Ventriculography with meglumine iothalamate

Syringohydromyelia: radiological evaluation of 82 patients in a developing country

A series of 82 patients presenting with syringohydromyelia and confirmed at operation were studied by conventional radiological techniques and computed tomography (CT). Cord collapse was demonstrated in 71% of the patients with wide bony canals and only 11% of patients with normal bony canals. It was most reliably shown with high resolution CT. Intrathecal CT metrizamide myelography (CTMM) failed to demonstrate contrast percolation into many cavities shown in the plain scans. Obliteration of the subarachnoid space at C1-2 levels appreciated in the plain scans strongly indicated coexisting tonsillar herniation, making CTMM unnecessary. In almost all patients, CTMM was found to be non-contributory if the high resolution plain CT scan failed to reveal cord cavitation.

Radiographic studies of the ventricles in syringomyelia

Radiographic investigations of 171 patients with "communicating' syringomyelia have been reviewed. Hydrocephalus was found in one-third of the cases and has occasionally progressed after operation on the posterior fossa, sometimes with accompanying clinical deterioration. The outlets of the fourth ventricle were usually abnormal; tonsillar descent, arachnoiditis and both together were seen. Arachnoiditis correlated strongly with a history of difficult birth. The foramen of Magendie was sometimes patent and sometimes blocked. There was no consistent level of occlusion corresponding to a persistent roof of the fourth ventricle. The cisterna magna was usually small or obliterated but some examples of large cisterns or subarachnoid pouches were found. Radiological demonstration of a communication from the fourth ventricle to the syrinx occurred in only seven patients by positive contrast material and not by air. It is suggested that a sizable communication is rare at the time when patients seek treatment.

Double-contrast ventriculography with oxygen and water-soluble positive contrast medium, metrizamide (Amipaque)

A technique for ventriculography using both gas and a positive contrast medium metrizamide (Amipaque) is presented. This ventriculographic method proved superior to computerized tomography (CT) scanning in revealing the cause of obstructive hydrocephalus. Small central tumors and intraventricular cysts, often missed with CT, were also well demonstrated. This technique has been used since 1975, and is simple and safe.

Ventriculography with water-soluble contrast media

Ventriculography with water-soluble contrast media is described. The advantage of subtraction and tomography is discussed. The incidence of side effects and complications of ventriculography with air and Dimer-X are given and compared with data about Conray 60.

[Diagnostic possibilities of positive contrast ventriculography (author's transl)]

A comparison has been made of the relative merits of air, Conray 60, and Dimer X ventriculography in 100 cases. The great virtue of positive contrast ventriculography is its superior ability to demonstrate abnormalities in the midline and in the posterior cranial fossa. Tomoventriculography using a multiple layer cassette permits exact localization of intraventricular lesions without causing additional discomfort to the patient. The subtraction technique confers additional benefits. Positive contrast ventriculography has its limitations when there are large extraventricular masses.