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PubMedDate not supplied

Metrizamide in urography. II. A comparison of 51Cr-EDTA clearance and metrizamide clearance in man.

In nine subjects undergoing urography with metrizamide measurements of total serum clearance of 51Cr-EDTA have been made before, during, and after the urography. During the urography both total serum clearances and renal clearances were determined for 51Cr-EDTA and metrizamide. The present study in man confirms the previous results from investigations in rabbits, that most of the intravenously injected metrizamide is excreted through the kidneys, that tubular reabsorption of metrizamide occurs and suggests that metrizamide might be used with advantage for urography.

Chromium Radioisotopes↗
PubMed1987

Further support for the glucose hypothesis of metrizamide toxicity. The effect of metrizamide and glucose analogue-free contrast media on hexokinase.

Metrizamide neurotoxicity has been hypothesized to be caused by an inhibitory effect of the drug on glucose metabolism. Metrizamide contains a glucose side chain, and glucose analogues including metrizamide have been shown to be inhibitors of hexokinase, an enzyme that is central to cerebral glucose metabolism. We studied the effect of the nonionic contrast agents iohexol, iotrol, and iopamidol, and the ionic contrast meglumine diatrizoate, on hexokinase in vitro. Although metrizamide reproducibly caused competitive inhibition of the reaction, the nonglucose contrast agents had no significant effect on the enzyme. These results add further support for the glucose hypothesis of metrizamide neurotoxicity.

Contrast Media↗
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↗
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↗
PubMed1982

Conventional metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. A comparative study.

A retrospective examination was performed to assess the accuracy of metrizamide myelography (MM) and computed tomographic metrizamide myelography (CTMM) in scoliosis. Of 81 consecutive scoliotic children studied by myelography, 30 had only MM while the remaining 51 had CTMM immediately afterward. CTMM added essential diagnostic information in 13 cases of dysraphism and 4 cases of idiopathic scoliosis; in the remaining cases, both methods gave the same information. The authors conclude that in patients with severe scoliosis, dysraphism, and scoliosis with localized neurological disturbances, CTMM should always be added to MM or be the only examination; while in idiopathic scoliosis with vague neurological disturbances a survey of the entire spine is essential, preferably with MM.

Adolescent↗
PubMed1986

Cervical radiculopathy: prospective evaluation with surface coil MR imaging, CT with metrizamide, and metrizamide myelography.

A prospective study was undertaken to compare the accuracy of surface coil magnetic resonance (SCMR) imaging, metrizamide myelography (MM), and computed tomography with metrizamide (CTM) in the determination of cervical radiculopathy. Surgical findings were the objective measure of accuracy. Fifty-two patients underwent all imaging studies. Studies were evaluated for disease location and type (bone vs. soft tissue). Twenty-eight patients underwent subsequent cervical surgery at 39 levels form an anterior interbody approach. Predictions made with SCMR imaging were surgically confirmed in 74% of patients, with CTM in 85%, and with MM in 67%. There was 90% agreement with surgical findings when SCMR imaging and CTM were used jointly, and 92% agreement when CTM and MM were used jointly, In general, SCMR imaging was as sensitive as CTM for identification of disease level, but not as specific for type of disease. MM was the modality least specific for disease type. The major advantage of CTM was its ability to distinguish bone from soft tissue, for which contrast material is unnecessary. SCMR imaging is a viable alternative to MM and, together with computed tomography, if needed, provides a thorough examination of the cervical region.

Adult↗
PubMed1986

[Conjoined lumbosacral nerve roots--diagnosis by metrizamide myelography and metrizamide CT].

Several kinds of the lumbosacral nerve root anomalies have already been recognized, and the conjoined nerve roots is the most common among them. It does not make symptoms by itself, but if there is a causation of neural entrapment, for example, disc herniation, lateral recessus stenosis, spondylolisthesis, etc., so called "biradicular syndrome" should occur. Anomalies of the lumbosacral nerve roots, if not properly recognized, may lead to injury of these nerves during operation of the lumbar spine. Recently, the chance of finding these anomalous roots has been increased more and more with the use of metrizamide myelography and metrizamide CT, because of the improvement of the opacification of nerve roots. We describe the findings of the anomalous roots as revealed by these two methods. They demonstrate two nerve roots running parallel and the asymmetrical wide root sleeve. Under such circumstances, it is important to distinguish the anomalous roots from the normal ventral and dorsal roots.

Adult↗
PubMed1979

[Usefulness and adverse effects of intrathecal metrizamide instillation (author's transl)].

