Assessment of the glomerular filtration rate (GFR) in kidney transplant recipients using Bayesian estimation of the iohexol clearance.

Background Plasma iohexol clearance (CLiohexol) is a reference technique for glomerular filtration rate (GFR) determination. In routine practice, CLiohexol is calculated using one of several formulas, which have never been evaluated in kidney transplant recipients. We aimed to model iohexol pharmacokinetics in this population, evaluate the predictive performance of three simplified formulas and evaluate whether a Bayesian algorithm improves CLiohexol estimation. Methods After administration of iohexol, six blood samples were drawn from 151 patients at various time points. The dataset was split into two groups, one to develop the population pharmacokinetic (POPPK) model (n = 103) and the other (n = 48) to estimate the predictive performances of the various GFR estimation methods. GFR reference values (GFRref) in the validation dataset were obtained by non-compartmental pharmacokinetic (PK) analysis. Predictive performances of each method were evaluated in terms of bias (ME), imprecision (root mean square error [RMSE]) and number of predictions out of the ±10% or 15% error interval around the GFRref. Results A two-compartment model best fitted the data. The Bayesian estimator with samples drawn at 30, 120 and 270 min allowed accurate prediction of GFRref (ME = 0.47%, RMSE = 3.42%), as did the Brøchner-Mortensen (BM) formula (ME = - 0.0425%, RMSE = 3.40%). With both methods, none of the CL estimates were outside the ±15% interval and only 2.4% were outside the ±10% for the BM formula (and none for the Bayesian estimator). In patients with GFR ≤30 mL/min/1.73 m2, the BM formula performed very well, while the Bayesian method could not be evaluated in depth due to too small a number of patients with adequate sampling times. Conclusions GFR can be estimated with acceptable accuracy in kidney transplant patients using the BM formula, but also using a Bayesian algorithm.

Assessment of iodine uptake by pancreatic cancer following chemotherapy using dual-energy CT.

Pancreatic cancer remains a major health problem, and only less than 20% of patients have resectable disease at the time of initial diagnosis. Systemic chemotherapy is often used in the patients with borderline resectable, locally advanced unresectable disease and metastatic disease. CT is often used to assess for therapeutic response; however, conventional imaging including CT may not correctly reflect treatment response after chemotherapy. Dual-energy (DE) CT can acquire datasets at two different photon spectra in a single CT acquisition, and permits separating materials and extract iodine by applying a material decomposition algorithm. Quantitative iodine mapping may have an added value over conventional CT imaging for monitoring the treatment effects in patients with pancreatic cancer and potentially serve as a unique biomarker for treatment response. In this pictorial essay, we will review the technique for iodine quantification of pancreatic cancer by DECT and discuss our observations of iodine quantification at baseline and after systemic chemotherapy with conventional cytotoxic agents, and illustrate example cases.

The effect of iodine uptake on radiation dose absorbed by patient tissues in contrast enhanced CT imaging: Implications for CT dosimetry.

OBJECTIVES: To investigate the effect of iodine uptake on tissue/organ absorbed doses from CT exposure and its implications in CT dosimetry. METHODS: The contrast-induced CT number increase of several radiosensitive tissues was retrospectively determined in 120 CT examinations involving both non-enhanced and contrast-enhanced CT imaging. CT images of a phantom containing aqueous solutions of varying iodine concentration were obtained. Plots of the CT number increase against iodine concentration were produced. The clinically occurring iodine tissue uptake was quantified by attributing recorded CT number increase to a certain concentration of aqueous iodine solution. Clinically occurring iodine uptake was represented in mathematical anthropomorphic phantoms. Standard 120 kV CT exposures were simulated using Monte Carlo methods and resulting organ doses were derived for non-enhanced and iodine contrast-enhanced CT imaging. RESULTS: The mean iodine uptake range during contrast-enhanced CT imaging was found to be 0.02-0.46% w/w for the investigated tissues, while the maximum value recorded was 0.82% w/w. For the same CT exposure, iodinated tissues were found to receive higher radiation dose than non-iodinated tissues, with dose increase exceeding 100% for tissues with high iodine uptake. CONCLUSIONS: Administration of iodinated contrast medium considerably increases radiation dose to tissues from CT exposure. KEY-POINTS: • Radiation absorption ability of organs/tissues is considerably affected by iodine uptake • Iodinated organ/tissues may absorb up to 100 % higher radiation dose • Compared to non-enhanced, contrast-enhanced CT may deliver higher dose to patient tissues • CT dosimetry of contrast-enhanced CT imaging should encounter tissue iodine uptake.

