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At least 19 recordsLinked to original sources
PubMed1996

MR-myelography: a comparison with conventional myelography.

After creating a MR pulse sequence, called MR-myelography, the purpose of the study was to evaluate the value of this sequence in comparison to conventional myelography. Twenty consecutive patients were examined with conventional and MR-myelography concerning the clinical questions of chronic lumbago, spinal canal stenosis, herniated disc, spondylolisthesis and instability. Six observers assessed both examinations independently for subjective criteria such as pictorial quality, depiction of the dural sac, the nerve roots and their sheaths, artifacts, and the usefulness of single MR-myelography slices. Furthermore the number and extent of stenoses had to be judged as an objective criteria. The employed MR-myelography technique is not able to concur with the quality of conventional myelography. A high-grade stenosis is usually overestimated and low grade stenosis underestimated by MR-myelography. But it is easier to depict further relevant stenoses in a preexisting high grade stenotic spinal canal with MR-myelography. Artifacts of the introduced MR-technique do not disturb pictorial and diagnostic quality very much. In conclusion MR-myelography cannot replace conventional myelography. But together with conventional MR-sequences, MR-myelography can be helpful in the assessment of spinal canal stenosis.

Adult↗
PubMed1989

The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: I. A comparison of computed tomography (CT), myelography, CT-myelography, discography, and CT-discography.

The accuracy of five imaging modalities for the diagnosis of lumbar herniated nucleus pulposus (HNP) is compared prospectively in 124 patients, all of whom underwent surgical exploration. All tests were read independently of each other and the level of confidence in each diagnosis was recorded. The results are based on negative (106) as well as positive (125) findings at the 231 disc sites (level and side) explored. Computed tomography-discography (disco-CT) was the most accurate test (87%) compared to 77% for CT-myelography (myelo-CT), 74% for CT, 70% for myelography, 64% for disc injection pain, and 58% for discography. The false positive rate was lower for disco-CT (19%) than for myelo-CT (24%), CT (24%), and myelography (30%). The false negative rate was also lower for disco-CT (8%) than for myelo-CT (22%), CT (29%), and myelography (30%). Disco-CT was the most accurate test (94%) in patients who had prior disc surgery compared with 81% for myelo-CT, 80% for CT, and 74% for myelography. Disco-CT was also the most accurate test for patients with foraminal HNP (91% compared with 71% for CT, 65% for myelo-CT, and 58% for myelography). Disc injection reproduced the patient's clinical pain pattern in only 36% of herniated discs. This test has high specificity (89%), but low sensitivity (43%). The risks from myelography followed by discography within a 72-hour period are similar to those reported for myelography alone. Disco-CT is the most accurate of these tests (P less than 0.05) for the diagnosis of lumbar HNP.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

The neuroradiographic diagnosis of lumbar herniated nucleus pulposus: II. A comparison of computed tomography (CT), myelography, CT-myelography, and magnetic resonance imaging.

The accuracy of computed tomography (CT), myelography, CT-myelography (myelo-CT) and magnetic resonance imaging (MRI) for the diagnosis of lumbar herniated nucleus pulposus (HNP) is compared prospectively in 59 patients, all of whom underwent surgical exploration. All tests were read independently of each other and the level of confidence in each diagnosis was recorded. The results are based on the negative (61) as well as positive (59) findings at the 120 disc sites (level and side) explored. Magnetic resonance imaging was the most accurate test (76.5%) compared with myelo-CT (76.0%), CT (73.6%), and myelography (71.4%). The false positive rate was lowest for MRI (13.5%) followed by myelography (13.7%), CT (13.8%), and myelo-CT (21.1%). The false negative rate was lowest for myelo-CT (27.2%) followed by MRI (35.7%), CT (40.2%), and myelography (44.1%). In that subset of 19 patients who had prior surgery, myelography was the most accurate means of diagnosing lumbar HNP (88.8%), followed by MRI (83.3%), myelo-CT (78.4%), and CT (72.6%). The false positive rates in these patients were 11.6% for myelography, 13.2% for MRI, 14.5% for CT, and 16.4% for myelo-CT; the false negative rates were 22.7% for MRI, 24.4% for myelography, 29.5% for myelo-CT, and 47.7% for CT. Magnetic resonance imaging compares very favorably with other currently available imaging modalities for diagnosing lumbar HNP. Magnetic resonance imaging is painless, has no known side effects or morbidity, no radiation exposure, and is noninvasive. The authors recommend it as the procedure of choice for the diagnosis of most lumbar disc herniations.

