Myelography: From Lipid-Based to Gadolinium-Based Contrast Agents.

Myelographic contrast media of various types have been used over the past 100 years. Many of the early contrast agents had significant toxicities. Gas myelography was tried, but the contrast between gas and soft tissue is poor. Pantopaque, an oil-based iodinated medium was successfully used for decades, but was not compatible with computed tomography (CT) scanning because it was viscous, insoluble, and caused streak artifact. 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.