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PubMed2006

Dynamic computed tomography myelography for the investigation of cervical degenerative disease.

Dynamic computed tomography (CT) myelography was conducted in 15 patients with cervical degenerative disease to assess the lesions responsible for their symptoms. CT myelography was performed using a multi-detector row helical CT system in dynamic positions (flexion or extension or both) in addition to the neutral position. Fine sagittal reconstructed images could be obtained in addition to axial images. This method provided static information including cervical vertebral body deformities, and good contrast images of the spinal cord, nerve roots, and cerebrospinal fluid space. In addition, laterality of the offending lesion and changes exaggerated by cervical motion were clearly shown in both axial and sagittal images. Ten of 15 patients demonstrated dynamic changes including dynamic canal stenosis or spinal cord impingement. The operative strategies were changed based on dynamic CT myelography findings in three of the 15 patients. Dynamic CT myelography can provide the axial and sagittal images required for flexion-extension studies, and in combination with conventional imaging modalities, provides valuable information for determining treatment strategies and objectives.

Adult↗
PubMed1980

Diastematomyelia in children: metrizamide and CT metrizamide myelography.

Diastematomyelia is an uncommon dysraphic lesion of the spine which has been diagnosed more frequently since the advent of newer diagnostic methods. A series of 21 cases was examined using metrizamide myelography and computed tomographic metrizamide myelography (CTMM) over a 3-year period. These examinations, in addition to plain radiographs of the spine, have demonstrated certain features of diastematomyelia hitherto unreported. A bony or cartilaginous spur was an uncommon finding, occurring in only six cases. Also, the split spinal cord was found within an unsplit dural sac in 15 cases. Coexistent tethering of the spinal cord, even in the absence of a spur, was present in 16 of the 21 cases. CTMM proved superior to metrizamide myelography in demonstrating the spinal cord anomalies; plain films and CT are complementary in showing the bony anomalies. The radiographic investigative protocol of diastematomyelia includes plain anteroposterior and lateral spine films, metrizamide myelography, and CTMM. Conventional tomography and plain CT are unnecessary; improved density resolution and availability of computed radiographic anteroposterior and lateral scout views will further reduce the need for plain films and intrathecal injection of contrast medium.

Adolescent↗
PubMed1989

Cauda equina syndrome with normal lumbar myelography.

The consequences of signs of emergency compression of cauda equina in combination with a normal lumbar myelography are reported in 19 patients. Two of them had a tumor and a herniated disc, respectively, in the thoracic spine discovered by a second myelography. One patient was considered to have a hysterical paresis. In 3 patients the symptoms were attributed to diseases not related to the spine. Thirteen patients recovered spontaneously. We conclude that the prognosis for patients with signs of compression of the cauda equina is favorable provided the myelography is normal; surgical exploration is then not indicated. However, if severe unexplained symptoms persist and computed tomography is normal, myelography of the thoracic spine should be considered.

Acute Disease↗
PubMed1984

beta-Endorphin-like immunoreactivity increases in human lumbar cerebrospinal fluid following routine metrizamide myelography.

Much interest has recently been focused on the possible role of the endogenous opiates in the perception of pain in humans. Several investigators have examined the levels of these substances in human cerebrospinal fluid (CSF) in attempts to identify the mechanisms by which electrical stimulation of the brain might induce analgesia. Most of these CSF samples were collected at the time of ventriculography or myelography. In the present study, the levels of beta-endorphin in the CSF of 22 patients undergoing myelography were examined before and after the injection of a contrast agent. beta-Endorphin increased an average of 356% (p less than 0.0005) 15 to 20 minutes following the injection of contrast material into the lumbar subarachnoid space. Thus, routine myelography may have a profound effect on the levels of beta-endorphin measured by radioimmunoassay in human CSF, and great care must be taken in interpreting the significance of changes seen in beta-endorphin levels in CSF collected from patients at the time of myelography or ventriculography. The effect of the injection of contrast material on beta-endorphin immunoreactivity must be distinguished from the postulated effects of any analgesia-inducing therapy.

Adult↗
PubMed1984

Evaluation of cervical spinal cord injuries with metrizamide myelography-CT scanning.

