metrizamide and Spinal-Cord-Diseases

The sensitivity of magnetic resonance imaging (MRI) to tissue alterations is particularly useful in spinal cord imaging. In addition to excellent anatomic display of this compact and complex area, syrinx cavities, tumors, and degenerating disks can be identified before they cause the anatomic distortion often necessary for detection by conventional means.

Topics: Astrocytoma; Bone Marrow Diseases; Brain Diseases; Ependymoma; Humans; Intervertebral Disc Displacement; Lipoma; Magnetic Resonance Spectroscopy; Meningeal Neoplasms; Metrizamide; Myelography; Neurofibroma; Spinal Cord; Spinal Cord Diseases; Spinal Cord Neoplasms; Spinal Diseases; Spinal Injuries; Spine; Syringomyelia; Tomography, X-Ray Computed

Topics: Adult; Aged; Arteriovenous Malformations; Cervical Vertebrae; Female; Humans; Joint Dislocations; Ligaments; Male; Metrizamide; Microsurgery; Middle Aged; Myelography; Ossification, Heterotopic; Spinal Cord; Spinal Cord Diseases; Spinal Cord Neoplasms; Spinal Diseases; Syringomyelia; Tomography, X-Ray Computed

The most important complications of intravascular administration of contrast agents include idiosyncratic (anaphylactoid) reactions, shock, congestive heart failure, cardiac arrhythmias, acute renal failure, and neurotoxic effects. The incidence of serious neurotoxic effects is low. Entry of contrast agents into the central nervous system normally is limited but may be increased by osmotic opening of the blood-brain barrier with cerebral arteriography or arch aortography. Most neurotoxic effects are thought to represent direct effects of the contrast agent on brain or spinal cord. Adverse effects with arteriography include seizures, transient cortical blindness, brain edema, and spinal cord injury. Most cases of focal brain deficit (other than cortical blindness) are attributed to embolism secondary to the catheter. Seizures may occur with intravenous administration, especially in patients with brain tumors or other processes disrupting the blood-brain barrier. The most important adverse effects observed with myelographic agents include acute and chronic meningeal reactions with iophendylate, and seizures and transient encephalopathy with metrizamide.

Topics: Animals; Blindness; Blood-Brain Barrier; Brain Diseases; Brain Edema; Central Nervous System Diseases; Cerebrovascular Disorders; Contrast Media; Diatrizoate; Dose-Response Relationship, Drug; Epilepsy; Humans; Injections, Intravenous; Injections, Spinal; Iophendylate; Metrizamide; Rabbits; Spinal Cord Diseases; Visual Cortex

Topics: Contrast Media; Humans; Injections, Spinal; Metrizamide; Spinal Cord Diseases; Spinal Cord Neoplasms; Syringomyelia; Tomography, X-Ray Computed

Topics: Humans; Injections, Spinal; Metrizamide; Myelography; Radiographic Image Enhancement; Spinal Cord; Spinal Cord Diseases; Spinal Diseases; Spine; Tomography, X-Ray Computed

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.

Topics: Adolescent; Adult; Aged; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Contrast Media; Double-Blind Method; Female; Headache; Humans; Injections, Spinal; Iodobenzoates; Iohexol; Male; Metrizamide; Middle Aged; Multi-Institutional Systems; Myelography; Nausea; Prospective Studies; Spinal Cord Diseases; Triiodobenzoic Acids; Vomiting

Computer tomography of the cervical spinal canal was carried out in 54 patients after the intrathecal injection of metrizamide (CT myelography). In 43 patients this was done after conventional myelography, in eleven it was the primary examination. In 32 patients the examination proved normal and in 22 abnormal. Correlation between the CT findings and conventional myelography was excellent. Quite small intraspinal structures both normal and abnormal, could be demonstrated. CT myelography is particularly valuable for determining the special relationships within the vertebral canal. The procedure can supplement and confirm conventional myelography, for instance round the foramen magnum. Under certain circumstances it may be regarded as the method of choice, since it is simpler for the patient and less likely to produce complications due to the contrast medium.

Topics: Adolescent; Adult; Aged; Child; Clinical Trials as Topic; Female; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Myelography; Posture; Radiographic Image Enhancement; Spinal Cord; Spinal Cord Diseases; Spinal Cord Neoplasms; Tomography, X-Ray Computed

The author reports that side effects were somewhat more frequent after metrizamide than after meglumin-iocarmate, in the course of a comparative study carried out at the reporting hospital from the beginning of 1977, using the water-soluble x-ray contrast media Amipaque (metrizamide) and Dimer X (meglumin-iocarmate).

