Injection Of Water-soluble Contrast Medium Research Articles

Intranodal CT Lymphangiography with Water-soluble Iodinated Contrast Medium for Imaging of the Central Lymphatic System.

Background Dynamic contrast-enhanced MR lymphangiography (DCMRL) is the reference standard used to diagnose various thoracic lymphatic disorders, such as traumatic chylothorax and plastic bronchitis. However, accessibility and logistical challenges have prevented the wide dissemination of this technology. Purpose To evaluate the feasibility of intranodal CT lymphangiography (ICTL) in the diagnosis and planning of subsequent intervention in patients with thoracic lymphatic disorders. Materials and Methods In this retrospective review, five women suspected of having lymphatic abnormalities (ranging from traumatic chylothorax to plastic bronchitis) and with contraindications to MRI underwent ICTL from September 2019 to May 2020. Needles (25 gauge) were placed in the bilateral inguinal lymph nodes with US guidance, and water-soluble iodinated contrast material was injected. CT fluoroscopy was used to monitor the opacification of the cisterna chyli to determine the timing of CT. After ICTL, the thoracic duct was catheterized, and lymphangiography was performed through the thoracic duct catheter. The ICTL and subsequent lymphangiographic findings were then visually compared by using three-dimensional reconstructions. Results Intranodal injection of water-soluble contrast medium was successful in all patients evaluated (five women; mean age, 68 years ± 11 [standard deviation]; range, 53-83 years). The central lymphatics were opacified in four of the five women, demonstrating abnormal pulmonary lymphatic flow from the thoracic duct into the lung parenchyma. In one of the five women, thoracic duct injection showed successful ligation of the thoracic duct. The time elapsed from injection of contrast medium to visualization of the thoracic duct ranged from 2 to 27 minutes. ICTL and lymphangiographic findings matched well. Conclusion Intranodal CT lymphangiography sufficiently depicted central lymphatic anatomy in patients with lymphatic abnormalities, thereby demonstrating its use as a feasible alternative to more technically challenging methods, such as dynamic contrast-enhanced MR lymphangiography. © RSNA, 2021.

Use of computed tomography-lymphangiography with direct injection of water-soluble contrast medium to identify the origin of chylous ascites.

Contrast lymphangiography is a useful technique to determine the site of lymphatic leakage in the patient with chylous ascites. Conventional lymphangiography with lipid-soluble contrast material carries the disadvantage of complications, such as oil emboli and lymphedema. The authors report a successful case of computed tomography (CT)-lymphangiography with direct injection of water-soluble contrast medium into a lower limb lymphatic vessel to determine the site of lymphatic leakage in a pediatric patient with refractory primary chylous ascites. The patient subsequently underwent laparoscopic ligation of the leaking site and recovered well. This novel technique offers superior potential for preoperative assessment and the planning of laparoscopic repair.

Visual evoked response changes following intrathecal injection of water-soluble contrast media: A possible method of assessing neurotoxicity and a comparison of metrizamide and iopamidol

An investigation was carried out to ascertain if there was a change in visual evoked responses following the intrathecal injection of water-soluble contrast media for myeloradiculography and if this change provided an indication of neurotoxicity as assessed by the onset of headache during a period of 20 h following the radiological examination. The patients were unselected and examined, when facilities for measuring the visual evoked response were available, immediately before and at 1 and 20 h after the examination. Control readings were carried out before, 1 h and 20 h after lumbar puncture in patients who did not have an injection of contrast medium. The first 25 patients in the series received metrizamide; when iopamidol became available a change to the newer medium was made and iopamidol was used on all subsequent patients. All the injections were carried out by the same radiologist and the patients were kept in hospital overnight and interviewed the next morning, avoiding a specific reference to headache unless the patient denied all symptoms. It was found that the latency of the visual evoked response was affected in some cases by the presence of contrast medium in the cerebrospinal fluid and that there was a correlation between the severity of headaches and the delay in the visual evoked response at the 20 h post-myelogram measurement, but not at 1 h after the examination. It would appear, therefore, that the visual evoked response measurement is a valid method of assessing, in the short term, the neurotoxicity of intrathecal water-soluble contrast media and that, on this evidence, iopamidol is less neurotoxic than metrizamide. We are not aware of any long-term complications resulting from the use of either contrast medium.

Parotid CT sialography.