Systematic radiation dose optimization of abdominal dual-energy CT on a second-generation dual-source CT scanner: assessment of the accuracy of iodine uptake measurement and image quality in an in vitro and in vivo investigations.

PURPOSE: To assess the accuracy of iodine quantification in a phantom study at different radiation dose levels with dual-energy dual-source CT and to evaluate image quality and radiation doses in patients undergoing a single-energy and two dual-energy abdominal CT protocols. METHODS: In a phantom study, the accuracy of iodine quantification (4.5-23.5 mgI/mL) was evaluated using the manufacturer-recommended and three dose-optimized dual-energy protocols. In a patient study, 75 abdomino-pelvic CT examinations were acquired as follows: 25 CT scans with the manufacturer-recommended dual-energy protocol (protocol A); 25 CT scans with a dose-optimized dual-energy protocol (protocol B); and 25 CT scans with a single-energy CT protocol (protocol C). CTDIvol and objective noise were measured. Five readers scored each scan according to six subjective image quality parameters (noise, contrast, artifacts, visibility of small structures, sharpness, overall diagnostic confidence). RESULTS: In the phantom study, differences between the real and measured iodine concentrations ranged from -8.8% to 17.0% for the manufacturer-recommended protocol and from -1.6% to 20.5% for three dose-optimized protocols. In the patient study, the CTDIvol of protocol A, B, and C were 12.5 ± 1.9, 7.5 ± 1.2, and 6.5 ± 1.7 mGycm, respectively (p < 0.001), and the average image noise values were 6.6 ± 1.2, 7.8 ± 1.4, and 9.6 ± 2.2 HU, respectively (p < 0.001). No significant differences in the six subjective image quality parameters were observed between the dose-optimized dual-energy and the single-energy protocol. CONCLUSION: A dose reduction of 41% is feasible for the manufacturer-recommended, abdominal dual-energy CT protocol, as it maintained the accuracy of iodine measurements and subjective image quality compared to a single-energy protocol.

Validation of a routine two-sample iohexol plasma clearance assessment of GFR and an evaluation of common endogenous markers in a rat model of CKD.

Endogenous markers of kidney function are insensitive to early declines in glomerular filtration rate (GFR) and in rodent models, validated, practical alternatives are unavailable. In this study, we determined GFR by modeling the plasma clearance of two compounds, iohexol and inulin, and compared the findings to common endogenous markers. All plasma clearance methods of both iohexol and inulin detected a decline in renal function weeks prior to any increase in endogenous marker. Iohexol plasma clearance and inulin plasma clearance had a very high agreement and minimal bias when using 12-sample models. However, only iohexol could be accurately simplified to a two-sample, one-compartment estimation strategy. Following an IV injection of low-dose iohexol and two timed blood samples at 30 and 90 min, one can accurately approximate a complex 12-sample strategy of plasma clearance. This method is simple enough to use in routine, longitudinal analysis of larger cohort animal studies.

Can contrast media increase organ doses in CT examinations? A clinical study.