Topics: Clinical Trials as Topic; Female; Humans; Iothalamate Meglumine; Male; Metrizamide; Myelography; Spinal Cord Diseases

Metrizamide and meglumine iocarmate (Dimer-X), which at present are the contrast media for myelography best tolerated by central nervous system, were compared in a double-blind test comprising a total of 86 patients, all with symptoms of lumbar or sacral root involvement. Symptoms appearing were recorded using a standard interview formula 24 hoaurs after myelography. EEG, routine laboratory analyses of CSF and neurologic examinations were also made. In some cases CSF paper electrophoresis, CSF pressure recordings and determination of CSF iodine content were obtained.

Topics: Adult; Aerophagy; Aged; Blood Cell Count; Clinical Trials as Topic; Contrast Media; Female; Headache; Humans; Iodobenzoates; Iothalamate Meglumine; Iothalamic Acid; Male; Metrizamide; Middle Aged; Myelography; Pain; Spinal Cord Diseases

This study reviewed the technical complication of 112 cases of lateral C1-2 puncture myelography for cervical spinal cord disorders. Spinal cord puncture and contrast injection, puncture between the occiput and C1, and blood vessel puncture were the main complications. These principally depended on the positioning of the patient's neck (hyperextension) and misdirection of the x-ray beam. For preventing major arterial puncture, the authors also reviewed 164 vertebral angiograms and determined the pathway of the vertebral arteries and the incidence of anomaly.

Topics: Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Needles; Punctures; Seizures; Spinal Cord Diseases; Spinal Cord Injuries; Vertebral Artery

A modified spinal cord puncture technique that was combined with CT metrizamide syringography for the evaluation of potentially cystic spinal cord lesions has been used in 5 patients. This procedure proved to be safe and efficacious in the preoperative differentiation of cystic neoplasms from syringohydromyelia. It also aided in planning a surgical approach by revealing details of the tumor location and/or syrinx dynamics. Spinal cord puncture associated with CT metrizamide syringography has a role in the diagnosis and therapy of patients with cystic spinal cord lesions.

Topics: Adult; Arnold-Chiari Malformation; Biopsy, Needle; Child, Preschool; Diagnosis, Differential; Female; Humans; Male; Metrizamide; Radiography; Spinal Cord Diseases; Spinal Cord Neoplasms; Spinal Puncture; Syringomyelia

Sixty-nine patients with cervical spondylotic myelopathy (CSM), radiculopathy (CSR), or both (CSMR) were studied with computed tomography (CT). Computer-assisted myelography (CAM) accurately determines the site and nature of spondylotic protrusions and provides good visualisation of the subarachnoid space and cord deformities even in areas with dilute metrizamide. However, excessive vertebral movement and bulging ligamenta flava with their effects on cord deformity, so easily visualised in myelograms, are completely or partially missed. In the assessment of CSM, metrizamide myelography (MM) followed by CAM should be performed, particularly when the myelographic images are unsatisfactory due to contrast dilution or blockage, when cord compression cannot be ascertained with MM and when cord atrophy is suspected. In CSR, the diagnostic information from MM and CAM is comparable. The diagnostic criteria in CAM are, however, less direct and since MM is adequate in uncomplicated cases, CAM is generally not necessary. The APD, APD/TD ratio, area and circularity are sensitive indices of cord deformity and the first two should be used more often to assist visual assessment of cord deformity. The relation between cord parameters and treatment response is better reflected in CSM cases managed conservatively and the results suggest that the degree of cord deformity is helpful in determining the outcome and hence the choice between surgical and conservative treatment. In plain CT, the osteophytes and calcified discs are adequately visualised and canal dimensions measured with accuracy, but the cervical cord and roots cannot be properly assessed and the diagnosis of CSM or CSR cannot be ascertained. At present, its role in cervical spondylosis is therefore limited.

Topics: Humans; Metrizamide; Myelography; Peripheral Nervous System Diseases; Spinal Cord Diseases; Spinal Nerve Roots; Spinal Osteophytosis; Tomography, X-Ray Computed

A 55-year-old man came to our hospital, complaining of progressive deterioration of gait disturbance 13 years following C4-7 laminectomy. Neurological examination showed marked spastic gait, hyperreflexia in the lower limbs, ankle clonus, hypesthesia below C5, and loss of position and vibratory sensations in great toes. Preoperative metrizamide CT clearly demonstrated pseudomeningocele and cervical cord herniation through the dural defect at C6-7 and narrow canal at C3. Moreover, sagittal and coronal reconstructions reveal a clear-cut posterior displacement of the cervical cord with posterior protrusion of the cord through the possible dural defect and the obvious extent of pseudomeningocele. At the operation, herniation of the posterior aspect of the cord through the dural defect at C6-7 was encountered as well as pseudomeningocele from the leakage at the C5 level. The cause of spinal cord herniation is classified into i) congenital, ii) traumatic, iii) iatrogenic. An iatrogenic spinal cord herniation is rare and its preoperative diagnosis used to be hard. Discussion was made on the points of preoperative diagnosis of a postoperative spinal cord herniation by metrizamide CT.