In the past, patients with injuries of the cervical spine and spinal cord have been diagnosed by means of myelography and polytomography. In an attempt to improve the radiographic evaluation of patients with cervical spinal cord injuries the authors performed computerized tomography (CT) scanning of the cervical spine following injection of metrizamide into the spinal subarachnoid space. In 23 patients with cervical spinal cord injuries, metrizamide myelography was performed via a C1-2 puncture. Myelography was used only for localization of the lesion and to determine the site of CT scanning. After myelography, CT scanning of the cervical spine in the transaxial plane was effective in determining the exact nature of compressive lesions and distinguishing the etiology among hematoma, disc, bone fragments, osteophytes, or ossification of the posterior longitudinal ligament. In several patients, metrizamide could be seen entering the spinal cord and was indicative of anatomical spinal cord disruption. In patients with fractures, CT scanning identified the site and nature of the injury without the need for turning the patient to the lateral position. In several patients with an apparently stable cervical spine, the CT scan showed apophyseal joint widening indicative of instability. The authors conclude that CT scanning of the cervical spine after the introduction of metrizamide into the subarachnoid space provides a definitive evaluation of the cervical spinal cord, the bone structures of the cervical spine, and their relationship to each other.

Adolescent↗
PubMed2000

[MR myelography: analysis of 126 cases].

OBJECTIVE: To investigate the value and limitation of MR myelography (MRM) in depicting the spinal canal obstruction. METHODS: Heavily T2-weighted coronal MR myelography was performed with 3D fast-spin-echo (FSE) and fat-suppression sequence in 126 cases, including 6 cerebellomedullary cistern, 18 cervical, 19 thoracic and 83 lumbar cases. The resulting slice were then projected into a composite image using a standard maxium intensity projection (MIP) algorithm. RESULTS: 90.5% (114/126) of MRM yielded reproducible high-quality image of the spinal thecal sac. 106 lesions (extradural, intradural, intramedullary) were detected in 101 cases (80.2%). The level and degree of spinal canal obstruction were visualized and confirmed by operation in 66 cases with a high sensitivity of 100%, and a diagnostic accuracy of 91.3%. CONCLUSION: Heavily T2 FSE MR myelography is a noninvasive and reliable method. MRM surpasses conventional and CT myelography and could replace them in some degree.

Adolescent↗
PubMed1990

[A comparative study of myelography and CAT in patients with lumbo-sciatica].

One hundred patients with acute lumbo sciatica symptoms probably due to disc hernia, have been studied. A CT scan and a myelography was performed in all patients. The clinical and radiologic (myelography and CT scan) findings have been evaluated in three categories based on their intensity and a correlation between these three parameters has been performed. Our results show a positivity of 94% in the clinical signs, 87% in the myelography findings and 88% in CT scan findings. The correlation results show that in very severe lumbo sciatica syndromes there is a greater positivity in the myelography than in CT scan findings and that there could be big radiologic changes without a clear clinical repercussion.

Acute Disease↗
PubMedDate not supplied

Reduction of the gastrointestinal side effects of metrizamide myelography with oral dexamethasone.

A prospective, double-blind study was undertaken to assess the effectiveness of oral dexamethasone premedication in reducing a variety of side effects associated with metrizamide myelography. We also examined the relationship between side effects and needle size, total metrizamide dose, radiographic findings, and personality. Patients were randomly assigned to either a placebo group (44 patients) or a dexamethasone group (38 patients). All patients completed a 24-item symptom checklist before and 24 hr after lumbar myelography. In addition, all patients completed the Minnesota Multiphasic Personality Inventory prior to myelography. Analysis of variance demonstrated a statistically significant decrease in the frequency of gastrointestinal side effects (loss of appetite, nausea, vomiting) in the dexamethasone group. There were no significant differences between the two groups for the other 21 symptoms examined. We concluded that premedication with oral dexamethasone significantly reduces the gastrointestinal side effects associated with metrizamide myelography. This reduction was especially important in older patients.

Administration, Oral↗
PubMed1988

[Spinal dural arteriovenous fistulae: exacerbation after myelography with metrizamide].

