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PubMed1978

Lumbar myelography with amipaque.

In lumbar myelography, early side effects occur in about half the patients examined with modern water-soluble contrast media. At myelography with Amipaque (metrizamide) these reactions are usually minor, and serious adverse reactions are rare. In our own series of 650 consecutive lumbar myelographies with Amipaque there were no serious adverse effects. Minor adverse reactions occurred in 56% of the patients. Transient electroencephalogram (eeg) changes were seen in 14% of the patients, with only 5 patients showing paroxysmal spike activity. Adhesive arachnoiditis following lumbar myelography occurs significantly less often with Amipaque than with any other contrast medium. The properties of Amipaque provide excellent possibilities for detailed studies of all parts of the spinal subarachnoid space, and the medium constitutes a new and interesting aid for these investigations.

Adult↗
PubMedDate not supplied

Metrizamide myelography in patients with iodine allergy or previous adverse reactions to iodinated contrast media.

Twenty-seven metrizamide myelographies were performed in 26 patients who had a history of iodine allergy or adverse reactions to iodinated contrast media. Three of the patients had had adverse reactions from a previous myelography procedure. All patients received atropine, diazepam, and metoclopramide as premedication. In ten examinations corticosteroids were also given. No patient, during or after myelography, had any reaction that could be related to hypersensitivity to the contrast medium. The incidence of headache, the most frequent side effect, was almost the same in patients who had corticosteroids in their premedication (30%) as in patients without (35%). These observations indicate that metrizamide myelography may be performed despite previous adverse reactions to contrast media.

Adrenal Cortex Hormones↗
PubMed1995

A controlled comparison of myelography, computed tomography, and magnetic resonance imaging in clinically suspected lumbar disc herniation.

STUDY DESIGN: A controlled prospective blinded study. OBJECTIVES: To compare the diagnostic power of myelography, computed tomography and magnetic resonance imaging in the diagnosis of low lumbar disc herniation. METHODS: Eighty patients with monoradicular sciatica were examined by myelography, computed tomography, and magnetic resonance imaging, and all underwent subsequent surgery. The images were evaluated twice in a blinded fashion, and the diagnostic power of the modalities was expressed by a decision-analytic regret function. RESULTS: In 57 patients (71%) a disc herniation at the expected level was disclosed at surgery. The largest amount of diagnostic information was gained from computed tomography, followed by magnetic resonance imaging and myelography. Both computed tomography and magnetic resonance imaging were significantly informative, whereas this was not the case for myelography. CONCLUSION: The results indicate that computed tomography or magnetic resonance imaging should be the first choice for imaging in patients with suspected lumbar disc herniation.

Adult↗
PubMed1988

Sequelae of myelography in the horse.

The records of 131 horses undergoing general anaesthesia and positive contrast cervical myelography with metrizamide were examined to determine the effect of the procedure on the 'patient'. Three per cent of minimally ataxic and moderately ataxic horses had serious complications after myelography. Thirty-two per cent of severely ataxic horses died or were destroyed after general anaesthesia and myelography. Although general anaesthesia and myelography are essential components of a complete neurological evaluation of a horse, they impose a significant risk.

Anesthesia, General↗
PubMed1978

The effect of dehydration on the side effects of metrizamide myelography.

The effect of dehydration on the incidence of side effects from metrizamide myelography was studied. One hundred consecutive patients scheduled for myelography fasted overnight and were then randomly divided into two groups. Group I received 2 liters of fluid intravenously just prior to myelography; Group II did not. Both groups were studied in the standard manner, using 170 mg l/ml of metrizamide. Side effects were recorded 24 and 48 hours after the procedure. Headaches, vomiting, and some other side effects were less common and less severe in the hydrated group. Clear liquids given orally or intravenous fluids are recommended prior to myelography to minimize side effects.

Adolescent↗
PubMed1982

A prospective comparison of computed tomography and myelography in the diagnosis of herniated lumbar disks.

Although CT effectively demonstrates normal and herniated intervertebral disks, the value of CT in low back pain has not been adequately evaluated. We compared CT prospectively with myelography in 107 patients referred to Ulleval Hospital Department of Radiology for myelography. Fifty-two patients subsequently had spinal explorations, one patient twice during the study and two patients at two levels. Forty-six CT and 44 myelographic diagnoses agreed perfectly with the operative diagnosis at that level. In 30 disk herniations, there were 29 true-positive CT diagnosis and 28 true-positive myelographic diagnoses. False-negative diagnoses of herniated nucleus pulposus were made twice on myelography and once on CT. In 24 other spinal operations, there were eight false-positive CT and nine false-positive myelographic diagnoses of herniated nucleus pulposus. CT demonstrates lumbar disk disease as effectively as myelography.

Adolescent↗
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↗
PubMed1986

Outpatient metrizamide myelography: prospective evaluation of safety and cost effectiveness.