Topics: Hernia; Humans; Laminectomy; Male; Metrizamide; Middle Aged; Postoperative Complications; Spinal Cord Diseases; Tomography, X-Ray Computed

We reviewed the magnetic resonance imaging (MRI) scans of the spine of 42 children who had neurologic signs compatible with lesions of the spinal cord. Twenty-three of the children had abnormalities identified by MRI. The spectrum of abnormalities included posttraumatic lesions, tumor, tethered cord, and syringohydromyelia. Tethered cord with or without lipoma and syringohydromyelia were the most common findings, affecting six and four children, respectively. Thirteen children studied by MRI also underwent conventional metrizamide myelography and/or computed tomography. In 12 cases, the findings of MRI were comparable to those of myelography and computed tomography. These observations indicate that MRI effectively detects lesions of the spinal cord in children. Because MRI can be performed on an outpatient basis and avoids the risks of metrizamide myelography, we conclude that MRI should be considered to be the preferred screening technique for children with suspected spinal cord disorders.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Magnetic Resonance Spectroscopy; Male; Metrizamide; Myelography; Spinal Cord; Spinal Cord Diseases; Spinal Cord Injuries

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.

Topics: Adult; Aged; Humans; Magnetic Resonance Spectroscopy; Metrizamide; Middle Aged; Myelography; Prospective Studies; Spinal Cord Diseases; Spinal Nerve Roots; Tomography, X-Ray Computed

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.

Topics: Adult; Aged; Cervical Vertebrae; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Peripheral Nervous System Diseases; Spinal Cord Diseases; Spinal Nerves; Tomography, X-Ray Computed

There are few reports of hemorrhagic central nervous system complications after chymopapain injection in humans. Two patients are reported who developed hemorrhagic complications after the lumbar injection of chymopapain. The first developed a hemorrhagic encephalomyelopathy followed by clinically suspected acute arachnoiditis, which responded to high doses of dexamethasone. The second patient developed subarachnoid hemorrhage secondary to vertebral artery aneurysm rupture after the injection of chymopapain.

Topics: Adult; Arachnoiditis; Cerebral Hemorrhage; Chymopapain; Diatrizoate Meglumine; Drug Interactions; Endopeptidases; Hemorrhage; Humans; Intervertebral Disc Displacement; Iothalamate Meglumine; Male; Metrizamide; Spinal Cord Diseases; Subarachnoid Hemorrhage

Posttraumatic progressive myelopathy (PTPM) was studied in nine patients and grouped into three categories on the basis of characteristic radiographic findings and response to therapy: (a) myelomalacia with no cystic degeneration, which has poor response to therapy; (b) small cysts, with poor response to therapy; and (c) large cysts, which are effectively treated by decompression. One type dominated in each patient, although a mixture of types was present in each. Magnetic resonance (MR) imaging gave slightly improved resolution and specificity of type, decreased morbidity, and simplification of procedure in comparison with imaging by delayed computed tomographic metrizamide myelography (DCTM). DCTM and MR imaging results correlated nearly equally with those of intraoperative sonography (IOS) and pathologic study at surgery. IOS was superior to DCTM or MR imaging in detecting septations and small additional cysts. IOS also was helpful in myelotomy positioning, shunt placement, and verification of cyst decompression. MR imaging may replace DCTM in the preoperative evaluation of PTPM, followed by IOS imaging as indicated. Patients with nonmyelopathic signs and symptoms (e.g., radiculopathy) probably still require study with conventional and/or CT myelography.

Topics: Adolescent; Adult; Cysts; Humans; Infant, Newborn; Intraoperative Care; Magnetic Resonance Spectroscopy; Metrizamide; Myelography; Spinal Cord Diseases; Spinal Injuries; Syringomyelia; Tomography, X-Ray Computed; Ultrasonography

A case of an extradural spinal arachnoid cyst is presented with emphasis on the neuroradiologic characteristics of this lesion. The cyst was definitely diagnosed by delayed metrizamide spinal computed tomography. Extradural spinal arachnoid cysts, or diverticula, have been the subject of much discussion in the neuroradiologic and neurosurgical literature. However, the appearance of a communicating arachnoid cyst on delayed spinal computed tomography after metrizamide myelography is heretofore undescribed in the English language neurosurgical literature.

