography at MRI of the lumbar spine.

PURPOSE: To determine whether a commercially available automated MR myelogram sequence improves the interpretation and diagnostic yield at MRI of the lumbar spine. MATERIAL AND METHODS: A total of 207 consecutive patients referred for MR examination of the lumbar spine for evaluation of low back pain or spinal radicular symptoms were included for study. All patients had initial imaging with sagittal T1-W and T2-W scans, followed by axial T2-W images. Subsequently an MR myelogram was acquired in each case in coronal, sagittal and oblique planes. MR myelogram images were evaluated initially and a diagnosis was established and recorded. Subsequently, a diagnosis was established by review of conventional images of the lumbar spine in sagittal and axial planes, in conjunction with the MR myelogram. The utility of the MR myelogram in establishing the diagnosis was graded on a 4-point scale, where grade 0 indicated that it contributed no additional information and grade 3 indicated that it was essential for diagnosis. Analysis of the additional value of myelography in patients with multilevel disease was made. RESULTS: Primary diagnoses were disc herniation in 69 cases (33%), degenerative disc disease in 51 cases (26%), spinal stenosis in 19 cases (9%), isolated lateral recess stenosis in 5 cases (2%), or other diagnoses, including facet degeneration in 48 cases (23%). Scans were normal in 15 cases (7%). MR myelography was graded as grade 0 in 151 cases (73%), grade 1 in 44 cases (21%) and grade 2 in 12 cases (6%). In no case was MR myelography essential for diagnosis (grade 3). In patients with multilevel disease (n=27), in 17 cases MR myelography was graded as grade 1 (63%) and in 8 cases grade 2 (30%). CONCLUSION: MR myelography when employed in routine practice was of limited value, assisting in establishing a diagnosis in a minority of cases (6%). The technique was of limited additional value in patients with multilevel pathology and to a lesser extent in patients with scoliosis, where it helped to establish the level most likely to account for pathology.

Adolescent↗
PubMedDate not supplied

Preoperative electroneuromyography and myelography in cervical root compression.

The preoperative diagnostic accuracy of electroneuromyography and myelography was evaluated in 77 patients with cervical radiculopathy and/or myelopathy. In 57% of the patients, the affected root level could be determined with ENMG (accuracy 1-2 segments), 10% had a non-specific finding, and in 33% of the patients, ENMG was normal. If the symptoms had lasted less than three months, 67% of the patients had a localizing finding in ENMG. Among the 97 operated root levels, there were distinct findings in myelography in 79, minor root sheath deformities in 13, and the finding was negative in five. In addition, in myelography there were clearly pathological root sheath deformities at 20 and minor changes at 20 root levels which were not operated. ENMG and myelography have a complementary role in the diagnosis of cervical root compression. By combining the information of ENMG and myelography, the functional significance of the morphological root sheath deformities can be assessed.

Adult↗
PubMed1979

Electromyographic abnormalities following myelography.

Electromyographic (EMG) abnormalities were found in 13 of 32 patients with previously normal studies following myelography. These abnormalities usually developed by the first day after myelography and resolved by the fourth day. The changes were evenly divided between those restricted to a single paraspinal muscle level, thus mimicking the frequent findings in radioculopathy, and those present bilaterally and at multiple levels. We were unable to correlate these EMG changes with the clinical status of the patient or with events occurring at myelography. Thus, the performance of EMG within four days following myelography can lead to false-positive results if paraspinal muscle EMG abnormalities are used as the diagnostic criteria.

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