A group of 228 consecutive patients undergoing metrizamide myelography was prospectively evaluated for postprocedure symptoms. The observed prevalence of these symptoms concurs with previously reported inpatient studies, with the most common sequelae being exacerbation or onset of spine or extremity pain, headache, nausea, and paresthesia. Limitation of administered dose of metrizamide in lumbar myelography may slightly reduce the occurrence of common symptoms, but withdrawal of contrast medium at the completion of examination had no impact on their occurrence. There was a higher occurrence of paresthesia in cervical myelography, but otherwise there was no significant difference in symptoms between cervical and lumbar studies. Outpatient metrizamide myelography can be performed with relative safety with the potential for significant cost savings.

Adolescent↗
PubMed1987

Lumbar disk herniation: diagnosis with CT or myelography.

The value of computed tomography (CT) and myelography as single investigations in the diagnostic evaluation of patients with radiating leg pain probably due to lumbar disk herniation (LDH) has been adequately demonstrated. However, the extent to which CT can replace myelography and the conditions in which the examinations should be combined and in which order are still uncertain. Results of CT scans and myelograms from 461 patients with symptoms of lumbar root compression, probably due to LDH, were evaluated and compared with surgical results, if available. The sensitivity of myelography exceeded that of CT (82% vs. 73%), but its specificity was lower (67% vs. 77%). The positive predictive value of myelography only slightly differed from that of CT (93% vs. 94%). These results were used to establish a sequential diagnostic workup for patients with radiating leg pain. If, in this population with a high prior probability for surgery, CT had been the investigation of first choice in patients suspected of having LDH, the number of myelographic procedures performed could have been reduced by two-thirds.

Adult↗
PubMed1989

Spinal cord compression due to metastatic disease: diagnosis with MR imaging versus myelography.

To determine the efficacy of magnetic resonance (MR) imaging and myelography for the diagnosis of spinal cord compression due to metastatic disease, the authors prospectively examined 70 patients who had known or suspected spinal involvement by malignancy. Most MR examinations consisted of T1-weighted sagittal imaging of the entire spine, with additional sequences as needed for clarification. Extradural masses were found in 46 patients, 25 of whom had cord compression. For extradural masses causing cord compression, the sensitivity and specificity of MR imaging was .92 and .90, respectively, compared with .95 and .88 for myelography. For extradural masses without cord compression the sensitivity and specificity of MR imaging was .73 and .90, versus .49 and .88 for myelography. MR imaging was much more sensitive for metastases to bone (.90 vs .49), as expected. MR imaging is an acceptable alternative to myelography for diagnosing spinal cord compression and is preferable as a first study because it is noninvasive and better tolerated.

Adult↗
PubMed1989

Lumbar myelography with iohexol in outpatients: prospective multicenter evaluation of safety.

A multicenter open, noncomparative evaluation of the safety of iohexol was prospectively conducted in 81 adult outpatients undergoing screen-film lumbar myelography. Iohexol (180 milligrams of iodine per milliliter) was administered via a lumbar route at a dose of 8-17 mL. Computed tomography (CT) was performed after myelography. The safety of iohexol was assessed by monitoring adverse reactions and neurologic status and by measuring vital signs and serum laboratory values. The most frequent adverse reaction was headache (16 of 81 patients [19.7%]). Twelve patients complained of a headache on the day of the myelographic procedure, and four patients reported a headache 24 hours after the procedure. Nausea or vomiting occurred in four of 81 patients (4.9%) only on the day myelography was performed. No other neurologic abnormalities were found. Iohexol produced myelographic and CT studies of good to excellent quality in all patients. This study indicates that iohexol can be employed safely in lumbar myelography of adult outpatients.

Adult↗
PubMed1993

Disk-caused nerve compression in patients with acute low-back pain: diagnosis with MR, CT myelography, and plain CT.

Ninety-five patients with acute low-back and radicular pain underwent magnetic resonance (MR) imaging and either plain computed tomography (CT) (n = 32) or CT myelography (n = 63) for diagnosis of herniated nucleus pulposus-caused nerve compression (HNPNC). Patients were followed up for at least 6-12 months. Fifty-six patients underwent surgery, and 39 received conservative treatment. Receiver operating characteristic (ROC) analysis was performed on correlation of results of blinded image reading with "true" diagnoses determined by an expert panel [corrected]. Results in subgroup analysis for ROC curve areas were MR, 0.84, versus plain CT, 0.86; MR, 0.81, versus CT myelography, 0.83; and MR, 0.82, versus findings with both CT techniques, 0.85. Results indicate no statistically significant difference in diagnostic accuracy of HNPNC among the three modalities. Thus, factors of cost, radiation dose, and invasiveness influence selection of modality. On the basis of accuracy findings, the authors suggest that MR should replace CT myelography because of the invasiveness of myelography but that MR should not replace plain CT because plain CT is equally accurate and much less costly.