Topics: Adult; Arachnoid; Cysts; Humans; Male; Metrizamide; Spinal Cord Diseases; Tomography, X-Ray Computed

We compared intrathecal metrizamide-enhanced CT (metrizamide-CT) and magnetic resonance imaging (MRI) in the evaluation of 17 patients with clinical suspicion of lesions at the cervicomedullary junction. MRI was superior in imaging the position of the cerebellar tonsils and the size and extent of mass lesions. MRI and metrizamide-CT were equal in detecting syringomyelia. CT with and without IV contrast enhancement was necessary to detect calcium or defects in the blood-brain barrier within neoplasms.

Topics: Adolescent; Adult; Aged; Arnold-Chiari Malformation; Brain Diseases; Brain Neoplasms; Child; Female; Humans; Magnetic Resonance Spectroscopy; Male; Medulla Oblongata; Metrizamide; Middle Aged; Spinal Cord Diseases; Spinal Cord Neoplasms; Syringomyelia; Tomography, X-Ray Computed

A case of subacute progressive spinal tetraparesis had myelographic evidence of cervical spinal cord swelling and a delayed metrizamide computed tomographic myelogram (MCTM) suggested cavitation within the swollen spinal cord. Surgical exploration of the cervical cord revealed inflammatory changes only. No syrinx or intramedullary tumour was found. The accumulation of metrizamide within the spinal cord, as demonstrated by MCTM, did not represent a syrinx or a cystic tumour, but more likely an area of inflammation. Because inflammatory myelopathy may simulate an intramedullary tumor or syrinx, careful analysis of all clinical and radiological information is necessary to help make a correct diagnosis.

Topics: Adult; Cysts; Diagnostic Errors; Female; Humans; Metrizamide; Myelitis; Myelography; Spinal Cord Diseases; Tomography, X-Ray Computed

The safety of post-myelogram computed tomography (PMCT) as an additional diagnostic procedure to metrizamide myelography was evaluated. One hundred and four consecutive patients with suspected cervical cord lesions were studied prospectively; 50 had both myelography and PMCT, and the 54 acting as controls had only myelography. PMCT did not increase the incidence, severity or duration of common side effects and the majority of patients accepted this additional procedure. It is concluded that as long as care is taken to avoid the occurrence of excessive contrast in the intracranial subarachnoid space, PMCT is a safe procedure.

Topics: Adult; Aged; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Risk; Spinal Cord Diseases; Time Factors; Tomography, X-Ray Computed

Ten patients with prior spinal cord trauma were examined preoperatively by metrizamide computed tomography (CT) and were studied subsequently by intraoperative spinal sonography. On comparing intraoperative sonography with metrizamide CT, it was found that metrizamide CT tends to overestimate the size and number of posttraumatic cysts, that areas of myelomalacia on metrizamide CT correspond to areas of abnormal echogenicity on intraoperative sonography, and that intracyst septations are seen only on intraoperative sonography. By monitoring the position of the shunting catheter during surgery, intraoperative sonography can assure its proper intramedullary placement and demonstrate the successful decompression of the cyst. If no cyst is found with intraoperative sonography, further surgery is obviated. Intraoperative sonography is recommended for all cases where decompression of cord cysts is planned.

Topics: Cysts; Humans; Intraoperative Period; Metrizamide; Spinal Cord Diseases; Spinal Cord Injuries; Tomography, X-Ray Computed; Ultrasonography

The normal CT configuration and dimension of the conus medullaris and adjacent spinal cord were determined in 30 patients who had no clinical evidence of conus compression. CT studies were also correlated with anatomic sections in cadavers. The normal conus on CT has a distinctive oval configuration, an anterior sulcus, and a posterior promontory. The anteroposterior diameter ranged from 5 to 8 mm; the transverse diameter from 8 to 11 mm. Intramedullary processes altered both the dimensions and configuration of the conus.

Topics: Astrocytoma; Humans; Metrizamide; Myelography; Radiographic Image Enhancement; Spinal Cord; Spinal Cord Diseases; Spinal Cord Neoplasms; Tomography, X-Ray Computed

Combined intrathecal metrizamide and arterial injection of contrast medium during dynamic computed tomography scanning was used to define the morphology and topographic aspects of a thoracic arteriovenous malformation. The information obtained from this new technique was decisive in establishing the operability of the lesion.

Topics: Angiography; Arteriovenous Malformations; Humans; Injections, Intra-Arterial; Male; Metrizamide; Middle Aged; Spinal Cord; Spinal Cord Diseases; Tomography, X-Ray Computed

An example of a symptomatic intradural arachnoid diverticulum is presented. The usefulness of computed tomographic metrizamide myelography in conjunction with conventional positive contrast myelography in the evaluation of such lesions is discussed.