Adolescent↗
PubMed1998

Comparative study of MR myelography and conventional myelography in the diagnosis of lumbar spinal diseases.

The purpose of this study was to investigate the usefulness of magnetic resonance (MR) myelography by comparing it with conventional myelography. MR myelography was performed on 40 patients (24 men and 16 women; mean age, 44 years) with lumbar spinal diseases. MR myelography was imaged three-dimensionally by fast spin-echo technique with fat suppression and maximum intensity projection. We assessed both the ability to provide the images of nerve root sheaths and the similarity of the findings to conventional myelography. Satisfactory images of nerve root sheaths in the lumbar region were provided almost equally by MR and conventional myelography. The images obtained by MR myelography were similar in quality to those obtained by conventional myelography. When combined with some other conventional MR imaging techniques, this diagnostic technique of imaging lumbar spinal diseases is further enhanced.

Adolescent↗
PubMed1991

Nerve root avulsion of birth palsy: comparison of myelography with CT myelography and somatosensory evoked potential.

Findings at myelography and computed tomographic (CT) myelography were reviewed in 21 patients (22 limbs) with birth palsy; nerve root shadows were the focus of this study. Myelography demonstrated 51 completely avulsed roots (78%) and 14 incompletely avulsed roots (22%). A traumatic meningocele was detected at 38 roots on myelograms and 51 roots on CT myelograms. Thirteen avulsed roots (eight completely and five incompletely avulsed roots) (20%) were not associated with a meningocele. In nine patients who underwent brachial plexus exploration, myelographic findings were compared with root somatosensory evoked potential (SEP). SEP was not induced at 22 of 25 completely avulsed roots and was induced at all seven incompletely avulsed roots. Myelography and SEP were consistent in 29 of 32 roots (91%). It is concluded that myelography is indispensable for preoperative evaluation of cervical nerve root avulsion of birth palsy, because CT myelography is not sensitive to nerve root avulsion without a traumatic meningocele, and SEP cannot enable one to discriminate incomplete avulsion from intact roots.

Brachial Plexus↗
PubMed1989

[Evaluation of CT myelography and conventional myelography for avulsion injury of nerve root--18 cases of birth palsy].

CT myelography (CTM) and conventional myelography were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. A traumatic meningocele was detected in 45 roots by CTM, and in 35 roots by myelography. CTM misinterpreted only one root with a very small meningocele. CTM was superior to myelography in delineating a traumatic meningocele, because CTM is sensitive to a poorly enhanced meningocele. On the other hand, CTM missed 9 avulsed roots without a meningocele. By myelography, these 9 roots were diagnosed as 6 roots of complete avulsion injury and 3 roots of incomplete avulsion. Myelography is indispensable in evaluating nerve root avulsion.

Child↗
PubMed1998

Positionally dependent spinal stenosis: correlation of upright flexion-extension myelography and computed tomographic myelography.

OBJECTIVE: Upright flexion-extension myelography has shown marked variation in the severity of lumbar dural sac stenosis during flexion and extension in some patients ("positionally dependent" stenosis). Axial computed tomography (CT) of the lumbar spine while the patient is supine may not demonstrate the maximal spinal stenosis shown by flexion-extension myelography. This study compares the severity of central lumbar spinal stenosis on CT myelograms and on upright flexion-extension myelograms in patients with positionally dependent spinal stenosis. PATIENTS AND METHODS: From January 1995 to December 1996, 210 patients underwent upright flexion-extension lumbar myelography for the assessment of back pain, radiculopathy or neurogenic claudication. In 33 of these patients (in whom 39 lumbar levels were seen) there was a difference of 30% or more in the diameter of the dural sac seen on anteroposterior lateral myelograms during flexion and extension. These findings were compared with the dural sac compression shown on the CT myelograms for these patients. RESULTS: In 10 of the 33 patients (12 levels), the CT myelogram underestimated spinal stenosis, as compared with the upright flexion-extension myelogram. In 5 levels, stenosis of 70% or more seen on flexion-extension myelography was measured as 50% or less on CT myelography. CONCLUSION: In patients with positionally dependent spinal stenosis, CT myelograms may underestimate the severity of the spinal stenosis, compared with upright flexion-extension myelograms. While upright flexion-extension myelography is not a first-line imaging modality for patients with spinal stenosis, it should be considered for patients whose symptoms are not explained by routine cross-sectional imaging studies to exclude positionally dependent spinal stenosis.

