Intrathecal Lipiodol

Case contributed by Dustin Roberts

Presentation

Chronic back pain

Patient Data

Age: 60 years
Gender: Male
X-ray

Multiple small, discrete radiodensities of varying sizes projected over the spinal canal of a density higher than bone, consistent with prior intrathecal injection of lipiodol.

Inverted images and a magnified lateral projection are shown for enhanced visualization.

CT

Multiple small intrathecal hyperdensities of varying sizes are seen along the length of the the spinal canal. Again, these are more dense than bone.

Case Discussion

Intrathecal use of Lipiodol®, a product of iodized poppy seed oil, was first used as a diagnostic tool in 1921 to identify spinal masses. It was later realized to be poorly absorbed by the central nervous system and, in some instances, inducing inflammation leading to arachnoiditis and neurological sequelae. This led to its widespread discontinuation shortly after the association was discovered. With the subsequent introduction of iophendylate-based oils, these complications were seen less often, though arachnoiditis still occurred in <1% of cases. Today, contrast-related complications have nearly vanished due to the universal replacement of lipid-based compounds with water-soluble and gadolinium contrast agents.

CT myelography was traditionally the gold standard for the diagnosis of foraminal nerve compression. While MRI has generally replaced this modality today, CT myelography remains a valuable diagnostic tool, primarily in patients with contraindications to MRI or when MRI is not available. In particular, CT is excellent for distinguishing vertebral osteophytes from soft tissue material within the spinal canal.  The development of water-soluble agents allowed even distribution in the subarachnoid space and excellent depiction of spinal anatomy on post-myelographic CT scanning. Although invasive, myelography will remain a useful tool for the foreseeable future.

This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center

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Case information

rID: 61373
Published: 6th Jul 2018
Last edited: 22nd Sep 2018
Inclusion in quiz mode: Included
Institution: David Geffen School of Medicine

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