Article Figures & Data
Figures
- Fig 1.
Gadolinium diskogram obtained in a 42-year-old man with back pain.
A, Sagittal fat-saturated T1-weighted image (TR 758, TE 10) demonstrates the excellent contrast between the gadolinium and adjacent tissues. The distinction between normal and abnormal disks is clearly evident. Note the contrast medium extending posteriorly through radial annular tears at L4–L5 and L5–S1, filling posterior disk protrusions. The L3–L4 nucleus pulposus appears relatively normal.
B, Axial T1-weighted, fat-sat (TR 760, TE 16) image from L4–L5 demonstrates a posterior annular tear with some contrast medium extravasation in the left foramen. There is also filling of a small left paracentral posterior disk protrusion.
C, Seven-day postdiskography image from the same patient demonstrates no detectable residual disk space gadolinium.
- Fig 2.
Axial fat-saturated T1-weighted image at L4–L5 from a gadolinium diskogram obtained in a 24-year-old white female patient with left radiculopathy and a focal disk protrusion at L5–S1 for which she had surgery planned.
A, Axial T1-weighted, fat-saturated (TR 829, TE 16) reveals an annular tear ending directly adjacent to the left L4 root.
B, Sagittal image again demonstrates the posterolateral annular tear directly adjacent to the intraforaminal nerve root.
C, Sagittal image obtained 2 days after diskography demonstrates significantly diminished gadolinium in the L4–L5 and L5–S1 disk spaces, whereas the L3–L4 disk space demonstrates diffusion of contrast medium throughout the annular fibers.
- Fig 3.
Images obtained in a 47-year-old man with back pain.
A, Sagittal T1-weighted, fat-saturated (TR 954, TE 15) from an initial postgadolinium diskogram again shows the excellent delineation of disk architecture with normal-appearing disk spaces at L2–L3 and L5–S1, whereas the L3–L4 level is severely narrowed, with no recognizable disk architecture remaining. Both the L3–L4 and L4–L5 levels have contrast filling subligamentous disk extrusions.
B, The same patient, 1 day after discography. Gadolinium has begun to diffuse across the annulus and is now seen in the outer annular fibers at all levels. At L3–L4, the most severely deranged level, the amount of residual gadolinium is markedly less than at the other levels.
Tables
Formula for gadolinium discography
1. Mix 1 cc Magnavist in 140 cc Sterile saline (use 250-cc bag and remove 110 cc). 2. Dilute 1 g Ancef powder in 10 cc sterile water. 3. Mix 9 cc dilute gadolinium mixture with 1 cc (100 mg) Ancef for every 10 cc of contrast needed.
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