Adult↗
PubMed1993

A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis.

The sensitivity, specificity, and accuracy of computed tomography (CT)-myelography, magnetic resonance imaging (MRI), and myelography in making the diagnosis of herniated nucleus pulposus (HNP) and spinal stenosis were compared in a retrospective study involving 59 surgical procedures in 57 patients who had all three tests performed preoperatively. One hundred nineteen levels were surgically explored for evidence of HNP and spinal stenosis. The results of each test were correlated with what was found at each surgical level explored. Overall, myelo-CT was the most accurate test for diagnosing HNP (76.4%) as well as the most sensitive (77.8%), whereas myelography was the most specific (89.2%). In making the diagnosis of spinal stenosis, myelo-CT and MRI were equally accurate (85.3%) and sensitive (87.2%), whereas myelography was the most specific (88.9%). In a special subset of patients who had revision surgery, the accuracy rate in diagnosing spinal stenosis or HNP was highest with MRI (84.9%), as was the sensitivity (69.2%) and specificity (95%). According to the results obtained from this series of patients, myelo-CT seems to be the most sensitive and accurate test in diagnosing HNP and spinal stenosis, whereas myelography is the most specific, although no statistical significance was noted in this study. However, because MRI did compare favorably with myelo-CT in most instances, particularly in revision surgery; it may be the procedure of choice due to its noninvasiveness and relative lack of side effects.

Adult↗
PubMed1985

Metrizamide CT myelography in cervical myelopathy and radiculopathy: correlation with conventional myelography and surgical findings.

Conventional myelography, metrizamide computed tomographic (CT) myelography, and surgical findings were correlated in 30 patients with cervical radiculopathy and/or myelopathy. In 60% of patients, metrizamide CT myelography provided significant additional information including better characterization of the abnormality, lateralization if the conventional myelogram was indeterminate, more definitive demonstration of cord atrophy, foraminal narrowing not appreciated on myelography, and demonstration of abnormalities distal to a myelographic block. In no case was a myelographic abnormality not detected on metrizamide CT myelography. In patients with cervical myelopathy, a cross-sectional diameter of the cord equaling less than 50% of the subarachnoid space is predictive of poor patient response to surgical intervention.

Adult↗
PubMed1992

CT, myelography and CT-myelography in the evaluation of common cervicobrachial neuralgia.

The CT technique used to explore intervertebral discs and foramina is described, as are the CT signs of nucleus pulposus (NP) herniation and cervical degenerative lesions. CT with intravenous contrast injection is the most efficient and easiest method to diagnose a radicular compression of discal or degenerative origin. The advent of high-resolution contrast CT will probably make obsolete the use of contrast media. CT measures the width of the vertebral canal, but it does not evaluate the repercussions on the spinal cord of compression caused by NP herniation or osteophytosis: only CT-myelography or, better, MRI can make this evaluation. Conventional CT scans are sometimes inadequate when exploration is hampered by superimposition of the shoulders (C6-C7 and more often C7-T1), when the scanner is of poor quality or when it is misused. Myelography and CT-myelography can then be utilized to resolve the problem posed by C7 or C8 cervicobrachial neuralgia (CBN). CT makes it possible to exclude most of the causes of non-discal CBN in the extradural spaces (e.g. bone tumour, neurinoma, vertebral vascular malformation, paravertebral expansive process, apical lung tumour). The search for an intradural cause (extra- or intramedullary tumour) rests on myelography, CT-myelography and MRI.

Adult↗
PubMedDate not supplied

Outpatient lumbar myelography. Analysis of complications after myelography comparing outpatients with inpatients.

