Lumbar Tomomyelography with Water-Soluble Contrast Medium

Abstract

Myelography, spinal phlebography and angiography may be used in the diagnosis of lesions of the Cauda equina and spinal nerve roots in the lumbosacral area. Spinal phlebography is considered useful in the diagnosis of space occupying lesions by demonstrating the displacement of the epidural and paravertebral venous system. Injection of contrast medium into the spinal processes at different levels enables the localisation of a tumour and a determination of its extension. Selective angiography by the femoral route is a method of choice in the diagnosis of vascular malformations or vascular tumours. Disc prolapses, malformations of the cuada equina, and anoma lies of the nerve root pockets are best demonstrated by water-soluble contrast media; at this department Dimer-X (methylglucamine iocarminate) is used. The in jection is made with the patient in the sitting position and films are taken in a.p., lateral and oblique projections.The material comprised 500 myelographies. In 250 patients myelography was performed as described. In 6 per cent of these patients no abnormalities were evident but the patients were operated upon on the basis of the clinical findings (sciatica, neurologic deficits). In all but three cases a disc prolapse was found. In order to re duce the percentage of these false negative results, tomography was applied in all patients subjected to lumbosacral myelography. In 150 cases tomography confirmed the pathologic findings of conventional myelography but the anatomic details were demonstrated more clearly, such as irregularities of nerve root pockets, which may Acta Radiologica (1975) Supplement 347