OBJECTIVE: The purpose of this article is to quantify the CT radiation dose increment in five organs resulting from the administration of iodinated contrast medium. MATERIALS AND METHODS: Forty consecutive patients who underwent both un-enhanced and contrast-enhanced thoracoabdominal CT were included in our retrospective study. The dose increase between CT before and after contrast agent administration was evaluated in the portal phase for the thyroid, liver, spleen, pancreas, and kidneys by applying a previously validated method. RESULTS: An increase in radiation dose was noted in all organs studied. Average dose increments were 19% for liver, 71% for kidneys, 33% for spleen and pancreas, and 41% for thyroid. Kidneys exhibited the maximum dose increment, whereas the pancreas showed the widest variance because of the differences in fibro-fatty involution. Finally, thyroids with high attenuation values on unenhanced CT showed a lower Hounsfield unit increase and, thus, a smaller increment in the dose. CONCLUSION: Our study showed an increase in radiation dose in several parenchymatous tissues on contrast-enhanced CT. Our method allowed us to evaluate the dose increase from the change in attenuation measured in Hounsfield units. Because diagnostic protocols require multiple acquisitions after the contrast agent administration, such a dose increase should be considered when optimizing these protocols.

Rapid assessment of renal reserve in young adults by cystatin C.

BACKGROUND: The kidney can increase glomerular filtration rate (GFR) in response to a protein load (renal reserve). In a pilot study of healthy young adults we examined renal reserve using changes in serum cystatin C (cysC). METHODS: Glomerular filtration rate was obtained using iohexol single slope plasma disappearance. To stimulate GFR, subjects ingested a beefburger containing 60 grams of protein. CysC was measured by immunonephelometry before and 125-141 minutes after protein loading. RESULTS: All subjects were found to have a normal iohexol plasma disappearance GFR with a mean of 104.6 ± 9.9 mL/min per 1.73 m(2). CysC decreased in each subject after the meat meal. Baseline cysC-based estimated GFR was 98.1 ± 9.1 mL/min per 1.73 m(2) with a mean increase of 12.0 ± 5.2 (p = 0.0003). CONCLUSIONS: Our study showed a consistent decrease in serum cysC and increase in cysC-based estimated GFR following a protein load in young adults. Further studies are needed using renal clearance methods to confirm that cysC accurately determines renal reserve in patients with and without chronic kidney disease.

Assessment of the tissue diffusion of anesthetic agent following administration of a low palmar nerve block in horses.

OBJECTIVE: To investigate tissue diffusion of anesthetic agent following administration of low palmar nerve blocks (LPBs) in horses. DESIGN: Randomized clinical trial. ANIMALS: 12 adult horses. PROCEDURES: In 9 horses, mepivacaine hydrochloride-iohexol (50:50 dilution) injections were administered bilaterally (2 or 4 mL/site) to affect the medial and lateral palmar and palmar metacarpal nerves (4 sites). Lateral radiographic views of both metacarpal regions were obtained before and at 5, 15, 30, 60, 90, and 120 minutes after block administration; proximal and distal extents of contrast medium (and presumably anesthetic agent) diffusion from palmar and palmar metacarpal injection sites were measured and summed to determine total diffusion. Methylene blue solution was injected in forelimbs of 3 other horses that were subsequently euthanized to determine the potential route of anesthetic agent diffusion to the proximal suspensory ligament region. RESULTS: Mean extents of proximal and total contrast medium diffusion were 4.0 and 6.6 cm, respectively, for the palmar metacarpal nerves and 4.3 and 7.1 cm, respectively, for the palmar nerves. Subtle proximal diffusion secondary to lymphatic drainage was evident in 17 of the 18 limbs. Contrast medium was detected in the metacarpophalangeal joint or within the digital flexor tendon sheath in 8 and 7 limbs, respectively. In the cadaver limbs, methylene blue solution did not extend to the proximal suspensory ligament region. CONCLUSIONS AND CLINICAL RELEVANCE: In horses, LPBs resulted in minimal proximal diffusion of anesthetic agent from the injection sites. Limbs should be aseptically prepared prior to LPB administration because inadvertent intrasynovial injection may occur.

