Myelography
Updates to Article Attributes
Myelography is is an imaging procedure performed to evaluate the subarachnoid spaces within within the spinal canal. Fluoroscopic, CT or MR imaging is performed after the intrathecal injection of either contrast media (for fluoroscopy, usually under fluoroscopicxrays, CT and MRI) or CT guidanceradiopharmaceuticals.
History
The concept of using a contrast agent to better image the contents of the spinal canal originated as an extension of pneumoencephalography, wherein air was instilled into the subarachnoid space as a negative contrast agent for evaluating structures of the brain. Although crude, requiring extraction of an equivalent volume of cerebrospinal fluid to instilled air, and and extremely painful, air-contrast myelography (or pneumomyelography) techniques allowed some visualisation of the intraspinal soft tissues as imaged by fluoroscopy.
In the 1920 and 1930s, myelography using 'positive' liquid contrast agents became more common. Initial agents included oil-based compounds such as Lipiodol®, and water-soluble compounds, such as Thorotrast®, and Abrodil®.
Iofendylate (Myodil/Pantopaque) was a popular myelography agent until the 1970s. An oil-based agent, it was not readily reabsorbed and thus often remained trapped within the subarachnoid spaces for decades 4. As with many of its pharmacological predecessors, it was notorious for causing arachnoiditis. It It was withdrawn from clinical use in 1988 4.
Procedure
Although conventional (i.e. fluoroscopic) myelography has been largely supplanted by modern CT and (especially) MRI of the spine, it remains a useful tool in the evaluation of spondylosis.
CT myelography is in some cases, especially useful in those patients who cannot undergo MRI or CSF leaks/fistulaswho who are suspectedbeing investigated for spontaneous intracranial hypotension.
MR myelography may also provide evaluation without the need for intrathecal gadolinium by utilising specific fluid-sensitive acquisition techniques.
-<p><strong>Myelography</strong> is an imaging procedure performed to evaluate the <a href="/articles/subarachnoid-space">subarachnoid spaces</a> within the spinal canal. Fluoroscopic, CT or MR imaging is performed after the intrathecal injection of contrast media, usually under fluoroscopic or CT guidance. </p><h4>History</h4><p>The concept of using a contrast agent to better image the contents of the spinal canal originated as an extension of <a href="/articles/pneumoencephalography">pneumoencephalography</a>, wherein air was instilled into the subarachnoid space as a negative contrast agent for evaluating structures of the brain. Although crude, requiring extraction of an equivalent volume of cerebrospinal fluid to instilled air, and extremely painful, <a href="/articles/air-contrast-myelography">air-contrast myelography</a> (or pneumomyelography) techniques allowed some visualisation of the intraspinal soft tissues as imaged by fluoroscopy.</p><p>In the 1920 and 1930s, myelography using 'positive' liquid contrast agents became more common. Initial agents included oil-based compounds such as <a href="/articles/lipiodol">Lipiodol<sup>®</sup></a>, and water-soluble compounds, such as <a href="/articles/thorotrast">Thorotrast<sup>®</sup></a>, and <a href="/articles/abrodil">Abrodil<sup>®</sup></a>. </p><p><a href="/articles/iofendylate">Iofendylate (Myodil/Pantopaque)</a> was a popular myelography agent until the 1970s. An oil-based agent, it was not readily reabsorbed and thus often remained trapped within the subarachnoid spaces for decades <sup>4</sup>. As with many of its pharmacological predecessors, it was notorious for causing <a href="/articles/arachnoiditis">arachnoiditis</a>. It was withdrawn from clinical use in 1988 <sup>4</sup>.</p><h4>Procedure</h4><p>Although conventional (i.e. fluoroscopic) myelography has been largely supplanted by modern CT and (especially) MRI of the spine, it remains a useful tool in the evaluation of <a href="/articles/spondylosis">spondylosis</a>. </p><p><a href="/articles/ct-myelography" title="CT myelography">CT myelography</a> is especially useful in those patients who cannot undergo MRI or CSF leaks/fistulas are suspected.</p><p><a href="/articles/mr-myelography">MR myelography</a> may also provide evaluation without the need for intrathecal gadolinium by utilising specific fluid-sensitive acquisition techniques.</p>- +<p><strong>Myelography</strong> is an imaging procedure performed to evaluate the <a href="/articles/subarachnoid-space">subarachnoid spaces</a> within the spinal canal. Fluoroscopic, CT or MR imaging is performed after the intrathecal injection of either contrast media (for fluoroscopy, xrays, CT and MRI) or radiopharmaceuticals. </p><h4>History</h4><p>The concept of using a contrast agent to better image the contents of the spinal canal originated as an extension of <a href="/articles/pneumoencephalography">pneumoencephalography</a>, wherein air was instilled into the subarachnoid space as a negative contrast agent for evaluating structures of the brain. Although crude, requiring extraction of an equivalent volume of cerebrospinal fluid to instilled air, and extremely painful, <a href="/articles/air-contrast-myelography">air-contrast myelography</a> (or pneumomyelography) techniques allowed some visualisation of the intraspinal soft tissues as imaged by fluoroscopy.</p><p>In the 1920 and 1930s, myelography using 'positive' liquid contrast agents became more common. Initial agents included oil-based compounds such as <a href="/articles/lipiodol">Lipiodol<sup>®</sup></a>, and water-soluble compounds, such as <a href="/articles/thorotrast">Thorotrast<sup>®</sup></a>, and <a href="/articles/abrodil">Abrodil<sup>®</sup></a>. </p><p><a href="/articles/iofendylate">Iofendylate (Myodil/Pantopaque)</a> was a popular myelography agent until the 1970s. An oil-based agent, it was not readily reabsorbed and thus often remained trapped within the subarachnoid spaces for decades <sup>4</sup>. As with many of its pharmacological predecessors, it was notorious for causing <a href="/articles/arachnoiditis">arachnoiditis</a>. It was withdrawn from clinical use in 1988 <sup>4</sup>.</p><h4>Procedure</h4><p>Although conventional (i.e. fluoroscopic) myelography has been largely supplanted by modern CT and (especially) MRI of the spine, it remains a useful tool in the evaluation of <a href="/articles/spondylosis">spondylosis</a> in some cases, especially in patients who cannot undergo MRI or who who are being investigated for <a href="/articles/spontaneous-intracranial-hypotension-2" title="Spontaneous intracranial hypotension">spontaneous intracranial hypotension</a>. </p><p><a href="/articles/mr-myelography">MR myelography</a> may also provide evaluation without the need for intrathecal gadolinium by utilising specific fluid-sensitive acquisition techniques.</p>
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