Topics: Arachnoid; Diverticulum; Humans; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Cervical Vertebrae; Contrast Media; Female; Humans; Iopamidol; Iothalamic Acid; Male; Metrizamide; Middle Aged; Myelography; Neck; Spinal Cord Diseases; Spinal Diseases

Computer-assisted myelography (CAM) is a technique in which computed tomography (CT) is combined with the intrathecal administration of metrizamide to demonstrate the spinal cord and surrounding structures. This retrospective study of 139 CAMs performed at Emory University Hospital included 125 CAMs that were preceded by routine metrizamide myelography (secondary CAM). The remaining 14 CAMs were primary studies without concomitant myelography. These CAMs and conventional myelograms were reviewed to provide indications for the use of CAM as a replacement for other radiodiagnostic studies or as an adjunct to radiological diagnosis. Eighty-one CAMs (58%) were positive for some pathological process. Of the 69 secondary CAMs demonstrating a pathological condition, 46 (67%) revealed some aspect of the lesion not apparent on routine metrizamide myelography. In no case with positive myelography was CAM negative. However, conventional myelography often added valuable diagnostic information. Although high resolution CT has allowed limited visualization of the spinal cord, CAM is often indicated for cases in which diagnosis requires more definition of cervicomedullary, extradural, intradural, extramedullary, and intramedullary lesions. Our clinical review found CAM to be extremely useful in the diagnostic evaluation of pathological conditions involving the spine and spinal cord and suggests clinical indications for the use of CAM based upon selected illustrative cases. Furthermore, CAM seemed to be superior to other radiological procedures in certain instances, such as in cases of spinal dysraphism and in the evaluation of lesions at the foramen magnum. Until more experience is obtained using spinal CT and CAM, CAM should not replace myelography altogether. The present study indicates that, rather than replacing conventional CT and myelography, CAM should be used as a primary study in situations where it has been shown to be superior and as a complementary study when other neurodiagnostic examinations are equivocal or nondiagnostic.

Topics: Adult; Child; Computers; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Metrizamide; Myelography; Spinal Cord Compression; Spinal Cord Diseases; Spinal Cord Neoplasms; Syringomyelia; Tomography, X-Ray Computed

The diagnostic value of plain film metrizamide myelography (PFMM) was compared with computed tomographic metrizamide myelography (CTMM) in a study of 106 individuals who had undergone high-resolution computed tomographic scanning of the spine. CTMM provided more significant information than PFMM in 42 of 106 cases (40%), but showed no advantage over PFMM in 63 of 106 cases (59%). In 19 of the 42 cases (45%), PFMM was useful in directing the CT analysis to the appropriate region of pathology. In one patient, PFMM revealed a mobile herniated disc that had not been visualized with CTMM. In 30 of 106 cases in which plain CT scans of the spine were also obtained, the addition of intrathecal metrizamide demonstrated additional pathology in ten individuals. In general, CTMM was useful in the delineation of a variety of pathologic entities, especially neoplasms and congenital abnormalities. Low-dose CTMM (3 ml of a 150 ml/mg concentration) was performed as an outpatient procedure and found to be a useful adjunct to plain CT in two patients. A schema for the radiological evaluation of pathology of the spine is presented.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Intervertebral Disc Displacement; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Spinal Diseases; Tomography, X-Ray Computed

The authors report a case of ossification of the ligamentum flavum at T-10 and T-11 associated with compressive myelopathy. Metrizamide myelography with computerized tomography allowed precise preoperative diagnosis and anatomic localization of the lesion. The patient had satisfactory and prompt improvement after surgical intervention.

Topics: Humans; Ligaments; Male; Metrizamide; Middle Aged; Myelography; Ossification, Heterotopic; Spinal Cord Diseases; Spine; Thorax; Tomography, X-Ray Computed

Topics: Humans; Intervertebral Disc Displacement; Metrizamide; Myelography; Spinal Cord Diseases; Spinal Cord Neoplasms

Topics: Contrast Media; Ependymoma; Humans; Iopamidol; Iothalamic Acid; Meningeal Neoplasms; Meningioma; Metrizamide; Myelography; Spinal Cord Diseases; Spinal Cord Neoplasms; Spinal Diseases

