A double-blind clinical trial of iopamidol versus metrizamide for lumbosacral myelography

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✓ A double-blind study was performed to compare metrizamide with the new iodinated water-soluble nonionic contrast medium, iopamidol, for conventional and computerized tomography lumbosacral myelography. Both contrast agents were used in 30 patients, and were equivalent in terms of image quality and clinical accuracy. Headaches and nausea were less severe using iopamidol. The most striking difference was found in adverse neurobehavioral reactions and associated electroencephalographic abnormalities, which were noted in 17% of the metrizamide group but were not seen with the use of iopamidol. Iopamidol appears to be superior to metrizamide for intrathecal applications. An explanation of the differential neurotoxicity is provided.

Article Information

Address for Dr. Sudilovsky: Squibb Institute for Medical Research, Princeton, New Jersey.

Address reprint requests to: Burton P. Drayer, M.D., Department of Radiology, Duke University Medical Center, Box 3808, Durham, North Carolina 27710.

© AANS, except where prohibited by US copyright law.

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Figures

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    Atomic structure of metrizamide and iopamidol. See Table 1 for their chemical properties.

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    Conventional (left) and computerized tomography (right) myelography of the normal conus medullaris using iopamidol.

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    A herniated nucleus pulposus at the L4–5 level (surgically verified) is well visualized on conventional myelography with iopamidol in the anteroposterior (upper left), oblique (upper right), and lateral (lower) projections.

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    Typical appearance on prone (left) and supine (right) myelography with iopamidol of a surgically verified low conus (arrowheads) tethered by a lipoma (arrow). Note the horizontal exit of the nerve root sleeves often seen with a low conus.

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    Computerized tomography (CT) scans in a patient with delayed brain blush. Iopamidol (in a similar fashion to metrizamide) traverses the CSF-brain barrier to enter the brain on these scans performed approximately 8 hours after the installation of contrast material into the lumbar thecal sac. The brain “blush” as seen on CT correlates with the delayed onset of adverse reactions and is consistently seen if a CT scan of the brain is performed a few hours after the intrathecal installation of a non-ionic hydrosoluble agent. The “blush” is maximal in the brain substance adjacent to the subarachnoid spaces and is far more striking in the cerebral and cerebellar hemispheres than in the brain stem.

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