Intrathecal gadolinium-enhanced MR myelography and cisternography: A pilotstudy in human patients

OBJECTIVE. This study was designed to evaluate the safety, MR imaging chara cteristics, and clinical response to intrathecal gadopentetate dimeglumine (gadolinium) administration in human patients. SUBJECTS AND METHODS. Eleven adult patients were included in this prospecti ve study. Via lumbar puncture, a single dose of either 0.2 ml, 0.5 ml, or 1 .0 ml of gadolinium (500 mmol/l) mixed with 5 ml of previously removed CSF was slowly injected into the lumbar subarachnoid space. Immediate and delay ed MR imaging were subsequently carried out using a 1.0-T magnet. RESULTS. No patient manifested gross behavioral changes, neurologic alterat ions, or seizure activity. The intrathecal gadolinium-enhanced MR myelograp hy revealed disk herniation (n = 4), posttraumatic spinal stenosis (n = 3), postsurgical noncommunicating cyst (n = 1), myelitis (n = 1), intradural e xtramedullary mass formation (n = 1), and intradural vascular malformation (n = 1). CONCLUSION. This pilot study shows the relative safety and feasibility of l ow-dose intrathecal gadolinium administration. The potential clinical appli cations include the evaluation of obstructions and communications of the su barachnoid space, spontaneous or traumatic CSF leaks, and CSF dynamics. Add itional animal and human studies must be performed to further evaluate the long-term safety and to prove the clinical applications of this procedure i n a larger number of subjects.