Over a 2-year period, 92 patients were submitted as outpatients to lumbar myelography using lopamidol, a new nonionic water-soluble contrast medium. The incidence and severity of adverse reactions associated with myelography in these cases were compared with those in 116 patients who underwent lopamidol myelography as inpatients. The hospitalized patients received 10 ml, and the outpatients 8 or 10 ml of contrast medium (300 mg l/ml). The severity of complications was graded as very mild, mild, moderate, or severe. The complication rate was 37% in the hospitalized patients and 40% in the outpatients. Adverse reactions, mostly in the form of headache, were very mild in approximately two thirds of cases in each group, and moderate or severe in 15% of the inpatients and 24% of the outpatients presenting complications. The incidence of moderate or severe reactions was lower in the outpatients receiving 8 ml of contrast medium compared with those given 10 ml. lopamidol lumbar myelography performed on an outpatient basis is a safe procedure. The outpatient regimen considerably reduces the cost of myelography and indirectly increases the availability of beds in orthopaedic and neurologic units.

Adolescent↗
PubMed1995

Assessment of the narrow cervical spinal canal: a prospective comparison of MRI, myelography and CT-myelography.

This study was designed to compare the accuracy of magnetic resonance imaging (MRI), myelography and computed tomography in the assessment of degenerative cervical spinal stenosis. We prospectively examined a total of 75 spinal segments in 18 patients with suspected cervical spinal canal stenosis, using sagittal spin-echo and axial gradient-echo sequences generated by a 1.5 Tesla imager, conventional myelography, and computed tomography with intrathecal contrast medium (CT-myelography). The degree of stenosis was often overestimated using MRI. This error was most prominent in cases of severe stenosis but was significant with minor to moderate stenosis. In these cases, the clinical consequences of such an overestimation can be serious, because treatment is misdirected. The error is probably caused by pulsation of the cerebrospinal fluid and truncation artefact (Gibbs phenomenon). MRI at 1.5 Tesla is thus frequently inadequate for diagnostic assessment of degenerative cervical spinal stenosis. Myelography and myelographic CT are still useful for decisions on operative treatment, especially in cases of moderate stenosis. This may, however, not apply to imagers operating at 0.5 Tesla as below.

Adult↗
PubMedDate not supplied

Comparison of myelography, CT myelography and magnetic resonance imaging in cervical spondylosis and disk herniation. Pre- and postoperative findings.

Twenty-six patients with cervical radiculopathy and/or myelopathy caused by spondylosis or disk herniation were examined with myelography, CT myelography and MR. Fourteen of the patients were operated upon and 11 of them underwent postoperative MR and CT. The three radiologic methods provided comparable information about narrowing of the subarachnoid space and compression of the spinal cord. It was more difficult to distinguish bone from soft tissue with MR only, but the combination of MR and conventional radiography gave sufficient information for this differentiation. When radiologic nerve root sheath deformity was compared with clinical radiculopathy, myelography, CT myelography and MR had similar sensitivity and accuracy. Postoperative MR could reveal remaining indentation on the thecal sac and the cord but CT without contrast medium was useful as a complement to determine the aetiology of the indentation. Because MR has several practical advantages, it is well suited as the primary imaging modality, together with conventional radiography, for the preoperative radiologic evaluation of patients with cervical radiculopathy and/or myelopathy. Postoperative MR is useful in patients with persistent or new symptoms.

Adult↗
PubMed1979

[Ascending and descending myelography with water-soluble contrast medium. A report on thoracic and cervical metrizamid-myelography in 200 patients (author's transl)].

Ascending and descending thoracic and/or cervical metrizamid myelographies were conducted in 200 patients of all age groups. The apparatus used was of the type usually available in x-ray departments. Diagnostic results were good, or at least satisfactory, for a broad spectrum of diseases. No additional myelographic examinations using conventional contrast media were necessary. Metrizamid myelography represents a successful compromise between air and iodine-oil myelography, ie it combined their essential advantages, absorbability of the contrast medium, or favourable contrast. It is superior to both methods in respect of clarity of detail. The incidence of complications can be kept low mainly by limiting the amount of contrast medium or the concentrations used, as well as by employing a careful examination technique. Previous experience in myelography with oily contrast media will prove very useful.