Total myelography with metrizamide at a concentration of 270 mgI/ml was carried out via lumbar puncture in 170 consecutive patients. Good opacification and/or diagnostic value was obtained in the lumbar, thoracic and cervical region at 88.8%, 77.6% and 72.4% respectively. Unsatisfactory results were mostly due to the poor technique of physicians and x-ray technicians. Also it was inadequate to perform this study in some lesions, such as ruptured arterio-venous malformation and occification of posterior longitudinal ligament. Several cases with previous oil myelography showed poor results, because the remaining of Myodil disturbed a good spreading of the newly injected media. It was requested to evacuate oily contrast media prior to metrizamide myelography. One of the most important clues to a successful myleography was to make dilusion of contrast media as little as possible, and the use of high concentration of metrizamide (250-270 mgI/ml) seemed to be tolerated. It was also important to avoid excessive movement of the patient and the rapid transit of the contrast media to the level of interest. It was recommended to study the entire spinal subarachnoid space as a whole. In sixty-three patients out of 170, one or more abnormal myelographical findings were detected at unexpected level. Immediately after the examination the patients were encouraged to drink a large quantity of diuretic beverages such as tee, juice or coffee for the purpose of reducing side effects. As Potts and coworkers and Eldevik and associates reported, it was recognized that the overhydration could reduce the severe side effects after the metrizamide myelography.

Topics: Adolescent; Adult; Aged; Child; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Spinal Diseases

Topics: Adrenal Insufficiency; Adult; Humans; Male; Metrizamide; Myelography; Spinal Cord; Spinal Cord Diseases; Tomography, X-Ray Computed

Thirty-four patients were submitted to the conventional cervical myelography by administration of metrizamide (Amipaque) through three routes (lumbar 23, suboccipital 6, C1-C2 lateral 5). After the injection of metrizamide (4-11 ml, 170-250 mgI/ml), all procedures of the cervical myelography were done as soon as possible within 9 minutes. The adverse reactions of Amipaque were observed in 29 cases (85%) out of 34 cases initially 1 hour after cervical myelography and disappeared completely in an average of 16 hours. The total number of the side effects was 140 incidences such as meningeal irritation (headache 18, nausea 17, vomiting 17), cerebellar signs (dizziness 11, dysarthria 8, tremor 5, bradylalia 2, dysmetria 2, tipsy feeling 2, dysdiadochokinesis 1), autonomic signs (flushing 7, pale face 4, fever 4, sweating 2, hiccup 2, fatigability 2, micturition disturbance 1), sensory signs (exacerbation of numbness 6, perioral numbness 3, back pain 1, chest pain 1), motor signs (focal muscle spasm 5, exacerbation of paresis 4, areflexia 1), psychiatric signs (dysphasia 3, disturbance of consciousness 2, euphoria 1, persecutory delusion 1) and muddiness 7. We observed that waxing and waning of side effects correlated tightly with transient cortical penetration of dye in CT and cortical dysfunction mainly slowing of the background activity and slow wave burst in EEG. According to high frequency of side effects in our study, we suggest that a greater incidence of side effects may result when high concentration of Amipaque comes in contact with the cerebral cortex by using an inadequate fluoroscopic table which has only fixed one plane image and rough positioning control. Slow absorption into blood stream may affect appearance and maintenance of side effects. In order to decrease side effects after Amipaque cervical myelography, we propose that we should introduce a mobile rotating chair coupled with high power image and chose C1-C2 lateral route using 1500-1700mgI of Amipaque.

Topics: Adolescent; Adult; Aged; Central Nervous System; Electroencephalography; Female; Headache; Humans; Male; Metrizamide; Middle Aged; Myelography; Nausea; Spinal Cord Diseases; Vomiting

Topics: Cervical Vertebrae; Humans; Metrizamide; Myelography; Spinal Cord Diseases; Spinal Diseases; Technology, Radiologic

A modified C1-2 myelogram, using metrizamide (Amipaque), provides excellent visualization of the cervical spinal cord. The mean values of the sagittal diameter of the spinal cord are given in 100 selected cases. Comparison with these normal values is useful in the preliminary diagnosis of cervical cord atrophy versus syringohydromyelia.

Topics: Adolescent; Adult; Aged; Cervical Vertebrae; Child; Humans; Male; Metrizamide; Middle Aged; Myelography; Reference Values; Spinal Cord Diseases; Syringomyelia

A double-blind study was performed on 20 patients comparing the safety and efficacy of Iopamidol and Metrizamide in cervical myelography. The radiographic qualities of the Iopamidol and Metrizamide examinations were equivalent when using the same volume (12 to 13 ml), concentration (200 mg I/ml), and a C1-2 route of administration. The performance of a CT scan on selected patients in specified areas of interest provided additional diagnostic information in some patients (e.g syringomyelia, degenerative spondylosis). The adverse reactions were mild in the Iopamidol group with 4 of the 10 patients experiencing no adverse reactions. The more severe reactions, including disorientation, agitation, dysarthria, asterixis, hyperreflexia and EEG abnormalities were limited to the Metrizamide group with one or more occurring in 2 of the 10 patients studied. Only one Metrizamide patient experienced no adverse reactions. In this study containing a limited number of patients, Iopamidol was shown to be a diagnostically effective and safer contrast medium for performing cervical myelography.