Computed tomographic (CT) scanning of the parotid gland during the injection of water-soluble contrast medium allows precise mapping of the gland's parenchyma and of any filling defects or extrinsic masses. Thirty-six patients were examined in this way. The most valuable information that was gained was the differentiation of extrinsic and intrinsic tumors and an accurate appraisal of the location of the facial nerve with respect to intrinsic parotid lesions. In the majority of patients the diagnosis of benign or malignant tumor is suggested by the patterns of tumor growth. Inflammatory disease shows diminution in the amount of parotid parenchyma in relationship to interstitial tissues, but the appearance is not sufficiently characteristic for definitive diagnosis.

The significance and principles of computerized axial tomography in idiopathic developmental stenosis of the bony lumbar vertebral canal.

Computerized axial tomography (CAT) in cases of stenosis of the lumbar bony vertebral canal may demonstrate features of diagnostic significance in the shape of the canal and the bony structures surrounding it. The distinguishing features are the measurements. Standardized measurements of the midsagittal diameters at the cephalad and caudad borders of the laminas of the vertebral canal are proposed as a means of furthering both surgical and comparative studies. Identification of these borders in CAT scans is described, as is the procedure for taking measurements. One or two interlaminar, transarticular CAT scans are also made. In these scans, the midsagittal diameters cannot be measured because the ligamentum flavum forms the posterior wall in the midline. The scans may, however, demonstrate narrow lateral recesses and deformities of the articular processes and joint spaces. Errors in measurement of midsagittal diameters result from the inability of CT body scanners to show the angle between axial sections and the anterior vertebral canal wall, and from the partial volume phenomenon. The diameters are then too large. Errors in the angle of axial sections also lead to distortion in reconstructions of sagittal sections of the vertebral canal from the soft material obtained from axial sections. New precision designs are described. The principal indication for the intrathecal injection of water-soluble contrast media in CAT scanning is the determination of the thickness of the ligamentum flavum. Apart from its value in distinguishing various forms of stenosis, CAT scanning may also reveal inadequacies in surgical decompression.

Unusual local reaction to iodinated contrast medium.

Injection of water-soluble contrast medium into a foot vein in a 5-month-old infant was complicated by intense edema and vesicle formation above the site of injection. This was due to local toxic effect of contrast medium entering the lymphatic system with backflow into the skin. The method by which the contrast medium entered the lymphatics could not be determined.

Reactions to suboccipital injection of water-soluble contrast media in rabbits.

Reactions to suboccipital injection of water-soluble contrast media in rabbits.

Variations in renal size in the diagnosis of renovascular hypertension.

Abstract Following the injection of water-soluble contrast medium and urea an increase in area of the renal shadow of less than 5 per cent was demonstrated on the affected side in 14 cases of hypertension due to renal artery stenosis (verified by operation and post-operative follow-up). On the contra-lateral side an increase of 7–20 per cent was observed in all cases. In 20 patients with hypertension and renal artery stenosis, but no surgical intervention, the same phenomenon was observed in six cases. In these patients other diagnostic criteria were also indicative of reno-vascular hypertension. It is concluded that the increase in renal size which is normally seen following the injection of water-soluble contrast medium and certain drugs is impaired in cases of significant renal artery stenosis. The underlying mechanism (also discussed in a previous paper) may in itself be responsible for the hypertension. If this be the case, measurements of variations in renal size during washout urograms would be ver...

Mammary duct injection in patients with nipple discharge.

Abstract Injection of water-soluble contrast medium into the mammary ducts was performed in 21 patients for the investigation of an abnormal discharge from the nipple. Preliminary plain mammograms were normal in all but two cases. The main lesions demonstrated by duct injection were intraduct papilloma, duct ectasia and intraductcarcinoma. The characteristic appearances of these conditions is described, and the value of the procedure is discussed.

Subarachnoid Injection of Contrast Medium A Complication of Vertebral Angiography

The inadvertent injection of water-soluble contrast medium into the subarachnoid space is a rare but dangerous complication of vertebral arteriography. This hazard is increased following subarachnoid haemorrhage when blood-stained cerebrospinal fluid may be mistaken for arterial backflow. A highly dangerous reaction may follow this occurrence. The symptoms are described, and a regime of management suggested.

Effect on the spinal cord of subarachnoid injection of water-soluble contrast medium. An experimental study in dogs.

(1961). Effect on the Spinal Cord of Subarachnoid Injection of Water-Soluble Contrast Medium. Acta Radiologica: Vol. 56, No. 6, pp. 449-465.