Preliminary assessment of dynamic contrast-enhanced CT implementation in pretreatment FDG-PET/CT for outcome prediction in head and neck tumors.

BACKGROUND: Recently published data show some controversy concerning the impact of [18F]-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in predicting head and neck tumors (HNT) outcome. Assessment of tumor blood supply parameters using dynamic contrast-enhanced CT (DCE-CT) may deliver additional information concerning this important question. PURPOSE: To evaluate the contribution of DCE-CT implemented in pretherapeutic FDG-PET/CT protocol for prognosis prediction in patients with HNT. MATERIAL AND METHODS: Ten consecutive patients (median age 50 years, range 47-74 years) with histologically proven HNT underwent FDG-PET/CT with DCE-CT before treatment. FDG uptake was measured by maximum standardized uptake value (SUV(max)). Relative tumor blood volume (rTBV) was determined from DCE-CT using Patlak analysis. Intratumoral heterogeneity was assessed by means of lacunarity analysis. Obtained values were compared with time-to-progression and overall survival. PET and DCE-CT images were compared on a pixel-by-pixel basis using Pearson coefficient of correlation. RESULTS: Three patients with lower FDG uptake (SUV(max): 8+/-1) and five patients with higher FDG uptake (SUV(max): 15+/-4, P=0.004) were free of local recurrence for 24 months. Two groups of patients with significantly differing lower (group A: 0.37+/-0.02, n=6) and higher (group B: 0.52+/-0.01, n=4; P<0.01), tumor heterogeneity (lacunarity) were identified. Corresponding mean rTBV was higher in group A (9.6+/-1.8 ml/100 ml) than in group B (6.2+/-0.6 ml/100 ml). All six patients with homogeneous tumor blood supply (lower lacunarity) and higher rTBV were free of local recurrence during 24 months, while two of four patients with heterogeneous tumor blood supply (higher lacunarity) and lower rTBV died during follow-up due to tumor relapse. A weak correlation between FDG-PET and DCE-CT rTBV was observed (R(2)=0.1). CONCLUSION: FDG-PET/CT and DCT-CT are complementary methods for surveillance assessment in patients with HNT. Implementation of DCE-CT in the pretreatment FDG-PET/CT protocol may improve tumor outcome prediction.

Study Protocol--accurate assessment of kidney function in Indigenous Australians: aims and methods of the eGFR study.

BACKGROUND: There is an overwhelming burden of cardiovascular disease, type 2 diabetes and chronic kidney disease among Indigenous Australians. In this high risk population, it is vital that we are able to measure accurately kidney function. Glomerular filtration rate is the best overall marker of kidney function. However, differences in body build and body composition between Indigenous and non-Indigenous Australians suggest that creatinine-based estimates of glomerular filtration rate derived for European populations may not be appropriate for Indigenous Australians. The burden of kidney disease is borne disproportionately by Indigenous Australians in central and northern Australia, and there is significant heterogeneity in body build and composition within and amongst these groups. This heterogeneity might differentially affect the accuracy of estimation of glomerular filtration rate between different Indigenous groups. By assessing kidney function in Indigenous Australians from Northern Queensland, Northern Territory and Western Australia, we aim to determine a validated and practical measure of glomerular filtration rate suitable for use in all Indigenous Australians. METHODS/DESIGN: A cross-sectional study of Indigenous Australian adults (target n = 600, 50% male) across 4 sites: Top End, Northern Territory; Central Australia; Far North Queensland and Western Australia. The reference measure of glomerular filtration rate was the plasma disappearance rate of iohexol over 4 hours. We will compare the accuracy of the following glomerular filtration rate measures with the reference measure: Modification of Diet in Renal Disease 4-variable formula, Chronic Kidney Disease Epidemiology Collaboration equation, Cockcroft-Gault formula and cystatin C- derived estimates. Detailed assessment of body build and composition was performed using anthropometric measurements, skinfold thicknesses, bioelectrical impedance and a sub-study used dual-energy X-ray absorptiometry. A questionnaire was performed for socio-economic status and medical history. DISCUSSION: We have successfully managed several operational challenges within this multi-centre complex clinical research project performed across remote North, Western and Central Australia. It seems unlikely that a single correction factor (similar to that for African-Americans) to the equation for estimated glomerular filtration rate will prove appropriate or practical for Indigenous Australians. However, it may be that a modification of the equation in Indigenous Australians would be to include a measure of fat-free mass.

