Iodinated Organic Compounds as Contrast Media for Radiographic Diagnoses

Abstract

Since the introduction of Pantopaque2 in 1941 as a diagnostic aid in contrast myelography (1), 150 Pantopaque myelograms have been made at Strong Memorial and Rochester Municipal Hospitals. The fluidity of the new medium has greatly simplified myelography, and, through this property, the results obtained in the demonstration and study of minimal and maximal defects of the subarachnoid space have been especially satisfactory. Analysis of the results shows that the accuracy of Pantopaque myelography, based on cases that have come to operation, is 95 per cent. Errors both in the use of the medium and in the radiological interpretation appear to be due more to subjective factors than to Pantopaque itself; thus, in the series reported here, most of the errors occurred among the first 50 cases. Since a personnel of varied degrees of experience was involved, these errors probably represent the training period required to obtain high accuracy. Myelography with Pantopaque Pantopaque is particularly satisfactory in contrast myelography of the lumbar and cervical regions of the spine. The series reported here, however, includes so few cervical myelograms that the discussion will be limited to the lumbar region. To reduce the excretory load on the body to a minimum, Pantopaque should always be removed from the spinal canal after the examination has been completed. This is easily accomplished by the procedure of Kubik and Hampton (2) provided a satisfactory mid-line puncture is made for the injection of the medium. With a good mid-line puncture the examination, including injection and removal, usually may be completed within fifteen to twenty minutes. Position of Patient: The patient is placed prone on a tilting fluoroscopy table with the head turned to either side. The hands grasp the edge of the table top at the level of the shoulders so that they will be out of the way, and so that the patient can steady himself during the examination. A small pillow is placed under the lower portion of the abdomen in order to straighten the lumbar curve moderately. The feet are placed firmly against the ftoorest of the tilt table. Injection of Pantopaque: Sterile precautions should be employed as in a routine lumbar puncture. The injection is made in the mid-line, usually between the third and fourth lumbar spinous processes. If a lesion is suspected at that level, however, the interval above or below (preferably below) should be selected. If injection in the lumbar subarachnoid space is not feasible, cisternal injection may be employed. After the skin and the subcutaneous tissues have been anesthetized by infiltration with procaine, an 18- or 20-gauge needle, preferably with short bevel, is introduced into the subarachnoid space. After the ligamentum flavum has been encountered, the needle is inserted gradually, with great care.