Lumbar myelography with iohexol and metrizamide: a comparative multicenter prospective study.

Abstract

Diagnostic quality of radiographs and adverse reactions associated with the use of metrizamide and iohexol as contrast agents in lumbar myelography were compared in a prospective randomized double blind study in 350 patients at seven centers. The contrast media were administered in comparable volumes at a concentration of 180 mg I per ml. Overall quality of radiographic visualization was graded good or excellent in 95% of 175 metrizamide studies and in 98% of 175 iohexol studies. Ninety-three patients examined using metrizamide (53%) and 130 patients examined using iohexol (74%) experienced no discomfort during or after myelography. Postmyelographic headache was associated with 38% of metrizamide examinations and 21% of iohexol examinations. Nausea and vomiting were also more common with metrizamide. Five patients examined using metrizamide (3%) experienced transient confusion and disorientation following lumbar myelography. No such reactions were observed following iohexol myelography.

Aseptic Meningoencephalitis after Iohexol CT Myelography

“…3 Newer agents such as iohexol and iopamidol replaced metrizamide, as comparative trials showed a decreased incidence of severe adverse neurologic effects with these agents. 4,5 Iohexol is a popular nonionic, water-soluble, radiographic contrast medium for myelography with an iodine content of 46.36%. Omnipaque 240, 300, and 350 contain 240 mg, 300 mg, and 350 mg of organic iodine per milliliter, respectively.…”

“…The most common minor adverse effects after iohexol myelography are headache (11% to 21%), 5,6 nausea (10%), vomiting (3%), and dizziness (3%). 5 Mild neckache and backache are also not unusual.…”

“…5 Mild neckache and backache are also not unusual. Complications of myelography include seizure, aseptic meningitis, 7-10 meningoencephalitis, [11][12][13] bacterial meningitis, 14 intracranial hemorrhage, 15 spinal hematoma, 16 encephalopathy, 17 transient confusion, 18,19 and paraplegia.…”

Single-puncture myelographic evaluation of epidural block in the young infant

“…In an infant we find 1 to 2 ml of 170 mgI/ml metrizamide is sufficient contrast, and 0.5 to 2 ml additional diluent will overcome the block. Other non-ionic contrast agents, such as iohexol and iopamidol, will undoubtedly become widely used in pediatric myelography because of their lower incidence of side effects [10,11]. They should easily lend themselves to this technique.…”

Intrathecal administration of iopamidol in children: clinical and diagnostic results

“…Serious reactions such as seizures, neurological changes and neurobehavioral disturbances are uncommon, but have been reported [1,2]. Other nonionic water-soluble contrast media have been developed in hope of decreasing the incidence of adverse reactions.Fairly extensive experience with the newer nonionic agents iopamidol and iohexol in adfilts has demonstrated the superiority of these agents over metrizamide with respect to the incidence and severity of adverse rections [3][4][5][6][7]. Several clinical trials have established the safety and efficacy of iopamidol for neuroradiologic imaging in adults.…”