0:00

With that, we can move on to contrast enhanced Mr. Myography. It usually, um,

0:05

it, it involves an off-label injection of gadolinium in the fecal sac.

0:09

It has a temporal advantage over, uh, um, over, uh, um, uh,

0:14

CT myography and slow and intermittent leaks and over many other forms of

0:18

myography.

0:19

Normally I perform the injection in the fluoroscopy suite and I usually make

0:22

sure that I'm in the fecal sac, uh, by injection of, uh, iodinated contrast. Um,

0:27

and then, um, I normally will raise the,

0:30

raise the pressure again using a manometer and l b solution.

0:33

We do a delayed m r i to allow time for the C S F leak to happen. Um,

0:38

uh, in general, um, I do it the same way that I, I do the, uh,

0:43

ultra fast, uh, pressure augmented, um, or not, sorry,

0:46

ultra fast CT myography and, and that I use a discogram set.

0:49

I use the coaxial set with a 20 gauge needle and a 25 gauge puncture needle so

0:54

that I'm making the smallest hole in the thecal sac possible. Um,

0:57

and in general, I just, I give it a little bit more time. The problem is,

1:00

is you're giving 'em so much delay time.

1:02

If you puncture them with a larger needle than a 25, it, it,

1:05

it is painful to raise the pressure with a 25 gauge needle,

1:08

but it's worth it in this case 'cause you're giving 'em so much time to leak.

1:11

Um, a larger needle can make a pretty impressive leak into the C S F or into the

1:15

epidural space, um, if you use a larger needle to do the lp.

1:18

So I do use a smaller needle for this and I use 0.3 mls of, of gadolinium, uh,

1:22

and essentially, uh, dilute it, uh, to a total volume of three mls,

1:26

either with Elliot Bs or with Optus C S F,

1:28

and then inject it directly back into their fecal sac. Um,

1:31

and then we do fat sat t one way and m r I.