Accuracy and anatomical coverage of perfusion CT assessment of the blood-brain barrier permeability: one bolus versus two boluses.

PURPOSE: To assess whether blood-brain barrier permeability (BBBP) values, extracted with the Patlak model from the second perfusion CT (PCT) contrast bolus, are significantly lower than the values extracted from the first bolus in the same patient. MATERIALS AND METHODS: 125 consecutive patients (29 with acute hemispheric stroke and 96 without stroke) who underwent a PCT study using a prolonged acquisition time up to 3 min were retrospectively identified. The Patlak model was applied to calculate the rate of contrast leakage out of the vascular compartment. Patlak plots were created from the arterial and parenchymal time enhancement curves obtained in multiple regions of interest drawn in ischemic brain tissue and in nonischemic brain tissue. The slope of a regression line fit to the Patlak plot was used as an indicator of BBBP. Square roots of the mean squared errors and correlation coefficients were used to describe the quality of the linear regression model. This was performed separately for the first and the second PCT bolus. Results from the first and the second bolus were compared in terms of BBBP values and the quality of the linear model fitted to the Patlak plot, using generalized estimating equations with robust variance estimation. RESULTS: BBBP values from the second bolus were not lower than BBBP values from the first bolus in either nonischemic brain tissue [estimated mean with 95% confidence interval: 1.42 (1.10-1.82) ml x 100 g(-1) x min(-1) for the first bolus versus 1.64 (1.31-2.05) ml x 100 g(-1) x min(-1) for the second bolus, p = 1.00] or in ischemic tissue [1.04 (0.97-1.12) ml x 100 g(-1) x min(-1) for the first bolus versus 1.19 (1.11-1.28) ml x 100 g(-1)min(-1) for the second bolus, p = 0.79]. Compared to regression models from the first bolus, the Patlak regression models obtained from the second bolus were of similar or slightly better quality. This was true both in nonischemic and ischemic brain tissue. CONCLUSION: The contrast material from the first bolus of contrast for PCT does not negatively influence measurements of BBBP values from the second bolus. The second bolus can thus be used to increase anatomical coverage of BBBP assessment using PCT.

Avaliação do ritmo de filtração glomerular / Assessment of glomerular filtration rate

A medida do ritmo de filtração glomerular (RFG) é a prova laboratorial mais utilizada na avaliação da função renal. Para tanto, usam-se marcadores indiretos, como as determinações de creatinina e cistatina C no sangue, ou procede-se à determinação do RFG propriamente dito, com indicadores como inulina; contrastes iodados, marcados ou não; e outras substâncias. O exame mais solicitado para avaliação do RFG no laboratório de patologia clínica é a dosagem da creatinina sérica. Em algumas condições, entretanto, o resultado encontrado da creatinina sérica deve ser corrigido (através da utilização de fórmulas que levam em consideração características próprias do indivíduo) para ser devidamente interpretado. De fato, a inulina ainda é vista como marcador ideal de filtração glomerular, mas seu uso não se destina à prática clínica, de modo que ainda hoje persiste a busca por testes adequados para uso rotineiro.

