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MRI Myelography - Uses and Contraindications

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MRI myelography is an imaging technique used to evaluate the subarachnoid spaces. Read this article to learn more about MRI myelography.

Written by

Dr. Narmatha. A

Medically reviewed by

Dr. Sugreev Singh

Published At November 7, 2022
Reviewed AtNovember 7, 2022

Introduction:

MRI (magnetic resonance imaging) myelography or MR myelogram is a medical imaging technique used to detect abnormalities in the spinal cord and nerve roots and to visualize the subarachnoid spaces. Subarachnoid spaces consist of cerebrospinal fluid (CSF), blood vessels, and cisterns (spaces between two meninges). MR myelography produces fast spin-echo images with a fat suppression technique and maximum intensity projection (MIP). In addition, MRI myelography enhances the intensity of CSF with background tissue signal subtraction.

What Are the Uses of MRI Myelography?

MRI myelography is used in the diagnosis of the following conditions:

  • Leakage of CSF [cerebrospinal fluid] (a clear liquid surrounds the brain and spinal cord).

  • Spinal trauma.

  • Spinal infection.

  • Planning of radiation therapy (use of ionizing radiation for killing cancer cells in cancer treatment).

  • A tumor (cancer) of the spine.

  • Planning of surgery in relation to the nerve roots.

  • Magnetic resonance imaging studies on spine and skull base.

  • Find out the degree of pressure exerted on thecal sac (outer covering of the spinal cord).

  • Disk herniation (bulging out of the disc into the spinal canal compresses the spinal nerves causing back pain).

  • Disc migration (displacement of the disc).

  • Facet arthrosis syndrome (a disease in which damage to the facet joints causes low back pain).

  • Spinal stenosis (narrowing of the spinal spaces).

  • Spondylolisthesis (a condition in which vertebrae slip out of place and exert pressure on the bone).

  • Arachnoid cyst (a fluid-filled sac in the brain and spinal cord).

  • Intra medullary cyst and tumors (a growth develops within the spinal cord).

How Do You Prepare for an MRI Myelography Scan?

  • Inform your doctor about your medical conditions and your regular medicines.

  • Tell your doctor if you had allergic reactions to contrast material from your previous scan.

  • Tell your doctor if you are afraid of closed spaces (claustrophobic). They may give you medicine that makes you feel comfortable and reduces your anxiety.

  • You may be asked to remove any metal jewelry or accessories, as magnets are used in this procedure. If you have any metal inside your body, such as pacemakers or cochlear implants, you cannot undergo this procedure.

  • Inform your doctor if you are pregnant. Injection of the contrast material during the scan is not recommended in pregnant women in their first trimester. It is considered safe during the second and third trimesters at 3.0 tesla (T) or less.

How Is MRI Myelography Performed?

  • Magnetic resonance imaging myelography is done using the same equipment as magnetic resonance imaging (MRI). During this procedure, patients may be asked to lie down on the table and moved into the scanner.

  • The radiologist injects local anesthesia into the skin of the target site. After that, they inject 0.5 mL diluted gadolinium-based contrast material (a special dye) into the spinal cord in the space between the third and fourth lumbar vertebrae (L3-L4) [intrathecal region]. Gadolinium rarely causes allergic reactions. Patients might be asked to roll on the table to properly distribute contrast material into the target area, such as the spinal cord and nerve roots. They may keep a pillow or blankets to make you comfortable.

  • MRI myelography is performed as a single shot TSE, with TR (repetition time) 8000 ms, TE (time to echo) 1000 ms (milliseconds), and TSE (turbo spin-echo) 256 and acquisition time 3:36.

  • Images are automatically reconstructed as maximum intensity projections (MIP) and produce nine consecutive images at 22.5 degrees intervals, extending from right lateral to left lateral projection.

  • MRI myelography is highly sensitive in the diagnosis of CSF (cerebrospinal fluid) leaks at the exact spinal levels.

  • The contrast resolution of MRI is superior to CT (computed tomography), myelography, and radioisotope cisternography (a nuclear medicine imaging technique used to detect cerebrospinal fluid leak).

  • Once patients are ready, the magnetic resonance imaging machine produces a strong magnetic field around them, and radio waves are directed to the target area to produce the images of the required area.

  • During the scan, patients may be provided with earphones to block the loud noise heard from the scanner during the imaging process. The technician will communicate with patients from a separate room through an intercom.

  • Patients may be asked not to move during the procedure, affecting the image quality. Sometimes, patients may be asked to hold their breath for a few seconds at varying times to get better images. The final images will appear on the computer screen.