Adolescent↗
PubMed1994

[3D-MR myelography in diagnosis of lumbar spinal nerve root compression syndromes. Comparative study with conventional myelography].

65 patients with nerve root compression syndrome were examined using a new type of MR-technique, which is comparable to the conventional X-ray myelography. The results of the prospective case study were compared with previous clinical experiences (1). For the examinations a 1.0T whole body MR-system (Siemens Magnetom Impact) was used. A strong T2*-weighted 3D-FISP sequence (TR = 73 ms, TE = 21 ms, alpha = 7 degrees) was applied in sagittal orientation using a circularly polarized oval spine coil. To obtain fat suppression a frequency selective 1-3-3-1 prepulse was applied prior to the imaging sequence. The acquired 3D-data set was evaluated using a Maximum Intensity Projection (MIP) program. Our results confirmed earlier experiences which showed that the diagnostic sensitivity of 3D-MR myelography (3D-MRM) is comparable to that of conventional X-ray myelography. In cases of severe spinal canal stenosis and spondylolisthesises, and in cases of postoperative scar tissue with nerve root compressions, the sensitivity of the 3D-MRM is higher as compared to that of conventional X-ray myelography.

Adult↗
PubMed1992

Spinal leptomeningeal neoplastic disease. Evaluation by MR, myelography and CT myelography.

Out of 16 patients, spinal leptomeningeal neoplastic disease was diagnosed by MRI in 4 patients, myelography in 14 patients and CT myelography in 12 cases. MR was superior to myelography in 2 patients, in another 2 patients MRI was equally diagnostic. The cerebrospinal fluid of every patient contained malignant cells. Histological evidence for primary central nervous system tumors was found in 5 cases. In 10 cases, non-neuraxial malignancy consisted of small cell carcinoma of the lung (7 cases), and leukemia and lymphoma (3 patients). In 1 patient, primary leptomeningeal malignant melanoma was confirmed at autopsy. Preferential thoracolumbar neoplastic morphologic manifestation correlated with the presence of conus and cauda equina syndrome in 9 patients, low back pain, paresthesia and spinal root signs in 7 patients. False-negative interpretation of myelography in 2 patients with positive MR findings, and the impressive sensitivity of gadolinium Dota to improve visualization of subarachnoid spread, favor MRI as an alternative imaging technique in the assessment of patients with suspected intradural extramedullary malignancy.

Adult↗
PubMed1997

Three-dimensional MR myelography of the lumbar spine: comparative case study to X-ray myelography.

Conventional myelography was compared with a new type of MR technique using a fat-suppressing 3D fast imaging with steady precession (FISP) sequence for diagnosis of the lumbar root compression syndrome. 80 patients with discogenic disease in the lumbar spine were examined with a 1.0-T whole-body MR system (Siemens Magnetom Impact, Erlangen, Germany). A strongly T2(*)-weighted 3D FISP sequence was applied in the sagittal orientation. To obtain fat suppression, a frequency-selective 1-3-3-1 prepulse was applied prior to the imaging sequence. The acquired 3D data set was evaluated using a maximum intensity projection (MIP) program. The measurement time was 7 min, 47 s. Magnetic resonance myelography has significant advantages over conventional myelography, particularly in cases of extreme spinal canal stenosis. Compared with the conventional method, this new MR technique shows comparable sensitivity in the visualization of the spinal nerve roots in the lumbar spine.

Case-Control Studies↗
PubMed1981

Myelography with metrizamide--an analysis of the complications encountered in cervical, thoracic and lumbar myelography.

Detailed analysis of complications in 363 patients undergoing myelography with metrizamide is presented. Patients have been separated into three groups: those who had lumbar myelograms via lumbar puncture; patients who had cervical myelograms via lumbar route and patients who had cervical myelograms via cervical puncture (lateral C1/C2. approach). Analysis has revealed that the incidence of minor complications like headaches, nausea, and vomiting is higher than that associated with myodil myelography. Nevertheless, it is concluded that because of lack of long term disability of arachnoiditis, and because of greater diagnostic accuracy, metrizamide represents the best contrast medium for myelography currently available.

Adolescent↗