Glomerular filtration rate (GFR) determination is the most frequently used laboratorial test to evaluate renal function. Indirect markers as blood determination of creatinine and cystatin C are used with this purpose, as well as the direct determination of GFR, with indicators like inulin; iodated contrasts, radioactive or not; and others. Serum creatinine is the test that is most commonly performed in order to evaluate GFR in the clinical pathology laboratory. However, in some conditions, aiming at the adequate interpretation of the test, the result of serum creatinine must be corrected (by using formulas that include individual characteristics of the subjects). In fact, inulin is still seen as the ideal marker of glomerular filtration, but its use is not directed to clinical practice; then the search for appropriate tests for routine use continues.

Cerebral perfusion mapping using a robust and efficient method for deconvolution analysis of dynamic contrast-enhanced images.

Dynamic contrast-enhanced (DCE) imaging using MRI or CT is emerging as a promising tool for diagnostic imaging of cerebral disorders and the monitoring of tumor response to treatment. In this study, we present a robust and efficient deconvolution method based on a linearized model of the impulse residue function, which allows for the mapping of functional cerebral parameters such as cerebral blood flow, volume, mean transit time, and permeability. Monte Carlo simulation studies were performed to study the accuracy and stability of the proposed method, before applying it to clinical study cases of patients with cerebral tumors imaged using DCE CT. Functional parameter maps generated using the proposed method revealed the locations of the cerebral tumors and were found to be of sufficiently good clarity for marked regional differences in tissue vascularity and permeability to be assessed. In particular, tumor visualization and delineation were found to be better on the parameter maps that were indicative of the breakdown of the blood-brain barrier.

Renal evaluation in the healthy green iguana (Iguana iguana): assessment of plasma biochemistry, glomerular filtration rate, and endoscopic biopsy.

Plasma biochemistry, iohexol clearance, endoscopic renal evaluation, and biopsy were performed in 23 clinically healthy 2-yr-old green iguanas (Iguana iguana). Mean (+/- SD) values for packed cell volume (30 +/- 3%), total protein (62 +/- 7 g/L, 6.2 +/- 0.7 g/dl), albumin (25 +/- 2 g/L, 2.5 +/- 0.2 g/dl), globulin (37 +/- 6 g/L, 3.7 +/- 0.6 g/ dl), total calcium (3.0 +/- 0.2 mmol/L, 12.0 +/- 0.7 mg/dl), ionized calcium (1.38 +/- 0.1 mmol/L), phosphorus (1.32 +/- 0.28 mmol/L, 4.1 +/- 0.9 mg/dl), uric acid (222 +/- 100 micromol/L, 3.8 +/- 1.7 mg/dl), sodium (148 +/- 3 mmol/L or mEq/ L), and potassium (2.6 +/- 0.4 mmol/L or mEq/L) were considered within normal limits. Values for urea were low (< 1.4 mmol/L, < 4 mg/dl) with 70% of samples below the detectable analyzer range. After the i.v. injection of 75 mg/ kg iohexol into the caudal (ventral coccygeal or tail) vein, serial blood collections were performed over 32 hr. Iohexol assays by high-performance liquid chromatography produced plasma iohexol clearance graphs for each lizard. A three-compartment model was used to fit area under the curve values and to obtain the glomerular filtration rate (GFR) using regression analysis. The mean GFR (SD) was 16.56 +/- 3.90 ml/kg/hr, with a 95% confidence interval of 14.78-18.34 ml/kg/hr. Bilateral endoscopic renal evaluation and biopsy provided tissue samples of excellent diagnostic quality, which correlated with tissue harvested at necropsy and evaluated histologically. None of the 23 animals demonstrated any adverse effects of iohexol clearance or endoscopy. Recommended diagnostics for the evaluation of renal function and disease in the green iguana include plasma biochemical profiles, iohexol clearance, endoscopic examination, and renal biopsy.

Assessment of possible nephrotoxicity from iohexol in patients with normal and impaired renal function.