Radiographic quality as well as adverse effects of intrathecal metrizamide instillation was prospectively investigated in thirty-three clinical cases admitted to the department of neurosurgery, University of Tokyo Hospital, and Kantoh Teishin Hospital. Metrizamide CT cisternography was performed in fifteen cases using in most cases 10 ml of 170 mg I/ml solution through lumbar route. Eleven cases exhibited "normal" pattern CSF circulation and the remaining four, "delayed" pattern. Eight cases (53%) experienced headache, nausea, and/or vomiting several hours after the instillation. All of these belong to the "normal" pattern group. Four cases of "normal" pattern received electroencephalographic examinations before and after metrizamide instillation. Three revealed appearance of negative spike and slow wave burst or sharp waves one to twenty-four hours after the instillation, along with penetration of metrizamide into brain parenchyma. Diagnostic quality was interpreted as "good" in eleven cases. Small acoustic neurinoma, pituitary adenoma, arachnoid cyst, and subdural hygroma were diagnosed among others. Metrizamide ventriculography was done in four cases. No untoward effect of significance was attributed to metrizamide per se. Cervical myelograpy and/or CT myelography was done in fourteen cases using, in most cases, 10 ml of metrizamide 170 mgI/ml. Polytome tomography with metrizamide instillation through lateral cervical puncture was highly diagnostic, whereas, ordinary X-ray with lumbar instillation yielded less satisfactory results. CT myelography in cases of subarachnoid block required good consideration on instillation site and positioning of the patient. Six cases (50%) among twelve cases where metrizamide had run into the cranial cavity experienced headache, nausea, and/or vomiting to a lesser degree than those of cisterno graphy. Metrizamide is the first contrast agent ever made which can be safely introduced into human subarachnoid space, if administered judiciously, nervous. However, metrizamide is weakly toxic to central system and provokes minor untoward effects as well as electroencephalographic abnormalities and, sometimes, clinical convulsive seizure. It would be wiser to restrict the dosage of metrizamide in cisternographic study, expecially in cases of "normal" pattern CSF circulation, to 1.2 gI or 7 ml of 170 mg I/ml solution. Routine use of X-ray cisternography should thus be discouraged because it needs higher concentration of metrizamide in the intracranial cisterns.

Adolescent↗
PubMed1979

The effect of metrizamide on the electroencephalogram: a prospective study in 61 patients.

A prospective study was made of changes in the electroencephalogram after the use of metrizamide for myelography and posterior fossa cisternography in 61 patients (62 studies). The EEG changed in 21 patients (34%); 3 of these had had previously abnormal records, and the abnormalities were accentuated on the second recording. Eight developed paroxysmal activity, including spike and wave in 1. EEG changes appeared 24 to 48 hours after the use of metrizamide in 6 patients whose intervening EEGs were normal. The percentage of records that changed tended to increase as metrizamide was brought to more rostral levels. Symptoms following the use of metrizamide were reviewed in 58 patients. Although there were no seizures in the present series, seizures did occur with subsequent use of metrizamide in 3 other patients at our institution. Previous reports may have underestimated the frequency of EEG changes after metrizamide since these may require 24 to 48 hours to develop. The appearance of such activity suggests that the use of metrizamide in patients with known seizure disorders, the anatomical level to which metrizamide is brought during radiography, removal of contrast medium, and further investigation of premedication with anticonvulsants all require careful consideration when use of metrizamide is being contemplated.

Adult↗
PubMed1981

Asterixis and encephalopathy following metrizamide myelography: investigations into possible mechanisms and review of the literature.

Marked asterixis occurred in two patients following metrizamide myelography. One also suffered generalized seizures and the other had severe stuttering speech for seven days. The spectrum of toxic manifestations of metrizamide is reviewed with emphasis on the unusual lethargy and other depressive effects seen with this relatively safe agent. The hypothesis that metrizamide exerts a ouabain-like effect on the cortical surface was tested. Metrizamide in concentrations as high as 20 mM had no inhibitory effect on rat cerebral K+-para-nitrophenylphosphatase, a partial reaction of (Na+K+)-adenosine triphosphatase. Because metrizamide is a 2-deoxyglucose analogue, a competitive inhibition of hexokinase at the first step in glycolysis was also postulated. Metrizamide was found to competitively inhibit commercial (microbial) hexokinase. The Michaelis constant for glucose rises from 0.13 to 0.25 to 0.33 to 0.91 mM in the presence of 0, 0.4, 1.0, and 2.0 mM metrizamide, respectively. Since the concentration of metrizamide over the cerebral cortex after routine myelography may be approximately 50 mM compared with a glucose concentration of only 3.6 mM (65 mg/dl), it is postulated that impaired brain glucose metabolism may be responsible for some of the toxic effects of metrizamide.

Animals↗
PubMed1984

Competitive inhibition of human brain hexokinase by metrizamide and related compounds.

