Iodine-containing Contrast Agent Research Articles

Multifunctional liposomal complex for detection of the acquired resistance to EGFR-TKIs and synergistic anticancer phototherapy

The emergence of acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) poses formidable obstacles to non-small cell lung cancer (NSCLC) therapy. Real-time monitoring of the efficacy of EGFR-TKIs to avoid invalid treatment remains a great challenge. Herein, we rationally designed a EGFR-TKI-modified liposomal complex co-loaded with a iodine-containing contrast agent ioversol (IOV) and a photosensitizer indocyanine green (ICG), namely ELIG, for simultaneous EGFR-TKI-mediated computed tomography/fluorescence dual-modal imaging to monitor drug resistance during the treatment, and combined photodynamic therapy (PDT) and photothermal therapy (PTT) to reverse drug resistance. ELIG exhibited good physicochemical properties, favorable photothermal effects, and high singlet oxygen production. ELIG can protect ICG and IOV from rapid degradation and prolong the circulation time. In addition, ELIG had a great ability to recognize drug-sensitive EGFR-mutated NSCLC cells, and could monitor the changes in the intracellular amounts of the imaging agents to detect the drug resistance and predict the efficacy during the treatments. Additionally, the heavy atom effect of IOV can increase the PDT effect of ICG obviously. With 808 nm laser irradiation, ELIG showed satisfactory anticancer effects to reverse drug resistance by the synergism of PDT and PTT in vitro and in vivo. Hence, this work holds great promise for providing a new idea and an effective strategy for predicting and managing the efficacy of EGFR-TKIs.

A microCT-based platform to quantify drug targeting

BackgroundHeterotopic ossification (HO) is a frequent and debilitating complication of traumatic musculoskeletal injuries and orthopedic procedures. Prophylactic dosing of botulinum toxin type A (BTxA) holds potential as a novel treatment option if accurately distributed throughout soft-tissue volumes where protection is clinically desired. We developed a high-resolution, microcomputed tomography (microCT)-based imaging strategy to assess drug distribution and validated this platform by quantifying distribution achieved via a prototype delivery system versus a single-bolus injection.MethodsWe injected an iodine-containing contrast agent (iodixanol 320 mg I/mL) into dissected rabbit musculature followed by microCT imaging and analysis. To contrast the performance of distributed versus bolus injections, a three-dimensional (3D) 64-cm3-printed soft-tissue holder was developed. A centered 2-cm3 volume of interest (VOI) was targeted with a single-bolus injection or an equal volume distributed injection delivered via a 3D-printed prototype. VOI drug coverage was quantified as a percentage of the VOI volume that was < 1.0 mm from the injected fluid.ResultsThe microCT-based approach enabled high-resolution quantification of injection distribution within soft tissue. The distributed dosing prototype provided significantly greater tissue coverage of the targeted VOI (72 ± 3%, mean ± standard deviation) when compared to an equal volume bolus dose (43 ± 5%, p = 0.031) while also enhancing the precision of injection targeting.ConclusionsA microCT-based imaging technique precisely quantifies drug distribution within a soft-tissue VOI, providing a path to overcome a barrier for clinical translation of prophylactic inhibition of HO by BTxA.Relevance statementThis platform will facilitate rapid optimization of injection parameters for clinical devices used to effectively and safely inhibit the formation of heterotopic ossification.Key points• MicroCT provides high-resolution quantification of soft-tissue drug distribution.• Distributed dosing is required to maximize soft-tissue drug coverage.• Imaging platform will enable rapid screening of 3D-printed drug distribution prototypes.Graphical

Studies on the use of iodine-containing contrast agent diatrizoate in rabbits (Oryctolagus cuniculus)

