What type of contrast solution should be used for myelography?

• A. Ionic solutions
• B. Non-ionic solutions
• C. Barium sulfate
• D. Gadolinium

Answer: (B)

Non-ionic contrast media are preferred for myelography because they are water-soluble and have lower osmolality, which reduces irritation and adverse reactions when injected into the subarachnoid space. This allows safe, effective outlining of the spinal cord and nerve roots with fewer complications such as chemical meningitis, seizures, or severe inflammatory responses. Ionic iodinated contrasts, being more irritating and higher in osmolality, carry greater risk in this intrathecal setting. Barium sulfate is contraindicated intrathecally due to dangerous inflammatory reactions in the meninges. Gadolinium is mainly used for MRI imaging, and intrathecal gadolinium is not standard practice for radiographic myelography due to safety and imaging concerns.