Magnetic resonance myelography

Magnetic resonance myelography (MR myelography or MRI myelography) is a noninvasive medical imaging technique that can provide anatomic information about the subarachnoid space. It is a type of MRI examination that uses a contrast medium and magnetic resonance imaging scanner to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, tumors and other abnormalities. The procedure involves the injection of a gadolinium based contrast media into the cervical or lumbar spine, followed by the MRI scan.^[1]^[2]

Procedure

The radiologist will first numb the skin with the local anesthetic and then inject the gadolinium based contrast media into the spinal cord at the interspace between third and fourth lumbar vertebrae (L3-L4). Then the patient will be asked to roll on the table until the contrast is evenly distributed in the spinal cord and fill the nerve roots. Then the patient will be transferred to the MRI table and the scan will be taken.

Postprocedural care

The patient should be adequately hydrated to remove contrast from the body.
The patient should be observed following the examination for adverse effects of contrast media.
The myelogram is performed on an outpatient basis, So the patient should be properly instructed regarding limitations following the procedure such as driving.
Instructions regarding postprocedural care, including warning signs of adverse reactions and the possibility of persistent headaches, should be given to the patient by a trained professional.
A physician should be available to answer questions and provide patient management following the procedure.

Indications

Demonstration of the site of a cerebrospinal fluid leak (postlumbar puncture headache, postspinal surgery headache, rhinorrhea, or otorrhea)
Surgical planning, especially in regard to the nerve roots.
Radiation therapy planning.
Diagnostic evaluation of spinal or basal cisternal disease.
Nondiagnostic MRI studies of the spine or skull base.
Poor correlation of physical findings with MRI.^[3]

Contraindications

Metallic Implants unless made up of titanium.^[4]
Pacemakers

Advantages

Major advantages of MR myelography over conventional radiographic myelography include its lack of ionizing radiation, noninvasive nature, and lack of need for intrathecal contrast material.

References

^ Demaerel, Ph (2000-09-14). Recent Advances in Diagnostic Neuroradiology. Springer Science & Business Media. ISBN 978-3-540-65723-1.
^ Jain, Anil K. (2016-01-01). Turek's Orthopaedics Principles and Their Applications. Wolters kluwer india Pvt Ltd. ISBN 978-93-5129-510-5.
^ Gillard, Jonathan H.; MD, H. Rolf Jager, FRCR (2015-11-20). Grainger & Allison's Diagnostic Radiology: The Spine. Elsevier Health Sciences. ISBN 978-0-7020-6934-5.{{cite book}}: CS1 maint: multiple names: authors list (link)
^ Kim, Yong-Ha; Choi, Manki; Kim, Jae-Won (January 2019). "Are titanium implants actually safe for magnetic resonance imaging examinations?". Archives of Plastic Surgery. 46 (1): 96–97. doi:10.5999/aps.2018.01466. ISSN 2234-6163. PMC 6369045. PMID 30685951.

[1] Demaerel, Ph (2000-09-14). Recent Advances in Diagnostic Neuroradiology. Springer Science & Business Media. ISBN 978-3-540-65723-1.

[2] Jain, Anil K. (2016-01-01). Turek's Orthopaedics Principles and Their Applications. Wolters kluwer india Pvt Ltd. ISBN 978-93-5129-510-5.

[3] Gillard, Jonathan H.; MD, H. Rolf Jager, FRCR (2015-11-20). Grainger & Allison's Diagnostic Radiology: The Spine. Elsevier Health Sciences. ISBN 978-0-7020-6934-5.{{cite book}}: CS1 maint: multiple names: authors list (link)

[4] Kim, Yong-Ha; Choi, Manki; Kim, Jae-Won (January 2019). "Are titanium implants actually safe for magnetic resonance imaging examinations?". Archives of Plastic Surgery. 46 (1): 96–97. doi:10.5999/aps.2018.01466. ISSN 2234-6163. PMC 6369045. PMID 30685951.

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