The use of the iodine-containing contrast agent diatrizoate was investigated in healthy rabbits and in rabbits with gastric dilatation and intestinal obstruction. For this purpose, transit times through the gastrointestinal tract and clinical use were investigated during a one year period. In addition, a possible influence on thyroid hormone levels was evaluated. Transit times of contrast agent through the different intestinal sections were examined radiographically in 14 healthy rabbits. For this purpose, 7 ml/kg of a 300 mg iodine/ml and 600 mg diatrizoate/ml containing solution were administered. Radiographs were obtained at different time intervals. Three different doses (D1 2 ml/kg, D2 7 ml/kg, D3 10 ml/kg) were administered, and blood samples were collected at two time points (60 min, 24 h) to analyze thyroid hormone levels (TT4, fT4, TSH). In addition, 70 rabbits that had received the contrast agent diatrizoate because of gastric dilatation and suspected intestinal obstruction were retrospectively evaluated during a period of one year. Focus was placed on arrival of the contrast agent in the cecum, laboratory changes, and mortalities. In all healthy rabbits, contrast medium was detectable in the cecum after a mean of 45-60 min. In the animals suffering from gastrointestinal obstruction, this was delayed to a mean of 121.2 min. These animals showed hypothermia in 92.4 % and hyperglycemia in 45.9 %. 56.1 % exhibited an increase in urea and 33.9 % an increase in creatinine. In 71.4 % of cases, medical treatment was possible, however 12 % of these individuals succumbed to the disease. 28.6 % of the cases were managed surgically which was associated with a mortality of 50 %. TT4, fT4, and TSH levels displayed significant alterations among the three contrast agent doses (p < 0.05). These changes were found to be transient when follow-up was performed two weeks later. When ileus is suspected in rabbits, diatrizoate may be helpful in evaluating the progression of the disease in addition to the use of native radiographs. Sufficient hydration and monitoring of renal function are advisable. Transient changes in thyroid hormones were evident but lacked clinical relevance.

Computer tomography in diagnostics and treatment of inflammatory complications of diverticular disease of the colon

AIM: to evaluate the role of computed tomography (CT) in the treatment and diagnostic algorithm in patients with complicated diverticular disease (CDD).PATIENTS AND METHODS: during the period from 2014 to 2020, 165 hospitalized patients with complications of CDD included in the study. Fifteen (9.1%) patients were hospitalized for elective indications and 150 (90.9%) as emergencies. The indications for hospitalization were inflammatory complications of CDD. Computed tomography with intravenous contrast was performed in 89 (53.9%) patients. The study was performed on a 64-slice CT “Philips Brilliance 64” with intravenous bolus injection of a low-osmolar iodine-containing contrast agent. The absence of the CT in the remaining patients is due to the presence of classical symptoms of acute diverticulitis with a previously verified diagnosis of CDD, the presence of an informative transabdominal ultrasound, as well as the refusal of patients from CT.RESULTS: the CT allowed to verify the presence of diverticula in the patients, to reveal the distinctive CT signs and pathognomonic symptoms of inflammatory complications of CDD, as well as to establish the severity of the complications that occurred. The specific signs of the destruction of the diverticulum and the complications developed were abdominal mass, abscess, peritonitis, and fistula. Besides the diagnostic value, CT scan permitted to choose the treatment approach and to clarify indications for surgery. Besides that, some CDD complications revealed by CT were considered as a predictor of ineffectiveness of conservative treatment, which requires surgery.CONCLUSION: CT is a valuable diagnostic method for CDD which allows to determine timely the clinical form of inflammatory complication, to find out indications for surgery and to predict high risk of recurrence.

Acute Nonsuppurative Sialadenitis After Contrast Material Administration For Computed Tomography Angiography

Introduction: By the use of iodine-containing intravenous contrast agents, sialadenitis rarely occurs with a sudden expansion of the salivary glands. Its pathogenesis is uncertain, but it appears to be the result of an idiosyncratic reaction or accumulation of iodine in the ductal system of the salivary gland. In this article, we aimed to present a case of contrast-induced sialadenitis after an iodine-containing contrast agent. Case Presentation: A sixty-six-year-old male with a history of abdominal aortic aneurysm was referred for CT angiography. The patient had referred to emergency service with mildly tenderness, pain, and swelling in the bilateral submandibular region. Physical examination also revealed mildly enlarged bilateral submandibular glands, with no fever. There was no erythema, ulcer, and no symptom in both oral and oropharyngeal mucosa. The US performed bilateral diffuse homogeneous expansion of the submandibular salivary glands. In the light of clinical and radiological findings, contrast-induced non-suppurative sialadenitis was considered. Conclusion: Non-suppurative sialadenitis is a rare adverse effect of contrast material administration, which true incidence is unknown. Chronic kidney failure and repeated dose of contrast material are risk factors for this complication. We think that this adverse effect deserves more attention, and follow-up, and prevention for recurrence because its long-term importance is unknown yet.