Acute Disease↗
PubMed1988

Absence status epilepticus resulting from metrizamide and omnipaque myelography.

Two cases of absence status are described, one case following metrizamide myelography and the other from omnipaque myelography. Metrizamide has been well known to cause convulsive seizures even in patients without epilepsy. The exact mechanism is not known but appears to be direct neuronal toxic effects possibly due to competitive inhibition of hexokinase activity. The acute confusional state following myelography from water soluble agents is reviewed. In view of the difficulty in clinical diagnosis and the excellent response to anticonvulsant therapy, the possibility of this clinical entity should be specifically excluded by EEG in any person suffering from prolonged confusion following myelography with water soluble agents.

Aged↗
PubMed1986

Impact of myelography on the radiotherapeutic management of malignant spinal cord compression.

From December 1981 through August 1984, 24 patients with spinal cord compression syndrome due to epidural neoplasms were evaluated for radiotherapy with clinical examination, radiographs of the spine, and myelography. All plain films were reviewed, and mock radiotherapy fields designed using specific criteria for margins. The same patients were reviewed a second time considering the additional information provided by myelography. The initial treatment fields were found to be inadequate in 69% of the patients. Even in patients with discrete bony lesions, the results of myelography affected the treatment 45% of the time. A history of previous spinal irradiation significantly influenced port design in only 1 of the 7 patients who had received previous radiotherapy. Although invasive, myelography is essential in planning the treatment of spinal cord compression.

Adult↗
PubMed1987

Metrizamide-enhanced computed tomography as an adjunct to metrizamide myelography in the evaluation of lumbar disc herniation and spondylosis.

Eighty patients with operatively proven lumbar disc herniation or lumbar spondylosis were preoperatively evaluated with metrizamide myelography followed by metrizamide-enhanced computed tomography (CT). The x-ray films were reviewed without knowledge of the operative findings, and the patients were subdivided into those with disc extrusions, spondylosis, or recurrent abnormalities. For the group as a whole, CT was correct in 82% and myelography was correct in 77%. Both CT and myelography together were accurate in 91%, a significant improvement (P less than 0.02). The authors conclude that, if both studies are performed, the percentage of cases correctly diagnosed is increased. Therefore, both metrizamide myelography and metrizamide-enhanced CT should be obtained in selected cases. A review of the literature is included.

Adult↗
PubMed2006

Utility of preoperative magnetic resonance imaging myelography for identifying dural defects in patients with spinal extradural arachnoid cysts: case report.

OBJECTIVE: Preoperative magnetic resonance imaging (MRI) myelography scans demonstrated a dural defect in a 50-year-old man with an epidural arachnoid cyst who had a 29-year history of untreated weakness and numbness both lower limbs. METHODS: MRI scans showed a dorsal intraspinal extradural cystic lesion at the level from Th11 to L1. Although preoperative cine-MRI scans failed to display the dural defect, an MRI myelography scan showed cerebrospinal fluid in the subarachnoid space containing a cyst. RESULTS: The site of shunting between the subarachnoid space and the cyst was visualized as a pulsating flow void to the right of Th12. We removed the cyst wall and closed the dural defect via laminectomy. CONCLUSION: Because the preoperative MRI myelography scan correctly identified the existence and location of the dural defect, we conclude that MRI myelography is helpful for detecting dural defects in patients with epidural arachnoid cysts.

Arachnoid Cysts↗
PubMed1976

A clinical trial of Amipaque in lumbar myelography.

Three hundred lumbar myelographies using a new water-soluble, non-electrolytic contrast medium, Amipaque, were assessed with reference to: 1) the correlation between radiological and operative diagnosis; 2) the side-effects during and after the myelography. Myelograms of the same reliability as those obtained with other water-soluble contrast media were obtained. However, arachnoiditis as sequelae to previous myelography with oil-soluble and earlier water-soluble contrast media prevented the correct evaluation in some cases. Spinal anaesthesia was not necessary. There was no case of muscle spasms or other serious complication. Eight patients who were re-examined with Amipaque more than two months later revealed no evidence of arachnoiditis as sequelae to the first Amipaque myelography.

Adult↗
PubMed1983

The relationship of complications to the time between myelography and discectomy.

This paper describes the relationship between post-myelographic symptoms and the timing of a subsequent spinal operation. A prospective study was performed comparing the post-operative symptoms of patients who underwent discectomy within 48 hours of myelography (Group 1) with those of patients who underwent discectomy at least seven days after myelography (Group 2). After myelography there was no statistical difference in the incidence of nausea and headache in the two groups. However, after operation the incidence of headache and nausea was significantly greater in patients who underwent early discectomy. The incidence of urinary retention was significantly greater in Group 1 at 24 hours after operation but not at 48 and 72 hours. We conclude that the temptation to perform discectomy shortly after myelography should be resisted until at least one week has elapsed between the two procedures, except in emergency situations.

Adult↗