Metrizamide dorsal myelography was performed in two patients with minor to moderate sensorimotor paraparesis. Direct and indirect myelographic signs of spinal arteriovenous aneurysm were seen and spinal cord angiography showed thoracic dural arteriovenous fistulae (AVF) in both cases. Within 24 hours following myelography, clear neurological worsening occurred, associated with cephalalgia, nausea and transient diplopia in one case, leading to paraplegia in a few days. Paraplegia was complete six months after surgery in one case, and had resolved after embolization of fistula in the other patient. The mechanism of neurological worsening may include: substraction of cerebrospinal fluid, sitting position during and after myelography and local increase of metrizamide concentration secondary to impaired resorption caused by the fistula. Water-soluble myelography is of invaluable aid in the diagnosis of dural AVF and must be followed by early angiography, thus allowing prompt therapeutic embolization.

Adult↗
PubMed1987

Use of pentobarbital sodium to reduce seizures in dogs after cervical myelography with metrizamide.

We conducted a prospective study to examine the effect of pentobarbital administration on the development of seizures in dogs that had undergone cervical myelography with metrizamide while anesthetized with halothane. Thirty dogs scheduled for cervical myelography were assigned to 3 groups. Dogs in group 1 received no pentobarbital. Those in group 2 were administered pentobarbital (5 mg/kg, IM) before induction of anesthesia, and those in group 3 received pentobarbital at the end of the procedure when the anesthetic vaporizer was turned off. Anesthesia was induced with thiamylal sodium in all dogs and was maintained with halothane. Dogs that underwent surgery immediately after the myelography were not included in the study. A significant difference was not found among the 3 groups in terms of number of dogs that had seizures, mean body weight of the dogs, duration of anesthesia after injection of metrizamide, time from extubation to first seizure, volume of metrizamide injected, or clinician performing the myelography.

Anesthesia, General↗
PubMed1987

[CT after myelography in complete spinal cord blocks].

In each patient (two meningiomas, two lymphomas, one spine fracture) myelography demonstrated only the lower level of the block, but not enough contrast medium leaked past the block to allow myelographic identification of the upper level. On the contrary, thanks to its high power of contrast resolution, CT immediately after myelography clearly outlined the subarachnoid space both below and above the level of the block. Descending myelography was therefore not necessary. Moreover, CT also revealed associated bone and soft tissue lesions, in two cases, providing a more accurate diagnosis. It is therefore concluded that combined myelography+CT can provide complete diagnosis of spinal blocks and any associated lesions.

Aged↗
PubMedDate not supplied

[Comparison of clinical examination, electromyography, myelography, computerized tomography and surgical findings in lumbar disc hernias].

The authors report 152 cases of patients with suspected herniated lumbar disk, operated on by traditional surgical approach. Thirteen of 152 patients underwent exploratory surgery at two vertebral spaces as a result of their neuroradiological examinations. All patients were examined clinically before of instrumental devices. CT-scan was performed on 113 patients, 62 underwent myelography and 36 electromyography. The authors verified reliability of clinical and instrumental devices on the basis of surgical results. Clinical examination was reliable in 83% of cases, electromyography in 78%, myelography in 83% and CT-scan in 87%. The percentage of false positive was 11% for the clinical examination, 9% for CT-scan, 8% for myelography and 11% for electromyography. The percentage of false negative was 6% for the clinical examination, 4% for CT-scan, 9% for myelography, and 11% for electromyography. The authors conclude that the CT-scan is the most reliable method of examination. This is even truer when dealing with extreme lateral disk herniation.

Adolescent↗
PubMed1977

Myelography with metrizamide.

Metrizamide (Amipaque) is a new water-soluble contrast medium for myelography. It differs from the conventional contrast media in that, because of its lower toxicity, it can be used also for cervical and thoracic myelography. The method of examination in myelography with water-soluble contrast media differs in some respects from that in myelography with oil-soluble contrast media. For the thoracic region, tomography is highly recommendable. After a description of the method of examination used, some examples of the abnormalities found are presented.

Adult↗
PubMed1977

Myelography with a water-soluble contrast medium: a revision of technique and a review of results.