Spinal motor segment labeling with a mixture of n-butyl-2-cyanoacrylate and iohexol in determining the level of thoracic spine surgery

To develop a safe minimally invasive low-traumatic and cost-effective method for preoperative marking the level of thoracic spine surgery. A mixture of biodegradable adhesive based on cyanoacrylate and water-soluble iodine-containing X-ray contrast agent was used for preoperative marking in 8 patients scheduled for thoracic spine and spinal cord surgery. This mixture was injected into paravertebral tissues at the level of further intervention. Preoperative marking ensured a fixed and clearly visible landmark during intraoperative fluoroscopy in 7 patients. In 1 patient, mixture spread in paravertebral soft tissues that did not allow us to obtain appropriate landmark during intraoperative radiography. The described method makes it possible to create an immobile X-ray-positive «mark» in paravertebral soft tissues, which can be used to control the level of intervention at all surgical stages.

Parathyroid glands verification using the auto-fluorescence identification tool

In the clinical cases, one of the methods of intraoperative verification of the parathyroid glands (PTG) by visualization of the autofluorescence is considered. PTG have a unique ability for near-infrared autofluorescence, using endogenous fluorophores that are not yet fully characterized. Intraoperative imaging of PTG autofluorescence is possible using a camera that provides laser excitation of near-infrared light and visible white LED light. Without the introduction of any contrast agent, the spontaneous fluorescence of PTG to near-infrared light allows accurate identification of unchanged PTG in almost all cases. Angiography using ICG fluorescence is performed to patients after thyroidectomy to visualize the blood supply of identified PTGs and assess their viability. In clinical cases, patients were described: 2 with diagnosed with papillary thyroid cancer, 1 with a diagnosis of primary hyperparathyroidism. Adenoma of the lower right PTG. In all cases, the specified method of imaging of the thyroid gland was used, first without contrast agent at the stage of PTG extraction, then with the introduction of indocyanine green solution (ICG) at the final stage of the operation. This greatly improved the imaging of unchanged thyroid glands, the assessment of their viability and the prognosis of possible hypocalcemia in the early postoperative period. This clinical cases suggest that the use of the effect of autofluorescence with intravenous intraoperative administration of iodine-containing contrast agent ICG, enables a clear visualization of the parathyroid glands and the evaluation of the vascular trophism of the latter. This is especially important in cases of total thyroidectomy with extensive neck dissections, since the risk of damage to the thyroid gland, especially when the latter within the thymus, is quite high. In addition, the laboratory tests performed in the postoperative periods peak in favor of the effect of autofluorescence, since it provides data for analysis and prevention of postoperative transient hypocalcaemia.

The Possibility for Iodine Concentration Determination in a Phantom with Known Titers of an Iodine-Containing Contrast Agent, by Using Dual-Energy Computed Tomography

Objective: to study the capabilities of single-source dual-energy computed tomography (DECT) in quantifying the concentration of iodine in solutions.Material and methods. Single-source DECT was performed using a phantom containing a set of 5 tubes with a different titer of the iodine-containing contrast agent Iopamidol. Further, the obtained images were used to construct iodine maps; and the concentration of iodine was measured within the volume of the titrated contrast agent.Results. Despite a high correlation between the measured iodine concentration in solution with the true concentration (Pearson's correlation coefficient r = 0.98; p &lt; 0.01), there is a measurement error that was 4.8 to 23% at different dilutions.Conclusion. Signal-source rapid voltage switching DECT does not allow precise measurements of the true concentration of iodine in solution. To eliminate measurement errors in further in vivo studies using singlesource DECT, it may be that attention must be paid to the measurement of normalized iodine concentration.

Acute Kidney Injury in the Intensive Care Unit - What is New?

The use of electronic alerts for detection of AKI combined with the use of standardized kidney care bundles can improve patient outcomes. Currently, it is important to find ways to implement these in everyday clinical practice. Volume replacement therapy should always be carried out with balanced solutions. The use of 0.9 % NaCl solution should be avoided. In individual cases, patients can also benefit from a colloidal solution in the form of human albumin. Urgently indicated radiographic diagnosis with iodine-containing contrast agent should not be delayed or canceled due to renal impairment. The prophylactic measures in this context are not different from the general recommendations in AKI (achieve euvolemia, avoid nephrotoxins), specific measures do not exist. Indiscriminate hydration of non-hypovolemic patients has no advantages and is associated with an increased risk of cardiac decompensation and AKI. Treatment dose and modality should be adapted to the clinical needs of the patient. The recommended dose of 20 - 25 ml/kg/h serves as orientation. Continuous and intermittent therapies should be available. Regional citrate anticoagulation (RCA) can also be safely used for patients with liver damage or lactic acidosis, provided that early signs of citrate accumulation are closely monitored. In the case of lactic acidosis, lactate clearance rather than baseline level of lactate is particularly important for the risk of citrate accumulation.