Topics: Chemical Phenomena; Chemistry; Double-Blind Method; Humans; Iopamidol; Iothalamic Acid; Metrizamide; Myelography; Spinal Cord Diseases; Spinal Diseases

Topics: Adult; Arachnoid; Cysts; Female; Humans; Iodized Oil; Metrizamide; Myelography; Spinal Cord Diseases; Stearates; Stearic Acids

The neuroradiologic evaluation and findings in 25 symptomatic patients with surgically proven progressive posttraumatic cystic myelopathy are reviewed. To follow patients with spinal cord injury, neuroradiologic algorithms were developed to confirm and define cystic myelopathy. The algorithm used in the early and mid 1970s relied on the myelographic demonstration of a large cord for suspicion of a cyst. Review of this material found that in progressively symptomatic patients 14 of 25 proven cysts were in large cords. A more recent algorithm used computed tomographic metrizamide myelography. In nine of 11 patients studied in this fashion, the cyst filled with contrast material 2--4 hr after injection, yet it did not communicate with the subarachnoid space at subsequent surgery. The origin of the cyst fluid and mechanism of cyst demonstration with metrizamide may be associated with transneural migration of fluid. This condition must be clinically suspected and radiologically confirmed for surgical treatment (cyst-shunt procedure) if neurologic preservation of function is to be maintained.

Topics: Cysts; Humans; Metrizamide; Myelography; Spinal Cord Diseases; Spinal Cord Injuries; Spinal Puncture; Tomography, X-Ray Computed

Topics: Adult; Aged; Cervical Vertebrae; Coma; Confusion; Epilepsy, Tonic-Clonic; Female; Hemiplegia; Humans; Intervertebral Disc Displacement; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Spinal Diseases

Topics: Aged; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Solubility; Spinal Cord Diseases

The exact evaluation of a hydrosyringomyelic cyst by metrizamide enhanced CT is reported. After intraventricular injection of metrizamide and overflow of contrast medium in the central canal of the spinal cord, CT scan revealed the exact shape and extension of the cyst from C0 to T7.

Topics: Adult; Contrast Media; Cysts; Humans; Injections, Intraventricular; Male; Metrizamide; Spinal Cord Diseases; Syringomyelia; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Brain Diseases; Child; Child, Preschool; Female; Humans; Hydrocephalus; Infant; Infant, Newborn; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Tomography, X-Ray Computed

Topics: Adolescent; Adult; Aged; Contrast Media; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases

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 metrizami

Topics: Adolescent; Adult; Aged; Brain Diseases; Cerebral Ventriculography; Cranial Nerve Neoplasms; Female; Humans; Injections, Spinal; Male; Metrizamide; Middle Aged; Myelography; Neuroma, Acoustic; Spinal Cord Diseases; Tomography, X-Ray Computed

Computerized Metrizamide ventriculomyelography consists of CT exploration of the head and neck performed one hour after introduction of Metrizamide into the lateral ventricle via a frontal burr hole. This procedure permits visualisation of all soft-tissue anomalies present in Chiari malformation with hydromyelia as seen in two cases.

Topics: Adult; Arnold-Chiari Malformation; Cerebral Ventriculography; Female; Humans; Male; Metrizamide; Spinal Cord Diseases; Tomography, X-Ray Computed

Of 16 consecutive patients with tethered spinal cord studied, most had undergone repair of a meningomyelocele. All were evaluated using somatosensory evoked potentials at 6 to 12-month intervals. Other possibilities include tethered filum terminale, lipomeningocele, membrana reuniens, and miscellaneous conditions (diastematomyelia, neurenteric cysts, etc.). Metrizamide myelography with polytomography was superior to gas myelography in showing a low-lying cord, obtuse nerve root angles, and a thin subarachnoid space between the cord and the dorsal meninges cephalad to the tether. Surgery is generally helpful in these patients.

