Metrizamide is a
non-ionic
An ion () is an atom or molecule with a net electrical charge.
The charge of an electron is considered to be negative by convention and this charge is equal and opposite to the charge of a proton, which is considered to be positive by convent ...
iodine-based
radiocontrast agent
Radiocontrast agents are substances used to enhance the visibility of internal structures in X-ray-based imaging techniques such as computed tomography (contrast CT), projectional radiography, and fluoroscopy. Radiocontrast agents are typically io ...
. It is also a density gradient medium for the
centrifugation
Centrifugation is a mechanical process which involves the use of the centrifugal force to separate particles from a solution according to their size, shape, density, medium viscosity and rotor speed. The denser components of the mixture migrate ...
of biological particles.
Historically metrizamide replaced
iofendylate
Iofendylate is a molecule that was used as a radiocontrast agent, typically for performing myelography studies. It was marketed under the trade names Pantopaque (in North America) and Myodil (rest of the world).
Iofendylate is a highly lipophilic ...
(trade names: Pantopaque, Myodil) as the contrast agent of choice for
myelography
Myelography is a type of radiographic examination that uses a contrast medium to detect pathology of the spinal cord, including the location of a spinal cord injury, cysts, and tumors. Historically the procedure involved the injection of a radioco ...
(an
X-ray study of the spine now largely replaced by
MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...
). The radio opacity characteristics are such that finer detail is displayed with metrizamide, as well as the advantage of reabsorption from spinal fluid and excretion from the body – since unlike iofendylate, metrizamide is a water-soluble substance.
Both agents are administered by
lumbar puncture
Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to ...
(also referred to as a spinal tap or cisternal puncture), at the cervicocranial junction. The human patient is rolled from the
lateral decubitus (lying on the side) to prone. Ankles are strapped to the end of a hard X-ray,
CT, or MRI table. To obtain images of the
cervical region the patient is then carefully tilted in the
Trendelenberg position (head down) so the contrast agent (particularly iofendylate) can enter the neck region. Care is given to prevent spilling dye into the
posterior cranial fossa
The posterior cranial fossa is part of the cranial cavity, located between the foramen magnum and tentorium cerebelli. It contains the brainstem and cerebellum.
This is the most inferior of the fossae. It houses the cerebellum, medulla and pons. ...
(back of the head) or to enter the cranial cavity in general. This speaks to the inability to remove the heavier or more viscous iofendylate without aspirating it with
spinal fluid
Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, body fluid found within the meninges, tissue that surrounds the brain and spinal cord of all vertebrates.
CSF is produced by specialised Ependyma, ependym ...
through a lumbar puncture needle in the low back (sticking up vertically) or back of the neck. Removal of iofendylate is necessary since it is not water-soluble. With metrizamide the issue is that if entering the
cranial cavity
The cranial cavity, also known as intracranial space, is the space within the skull that accommodates the brain. The skull minus the mandible is called the ''cranium''. The cavity is formed by eight cranial bones known as the neurocranium that in ...
and high dose exposure to the
blood brain barrier
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the Cell (biology), cells, and transports Metabolic waste, metabolic waste products away from th ...
, side effects are more likely encountered. Issues related to absorption into the general circulation are also encountered.
Side effects
* Headache
* Nausea
* Vomiting
*
Mass effect
''Mass Effect'' is a military science fiction media franchise created by Casey Hudson, Drew Karpyshyn and Preston Watamaniuk. The franchise depicts a distant future where humanity and several alien civilizations have colonized the known univers ...
,
herniation
A hernia is the abnormal exit of tissue or an organ, such as the bowel, through the wall of the cavity in which it normally resides. Various types of hernias can occur, most commonly involving the abdomen, and specifically the groin. Groin herni ...
, and major central nervous system complications including spinal cord compression
*
Seizures
An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or neural oscillation, synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much o ...
* Muscle rigidity and
dystonic
Dystonia is a neurological hyperkinetic movement disorder in which sustained or repetitive muscle contractions result in twisting and repetitive movements or abnormal fixed postures. The movements may resemble a tremor. Dystonia is often intens ...
reaction
*
Aphasia
Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in th ...
History
Metrizamide was approved in the US in 1978. Its marketing is discontinued as of 2021.
References
Further reading
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External links
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{{Contrast media
Radiocontrast agents
Iodoarenes
Acetanilides
Glucosides