PURPOSE: To evaluate the possible nephrotoxic effects of iohexol in patients with normal and impaired renal function. MATERIAL AND METHODS: A prospective urographic study using iohexol (50 ml, 300 mg I/ml) was performed in 100 patients, 63 with impaired renal function (IRF) and 37 with normal renal function (NRF). The group included 24 patients with diabetes mellitus, 17 of them with IRF. Renal function parameters and adverse events were recorded for one week after the urography. RESULTS: There were no significant changes in serum creatinine, creatinine clearance, or beta-2-microglobulin. The 24-h urine protein excretion showed a statistically significant increase in patients with NRF as well as in patients with IRF. Nine patients experienced adverse events but none of them required any treatment. CONCLUSION: Iohexol was tolerated well in patients with NRF and in patients with IRF without significant overall nephrotoxic effects. Some minor adverse events were recorded.

Adrenal adenomas and nonadenomas: assessment of washout at delayed contrast-enhanced CT.

PURPOSE: To measure the changes in wash-in and washout of contrast material on contrast material-enhanced computed tomographic (CT) scans in patients with adrenal adenomas and nonadenomas. MATERIALS AND METHODS: One hundred twenty-two patients with 135 adrenal masses (74 adenomas, 61 nonadenomas) underwent helical CT. Unenhanced CT was followed by enhanced CT at 30, 60, and 90 seconds and 3, 10, and 30 minutes. RESULTS: The adenomas enhanced significantly more than the nonadenomas at 60 seconds (P < .001), but the percentage enhancement of the adenomas was significantly greater than that of the nonadenomas at 30, 60, and 90 seconds (P < .001). At 3, 10, and 30 minutes, the absolute percentage loss of enhancement and the relative percentage loss of enhancement were significantly greater for the adenomas than for the nonadenomas (P < .001). Delayed enhanced CT at 10 minutes (sensitivity, 92%; specificity, 95%) and 30 minutes (sensitivity, 97%; specificity, 100%) was more accurate for differentiation of adenomas and nonadenomas than unenhanced CT (sensitivity, 82%; specificity, 95%). CONCLUSION: Adrenal adenomas exhibit greater washout of contrast material than do adrenal nonadenomas. The percentage change in washout of contrast material is a useful adjunct to absolute CT attenuation values in differentiation of adrenal adenomas and nonadenomas.

Intracranial iohexol-distribution following cervical myelography, postmyelographic registration of adverse effects, psychometric assessment and electroencephalographic recording.

Cervical myelography (CM) was taken from 14 cases with cervical root-compression symptoms. Prior to myelography, there was complete cranial CT registration to assess the subarachnoid, intraventricular, subcortical and periventricular densities. Control scans at 3,6,24 and 48 h following myelography disclosed intracranial contrast medium at level of basal cisterns, the fourth ventricle and fissura Sylvii. Nine and 11 patients, respectively, had enhancement in the third and lateral ventricles. All patients had subcortical enhancement, and 9 patients had periventricular enhancement; at the 3-h control CT after myelography a minor subcortical edema was disclosed, which declined during the following hours. Two days after myelography, a minimal residual contrast was disclosed subcortically at the level of fissura Sylvii and in the subarachnoid space at the level of fissura Sylvii and the convexity. Hence, we recommend, that diagnostic cranial CT is performed before or postponed until 3 days after cervical myelography. The patients were questioned about adverse effects, and they underwent psychometric assessment and EEG-recordings: 11 had adverse effects, chiefly mild and exclusively transient, without sequelae. Three patients had no side effect. The psychometric assessment, however, disclosed pronounced deterioration in all patients at test 28 h after myelography, especially marked in the verbal paired associates test, however these disturbances were totally absent at retest one week later. No EEG-abnormalities developed; consistently, no patient had seizures. In conclusion, following CM iohexol is taken up by the brain parenchyma, gradually disappearing within 48 h, during which time a brain CT will be disturbed. During the same period some deterioration of psychometric tests may be found.