Topics: Child; Child, Preschool; Evoked Potentials; Female; Humans; Male; Meningocele; Meningomyelocele; Metrizamide; Myelography; Postoperative Complications; Spinal Cord Diseases; Subarachnoid Space

The adverse side effects in a series of 439 myelographies with metrizamide were analyzed. The most frequent side effect was headache, which could be differentiated as early onset headache, related to hydrodynamic modifications in the spinal fluid following lumbar puncture, and late onset headache related to a metrizamide effect. The frequency of late onset headache was at least 27%, but all together 46% of the patients had postmyelographic headache. Meningeal irritation was seen in 5%, sometimes in a severe form, mimicking a septic complication. Spinal irritation and epileptic fits were rarely seen. Striking was the occurrence of an acute psycho-organic syndrome, frequently observed after cervical myelography which was performed with a higher than usual dose of iodine. We can not confirm the general opinion that the central nervous system had a good tolerance for metrizamide.

Topics: Anaphylaxis; Emotions; Epilepsy; Headache; Humans; Metrizamide; Myelography; Neck; Pain; Perception; Spinal Cord Diseases

Metrizamide, a new, water-soluble contrast agent, was clinically evaluated as a myelographic agent in 17 dogs. Nine dogs were given lumbar subarachnoid injections and six were given cisternal injections. Two dogs were given cisternal and lumbar injections; in one dog, both injections were given on the same day. The dosage ranged from 0.3 to 0.57 ml/kg of body weight, using an isotonic solution of metrizamide. Of eight dogs given cisternal injections, two experienced convulsive activity requiring diazepam treatment during the anesthetic recovery period. The lumbar injections did not cause convulsions. Satisfactory radiographic density persisted up to 45 minutes after injection, allowing time for several views to be obtained. In general, metrizamide appeared to be an adequate myelographic agent in the dog.

Topics: Anesthesia; Animals; Cisterna Magna; Dog Diseases; Dogs; Female; Injections; Lumbar Vertebrae; Male; Metrizamide; Myelography; Seizures; Spinal Cord Compression; Spinal Cord Diseases

Topics: Animals; Female; Horse Diseases; Horses; Male; Metrizamide; Myelography; Spinal Cord Diseases

Topics: Arachnoiditis; Humans; Metrizamide; Radiography; Spinal Cord Diseases; Spinal Puncture

Cervical myelography with metrizamide was performed in a series of 30 patients. Minor modifications to the conventional technique made it possible to carry out measurements of the sagittal diameter of the cord and to improve the opacification of the upper cervical--foramen magnum region. Computer tomography was performed with a head scanner within 1 h after the conventional examination, and the spinal cord surrounded by contrast medium was shown from C-3 to the foramen magnum region. Measurements of the sagittal diameter of the spinal canal and the cord at corresponding levels using the two methods showed good correlation.

Topics: Adolescent; Adult; Aged; Cervical Vertebrae; Child; Female; Foramen Magnum; Humans; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord Diseases; Tomography, X-Ray Computed

The non-ionic water-soluble contrast medium metrizamide (Amipaque) allows the examination of all regions of the spinal canal. Excellent visualization, the low toxicity for nervous tissue, and small side effects make metrizamide the best contrast medium for myelography, even in infants and children. The technique used is described and results are demonstrated.

Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Metrizamide; Myelography; Neural Tube Defects; Spinal Cord Diseases; Spinal Cord Neoplasms

Either arachnoriditis or dural/arachnoidal tears may cause symptoms in the postoperative spinal patient. Surgery and myelography as causes of arachnoiditis are discussed. Intradural arachnoid cyst formation and intramedullary cavitation may present as unusual sequelae of arachnoiditis. Extra-dural cysts and cerebrospinal fluid fistulas resulting from dural/arachnoidal tears are unusual postoperative complications presenting striking myelographic features. Their mechanisms of formation, clinical significance, and radiographic features are discussed.

Topics: Animals; Arachnoid; Arachnoiditis; Central Nervous System Diseases; Cerebrospinal Fluid; Contrast Media; Cysts; Dura Mater; Fistula; Iothalamate Meglumine; Mesylates; Metrizamide; Myelography; Postoperative Care; Postoperative Complications; Solubility; Spinal Cord Diseases; Steroids; Water

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.

Topics: Adult; Arteriovenous Malformations; Female; Headache; Humans; Iodobenzoates; Male; Metrizamide; Middle Aged; Myelography; Neurofibromatosis 1; Solubility; Spinal Cord Diseases; Tomography, X-Ray

A very simple procedure is described which leads to adequate visualization of the structures in the craniocervical area that are otherwise often very insufficiently investigated during myelography routinely performed with metrizamide.

Topics: Adult; Arteriovenous Malformations; Arthritis, Rheumatoid; Cervical Atlas; Contrast Media; Female; Humans; Male; Metrizamide; Middle Aged; Myelography; Spinal Cord; Spinal Cord Diseases