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Summary
Metrizamide (Amipaque) is the preferred contrast medium for lumbar myelography, as it has not been linked to adhesive arachnoiditis. Other contrast agents, like Pantopaque and ionic media, have reported cases of this serious complication.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Adhesive arachnoiditis is a known complication of myelography.
- Oily contrast media (Pantopaque) and ionic water-soluble contrast media have been associated with this sequela.
Purpose of the Study:
- To evaluate the safety of nonionic water-soluble contrast media for lumbar myelography.
- To identify contrast agents with a lower risk of adhesive arachnoiditis.
Main Methods:
- Review of reported cases of adhesive arachnoiditis following myelography.
- Comparison of complication rates between different types of contrast media.
Main Results:
- Adhesive arachnoiditis has been reported with oily and ionic water-soluble contrast media.
- No cases of adhesive arachnoiditis have been reported with metrizamide (Amipaque).
- Increased spinal fluid osmolality correlates with higher arachnoiditis frequency.
Conclusions:
- Metrizamide (Amipaque) is considered the contrast medium of choice for lumbar myelography due to its safety profile.
- Using recommended doses of metrizamide (10 ml, 170 mg/ml iodine concentration) makes adhesive arachnoiditis unlikely.
- Nonionic contrast media offer a reduced risk of post-myelography complications.