  • After the test, patients can continue their regular activities. They are instructed to drink plenty of water to flush out the contrast material from the body used in this procedure. Nausea (urge to vomit), vomiting, headache, and skin rashes may occur as a side effects of the procedure due to the contrast material used.

What Are the Contraindications of MRI Myelography?

  • Magnetic surgical clips or staplers.

  • Intracranial aneurysm clips (surgical treatment for brain aneurysm [enlargement of an artery caused by weakness in the arterial wall] by placing the metal clip).

  • Any electrically or magnetically activated implant such as a cardiac pacemaker, insulin pump bio stimulator, neurostimulator, hearing aids, or cochlear implant.

  • Metallic foreign bodies such as bullets in the body.

Conclusion:

Magnetic resonance imaging myelography is a noninvasive imaging technique. MR myelography is the first-line imaging technique recommended for lower back pain. The advantage of magnetic resonance imaging myelography is that it does not use ionizing radiation and the imaging time is short. Both the superior and inferior extent of the spinal cord are shown in this scan. This procedure does not require hospitalization. MRI myelography has more accuracy in diagnosing intrinsic spinal cord diseases than myelography. Magnetic resonance imaging myelography shows the degree of compression of spinal nerves with more accuracy.

Frequently Asked Questions

1.

What Is the Major Between an MRI and a Myelogram?

A magnetic field and radio waves produced by a computer are used in the magnetic resonance imaging (MRI) medical imaging procedure to provide precise images of the organs and tissues inside the body. A myelogram is an imaging procedure examining the connection between the vertebrae and discs via the spinal cord, nerves, and nerve roots.

2.

Does Myelography Require Radiation?

Yes, Myelography uses radiation. Compared to other radiographic techniques, Myelography's radiation dosage is low.

3.

What Are the Disadvantages of Using Myelography?

The disadvantage of using Myelography includes the following:
- Pregnancy.
- Unwilling patient.
- Marfan and Ehlers-Danlos syndromes.
- Vomiting and nausea caused by uncontrolled hyperglycemia (ketoacidosis) can make post-myelography treatment more difficult.
- Bleeding Disorder.
- Severe Headache.

4.

How To Perform Myelography?

Before the procedure, the spinal column is injected with contrast dye. The contrast dye allows the spinal cord, subarachnoid space, and other nearby structures to be visible on an X-ray screen so that the radiologist can see them more clearly than with regular X-rays of the spine.

5.

Is an MRI More Accurate Than a Myelogram?

Magnetic resonance imaging (MRI) is generally more accurate than a myelogram.

6.

Can a Myelogram Result in Paralysis?

After Myelography, there is an uncommon but well-documented consequence called transient post-procedural paraplegia, which has also been associated with lumbar puncture (LP).

7.

What size needle is employed during a myelogram?

A 22 to 26-gauge needle can be used for myelograms.

8.

What Are the Adverse Effects of Myelogram?

The adverse effect of myelogram includes:
- Leg numbness and tingling
- Discharge of any kind, including blood, from the injection site
- Pain at or near the injection location
- Nausea or vomiting
- Inability to urinate
- Fever
- Stiff neck
- Tingling in the legs
- Headaches.

9.

Where Are Myelograms Done?

A radiologist examines the hospital's radiology department or an outpatient imaging facility.

10.

Can a Myelogram Result in Seizures?

According to reports, the current contrast media risk causing a seizure ranges from 0.093 % to 0.847 %. After Myelography with iopamidol and iohexol, only case reports of seizure activity were found in the literature review.

11.

Can A Myelogram Induce Pain in the Nerves?

The dangers associated with Myelography are relatively low to the nerves. A nerve injury during the lumbar puncture might cause sharp pain that travels down the leg or into the buttocks, lasting for days or weeks or completely disappearing. Bleeding surrounding the fluid sac

12.

A Myelogram: How Painful Is It?

A tiny needle with drugs to numb the area on your back will cause you to experience a brief sting. Additionally, the patient may experience some pressure while the long, thin spinal needle is inserted into the spinal canal. When the needle moves in the spine, the patient can experience sudden, severe pain running down the leg or buttock.

13.

How Long Does Pain Last After a Myelogram?

Myelography is a highly safe operation with minimal potential risk, including injured nerves. A nerve damaged during a lumbar puncture may cause sharp pain that travels down the leg or into the buttocks. This discomfort may last for days or even weeks before going away.

14.

Is There Any Alternative Method for a Myelogram?

Most surgeons agree that CT myelography is superior to other imaging techniques for detecting bone pathologic abnormalities in the cervical and lumbar spine. However, MR imaging is a better screening study than Myelography because it is less invasive, more affordable, and less labor-intensive.
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Dr. Sugreev Singh
Dr. Sugreev Singh

Internal Medicine

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