We have compared the competitive inhibitory effects of 2-deoxyglucose, glucosamine, N-acetylglucosamine, N-benzoylglucosamine, and the commonly used radiographic and density gradient agent metrizamide (2-[3-acetamido-2,4,6-triiodo-5-(N-methylacetamido) benzamido]-2-deoxyglucose) on the mitochondrial and soluble forms of human brain hexokinase. Metrizamide produces a classical competitive inhibition with glucose for human brain hexokinase, with Kis of 2.8 and 2.5 mM, respectively, for the mitochondrial and soluble forms. Glucosamine exhibited Kis of 0.58 and 0.29 mM, while 2-deoxyglucose exhibited Kis of 0.074 and 0.15 mM and N-acetylglucosamine 0.098 and 0.092 mM for these two forms, respectively. N-Benzoylglucosamine was by far the most effective inhibitor tested, with Ki values of 0.0086 and 0.022 mM, respectively. In order of increasing potency as a competitive inhibitor for mitochondrial hexokinase are metrizamide, glucosamine, N-acetylglucosamine, 2-deoxyglucose, and N-benzoylglucosamine. For the soluble form of the enzyme in increasing potency are metrizamide, glucosamine, 2-deoxyglucose, N-acetylglucosamine, and N-benzoylglucosamine. Since N-benzoylglucosamine was over 100 times more potent than metrizamide, some of the effects of metrizamide could be due to contamination by N-benzoylglucosamine. However, gas chromatography-mass spectrometry analysis of metrizamide did not indicate the presence of N-benzoyl-glucosamine. In addition, column chromatographic separation of commercially available metrizamide and reconstitution of freeze-dried eluate fractions localized the inhibitory effect to the metrizamide peak.

Adult↗
PubMed1983

A new look at the neonatal bowel-contrast studies with metrizamide (Amipaque).

Metrizamide is the first water-soluble radiographic contrast agent which, because it is nonionic, can be used in isotonic solution and gives good visualization of the desired body structure. Its only major disadvantage is that it is very expensive. Metrizamide can be used to study the neonatal bowel in clinical situations where all the other existing contrast agents are contraindicated. The results of 55 metrizamide studies of the bowel in infants are reviewed. In necrotizing enterocolitis metrizamide aids in confirming or rejecting the diagnosis, identifying patients for surgery, and in evaluating the response to surgery. Metrizamide can identify the etiology in unusual cases of bowel obstruction. Metrizamide correctly identified a thoracic origin of free peritoneal air in four cases and a bowel origin in two cases. It identified bowel perforation in two patients in the absence of pneumoperitoneum. In six patients, the metrizamide study identified the cause for a gasless abdomen. It is concluded that metrizamide has a valuable role to play in evaluating a variety of neonatal bowel disorders.

Drug Evaluation↗
PubMed1986

Iotrol versus metrizamide in lumbar myelography: a double-blind study.

In a prospective, randomized, double-blind study, 49 patients underwent lumbar myelography using iotrol (24 patients) or metrizamide (25 patients). The diagnostic imaging adequacy of iotrol was comparable with that of metrizamide. After iotrol myelography, adverse reactions were fewer, less severe, and of shorter duration than were those following metrizamide myelography. Thirteen of 24 patients (54%) receiving iotrol reported some adverse reactions compared with 24 of 25 patients (96%) receiving metrizamide. Five moderate and one severe adverse reaction occurred in the group receiving iotrol. Fourteen moderate and eight severe adverse reactions occurred in the group receiving metrizamide. Thirty-eight patients underwent electroencephalography both before and after myelography (19 iotrol and 19 metrizamide). None of the EEGs obtained after iotrol myelography changed from baseline, while seven of the EEGs obtained after metrizamide myelography showed changes from baseline. Iotrol was judged superior to metrizamide as a contrast medium in this patient population.

Contrast Media↗
PubMed1989

[The effects of metrizamide myelography on electroencephalographic changes].

Metrizamide, a non-ionic water soluble contrast medium, is used in myelography for detecting spinal cord lesions. Because it is an injection in the subarachnoid space, the effects on the central nervous system following metrizamide myelography should be studied. Electroencephalography can offer a non-invasive and objective method for evaluating the functions of the central nervous system. From September to December 1986, 30 cases which had received cervical or lumbar metrizamide myelography were collected. After myelography, in addition to a history review and neurologic examination, electro-encephalography was carried out within 24 hours. If the EEG record revealed abnormal, a series of EEG follow-ups were conducted until recordings were normal. The incidence of clinical adverse effects following Metrizamide myelography was 53.3% and 66.6% respectively in cervical and lumbar injections. No significant difference was found between the two groups. Secondly, the abnormal rate of the EEG record was 40.0% and 60.0% following cervical and lumbar myelography. The difference was also not significant. Lastly, the relation between clinical adverse effects and an abnormal EEG records was poor in cervical metrizamide myelography but good in lumbar myelography. The conclusions suggested by this research that the clinical adverse effects and the abnormal EEG record after metrizamide myelography are transient and are reversible changes. The mechanism of complications following cervical and lumbar metrizamide are different. Although complications may occur following cervical and lumbar metrizamide myelography, it remains a practical method in detecting spinal cord lesions.

Adult↗