Outpatient Myelography with Iohexol and Iopamidol; Pilot Study and Contrast Trial

50 patients underwent myelography on an outpatient basis; the incidence and severity of side effects were compared, in a prospective study, with 180 inpatient examinations over the same period. In addition, in the initial 200 myelograms (36 outpatient and 164 inpatient) iohexol and iopamidol were compared in a double blind trial. Headache was the most common side effect in both patient groups, recorded in 50% of outpatients and 25% of inpatients. Other side effects were of comparable incidence. 84% of outpatients undergoing myelography found it “acceptable”, and did not consider a night in hospital necessary after the procedure. No difference in side effects was demonstrated between the two contrast media. This pilot study suggests that outpatient myelography is practical and safe, with considerable cost saving implications.     

The value of spinal computed tomography in diagnosis of herniated lumbar discs

Summary In this study the diagnostic value and topographical accuracy of spinal computed tomography (CT) in the preoperative diagnosis of lumbar disc herniations were tested in 36 patients with surgically proven herniated discs. All patients also underwent metrizamide myelography. CT findings and myelograms were compared and correlated with the surgical observations. Especially in demonstrating exact diagnosis (lateral or more medial protrusion), and in showing the extent of upward or downward displacement of free disc material, CT provides valuable preoperative information. As a non-invasive diagnostic procedure, spinal CT scan may replace lumbar myelography in many patients with radicular lumbar pain.     

Frequency and severity of headache after lumbar myelography using a 25-gauge pencil-point (Whitacre) spinal needle

We studied 63 patients between the ages of 20 and 81 years undergoing lumbar myelography, using a 25-gauge pencil-point (Whitacre) spinal needle. With the use of a questionnaire, the incidence and severity of post-dural-puncture headache (PDPH) was investigated. There were three patients who complained of PDPH (4.7%), two of whom described their headache as moderate and one as mild on a visual analogue scale. All the headaches were alleviated by mild analgesics and no patient experienced severe headache needing treatment with a blood-patch. There were three other patients who experienced a post dural-puncture-related headache which, unlike PDPH, was not postural. Four patients had ordinary mild headache. The quality of the myelograms was good.     

腰椎间盘突出症的CT表现：附120例分析

笔者对CT诊断、手术证实的腰椎间盘突出症120例进行了回顾性分析,结果表明,CT诊断与手术总的符合率为94％(113例)。CT征象中,1.软组织块占98％,2.硬膜外脂肪受压变窄占89.2％,3.硬膜囊受压占92.5％,4.神经根移位、淹没征占25％,5.钙化20％。Amipaque脊髓造影CT对椎间盘突出的形态、椎管内结构显示更为清楚。文中对鉴别诊断进行了讨论。     

Computed tomography in the diagnosis of syringomyelia

We describe the usefulness of computed tomography (CT) in the diagnosis of syringomyelia in 12 patients for whom the diagnosis had remained unconfirmed with other diagnostic methods. In 7 of these patients, CT myelography revealed an intramedullary cavitation filled with contrast medium. In 3 patients, the cavitation was not filled, and positive contrast medium was not used in another 2. In these 5 cases, however, CT visualized low-density areas within the cord. CT would seem to be the most preferable method for confirming the clinical diagnosis of syringomyelia and is particularly useful in atypical cases.     

Side effects after diagnostic lumbar puncture and lumbar iohexol myelography

Summary A prospective, controlled study was performed to compare side effect incidences after lumbar iohexol myelography (n=97) and diagnostic lumbar puncture (n=85). No significant side effect incidence differences (iohexol vs. controls) were found regarding number of patients with any side effect (63 vs. 73%), headache (44 vs. 54%), nausea, dizziness, visual, auditory, or psychic symptoms. Early-onset headache occurred significantly more often in the iohexol group (17 vs 5%), while postural headache occurred most frequently after lumbar puncture (25 vs. 41%). These results suggest that apart from the slight early-onset headache, most side effects after lumbar iohexol myelography are related to the puncture per se, not to the contrast agent.     

Influence of the spread and period of retention of Iotrolan in the subarachnoid space on the side effects rate in myelography

Summary Fifty patients underwent myelography with the newly developed CSF-isotonic, dimeric, non-ionic contrast medium Iotrolan. Repeat spinal and cranial computerised tomographic studies with measurement of the attenuation values were conducted to demonstrate the administered contrast medium in the spinal canal and intracranial subarachnoid space. The patients were examined neurologically, observed clinically and asked about concomitant symptoms. The period of retention and the spread of the contrast medium in the subarachnoid space was not found to have any influence on the side effects rate. In particular, no association was confirmed between intracranially demonstrable contrast medium and the occurrence of side effects.     

Metrizamide myelography in cervical root avulsion injury

A cervical root avulsion with an unusual radiographic finding observed on metrizamide myelography is described which has not been previously reported. The advantage of using this new water-soluble contrast agent is discussed.     

Exacerbation of systemic lupus erythematosus,aseptic meningitis and acute mental symptoms,following metrizamide lumbar myelography

Summary A clinical constellation of exacerbation of systemic lupus erythematosus (SLE), together with aseptic meningitis, and acute mental symptoms occurred following lumbar myelography with metrizamide. Exacerbation of SLE has not been previously described following myelography with any contrast agent. Meningeal reactions and acute mental symptoms have been reported earlier, but this clinical constellation is new.     

Role of FIESTA combined with conventional MRI in the evaluation of traumatic brachial plexus roots injury

Purpose

Purpose was to evaluate the role of Fast imaging employing steady-state acquisition (FIESTA) together with conventional MR sequences in the evaluation of traumatic brachial plexus roots injury compared to post contrast MR and Spin Echo MR myelographic studies.

Patients and methods

In this prospective study, 16 patients with a mean age of 17.9 y who presented with traumatic brachial plexus roots injury in motor cycle and car accidents were studied with FIESTA, conventional MR, post contrast MR and MR myelography sequences. Imaging findings included: pseudo-meningocele/hemorrhage near the nerve root exit, failure of visualization of the nerve root (dorsal, ventral or both), retracted avulsed nerve root ends, spinal cord edema, and para spinal muscles edema and hemorrhage. Diagnostic accuracy was calculated for each MR sequence. Imaging findings were compared with the gold standard operative findings.

Results

FIESTA combined with conventional MR depicted pseudomeningoceles, non visualized nerve roots, cord displacement, and para spinal muscles abnormalities in 15 patients (93.8%), cord edema in four patients (25%). Pre and post contrast MR detected pseudomeningoceles and non visualized nerve roots in 13 patients (81.3%) while Spin Echo myelography detected pseudomeningoceles and non visualized nerve roots in 14 patients (87.5%). FIESTA combined with conventional MR showed the highest diagnostic accuracy (93.8%) compared to pre and post MR (81.3%) and Spin Echo myelography (87.5%).

Conclusion

It is crucial to differentiate between preganglionic and postganglionic injuries for optimal treatment planning in patients with BPI. Conventional MR imaging yielded suboptimal information regarding the fine details of nerve roots’ injury. MR myelography showed some artifacts that decreased overall diagnostic accuracy, FIESTA combined with conventional MR depicted nerve segments in greater detail and provided important information about the relationship of the nerves to nearby structures, it provided high contrast resolution between cerebrospinal fluid and solid structures, allowing the reconstruction of elegant multi-planar images that highlight the injured nerves. Contrast study is recommended in mild trauma cases with normal morphological study.