Experience with Dimer-X myelography in 3000 patients provides some indication of the scope of examination of the lumbar, thoracic and cervical segments of the spinal canal with a water-soluble contrast medium. Myelography with any contrast medium should only be applied for serious indications, and never as an outpatient procedure, for the patient requires careful after-treatment. However, the routine use of myelography may offer the best insurance against the disappointment and embarrassment of surgery by trial and error. The application of a careful, standardized technique makes it possible to obtain accurate information about the whole spinal canal and to avoid the danger of the false results to which examination with oily media are liable at all levels. The development of ever safer contrast media may help to limit the problem of spinal fibrosis, which is not a rare complication of myelography and spinal surgery.

Child↗
PubMed1984

Relationship between contrast medium dose and adverse effects in lumbar myelography.

In a prospective double-blind randomized study involving 40 patients undergoing lumbar myelography, an attempt was made to correlate adverse effects of the examination with contrast medium dosage. Metrizamide for myelography is dispensed in two dosage aliquots, 3.75 and 6.75 g. In one group of 20 patients (10 males and 10 females) the higher dose was utilized routinely, in a second similar group the lower dose. 24 h after myelography complaints of headache were noted in 9 out of 40 patients; nausea, sometimes with vomiting, in 3 out of 40, and giddiness or light-headedness in 6 out of 40. No other side effects were registered. Complaints after myelography occurred significantly more often in females than in males, but there was no correlation between the incidence of complaints and the dose of metrizamide administered.

Clinical Trials as Topic↗
PubMedDate not supplied

Advantages of supplementary CT in myelography of intraspinal masses.

Computed tomographic (CT) myelography subsequent to nonionic water-soluble contrast medium myelography has provided additional diagnostic information for evaluating intraspinal mass lesions. In 20 patients thus studied, there were eight intramedullary tumors, eight intradural extramedullary masses, and four extradural neoplasms. In intramedullary tumors CT enabled more precise delineation of the extent and location of expansion of the spinal cord. In intradural and extradural tumors, rotation and compression of the spinal cord as well as bony and paraspinal soft-tissue changes were more accurately demonstrated in the axial plane. When a complete block was present, the greater contrast sensitivity of CT permitted visualization beyond the level of the block. Histologic prediction is not feasible by CT myelography except for hyperlucent lipoma. CT can provide useful supplemental information to conventional metrizamide myelography.

Adolescent↗
PubMedDate not supplied

Cervical disk syndromes: value of metrizamide myelography and diskography.

This paper reports on the respective diagnostic values of myelography with water-soluble contrast media and diskography in a study of 100 patients examined between 1979 and 1981 and operated on because of cervical disk disease. The results of the study led to a change of the diagnostic procedures formerly applied in radicular syndromes (i.e., diskography, and then perhaps myelography) and in cervical myelopathy (myelography, rarely followed by diskography). Now cervical metrizamide myelography is always performed first. Diskography is only indicated in radicular syndromes to determine the segment causing clinical symptoms when there is a polysegmental space-occupying lesion on the myelogram in combination with a mono- or oligoradicular neurologic symptomatology; or in the case of a normal myelogram with complaints resistant to conservative treatment.

Cervical Vertebrae↗
PubMed1984

[Fundamental and clinical studies on CT gas myelography of the cervical spine].

We applied CT gas myelography at the cervical spinal region and investigated the clinical value of CT gas myelography as a supplementary diagnostic method for the spinal cord and vertebral diseases. Fundamental studies of the conditions of window width and window height and the permitted limit of the angle of incidence were made with phantoms of human neck to establish proper conditions of these factors. In clinical studies, 23 adult persons, who had no abnormality in the cervical spine and in the cervical spinal cord were observed to have normal CT gas myelograms of the cervical region, whereas 37, of clinical cases including 18 of cervical spondylosis, 10 of OPLL, 2 of cervical discopathy, 3 of fracture and dislocation of the cervical spine, 2 of cervical vertebral tumor and 2 of CYL, were found to show clear pathologic findings in the cross sections of the vertebral foramen, subarachnoidal space and spinal cord on the CT gas myelograms. The representative cases of these diseases were presented. The gas myelograms were morphologically classified and investigated in relation to the clinical findings. From the result of these investigations, CT gas myelography appears to be highly useful as a supplementary diagnostic method for diseases of the cervical spine and the cervical spinal cord. Furthermore, we compared the effect of this method with that of CT myelography using metrizamide, a recently developed water-soluble contrast medium.

Adult↗