Analysis of the hepatic vessels structure in potential liver donors

Aim. To analyze anatomic variants of arterial and venous blood supply of liver in potential liver donors by using of CT-angiography (CTA).Material and methods. CTA data of 151 potential donors have been examined for the period 01.01.2016-01.01.2018. Non-ionic iodine-containing (320 mg/ml) contrast agent was used at a dose of 1.4 ml/kg and infusion rate near 4.0 ml/s. Variants of arterial anatomy were classified according to N. Michels, portal vein anatomy — according to T Nakamura classification (2002).Results. N. Michels type I was the most common variant of arterial structure (n = 108, 71.5%). Types II and III were observed in 8.6% and in 7.9% of cases, respectively. Types IV and IX included the same number of donors (2.6%). Types VII and VIII were the rarest (0.7% and 1.3%). Types V, VI, X were absent. There were 7 cases (4.6%) with arterial variants which are not described by N.Michels classification. Moreover, 3 types were not previously described by other authors.Conclusion. Hepatic artery variations coincide with the classification of N. Michels as a rule (95.4%). Other anatomic variants not described in this classification were observed only in 4.6% of cases.

Does the use of an iodine-containing contrast agent to visualise the PICC tip in preterm babies cause hypothyroidism? A randomised controlled trial

AimTo compare thyroid function tests in preterm neonates (<30 weeks and >48 hour old) exposed to iodine-based contrast with controls and ascertain the certainty of peripherally inserted central catheter (PICC)...

Electrochemical reductive dehalogenation of iodine-containing contrast agent pharmaceuticals: Examination of reactions of diatrizoate and iopamidol using the method of rotating ring-disc electrode (RRDE)

AbstractThis study examined the electrochemical (EC) reduction of iodinated contrast media (ICM) exemplified by iopamidol and diatrizoate. The method of rotating ring-disc electrode (RRDE) was used to elucidate rates and mechanisms of the EC reactions of the selected ICMs. Experiments were carried at varying hydrodynamic conditions, concentrations of iopamidol, diatrizoate, natural organic matter (NOM) and model compounds (resorcinol, catechol, guaiacol) which were used to examine interactions between products of the EC reduction of ICMs and halogenation-active species. The data showed that iopamidol and diatrizoate were EC-reduced at potentials < −0.45 V vs. s.c.e. In the range of potentials −0.65 to −0.85 V their reduction was mass transfer-controlled. The presence of NOM and model compounds did not affect the EC reduction of iopamidol and diatrizoate but active iodine species formed as a result of the EC-induced transformations of these ICMs reacted readily with NOM and model compounds. These data provide more insight into the nature of generation of iodine-containing by-products in the case of reductive degradation of ICMs.

МОДИФИЦИРОВАННЫЙ PAD-TEST В ДИАГНОСТИКЕ МИНИМАЛЬНОГО НЕДЕРЖАНИЯ МОЧИ ПРИ НАПРЯЖЕНИИ У ЖЕНЩИН

Background. Difficulties in the diagnosis of stress urinary incontinence (SUI) occur with minimal volumes of involuntarily lost urine. The aim was to develop a method for documenting diagnosis of minimal forms of SUI in women. Material and methods. We modified the well-known 1-hour Pad test by the intravenous injecting of a solution of indigo carmine and an iodine-containing contrast agent before the test. Results. The main advantage of the modification is the ability to visually confirm the fact of involuntary loss of minimal volumes of urine by detecting a spot of indigo carmine on the sanitary pad and a contrast stain on the x-ray film of the pad after the 1-hour Pad test. A colored spot on the pad and a contrasting shadow on the roentgenogram of the pad is a documentary confirmation of the involuntary loss of the contents of the bladder which is a sign of SUI. The procedure was used in 21 patients who were suspected to have minimal SUI. Minimal SUI was documented in 19 (90%) and excluded in 2 (10%) patients. Conclusions. The method allows confirming and documenting the minimum amount of involuntarily lost urine.

Thyroid hormone profile after the single dose of iodine-containing contrast agent administration during coronary angiography-prospectice study

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Coronary heart disease is not significantly linked to acute kidney injury identified using Acute Kidney Injury Group criteria

BackgroundPatients with unstable angina or myocardial infarction are at risk of acute kidney injury, which may be aggravated by the iodine-containing contrast agent used during coronary angiography; however, the relationship between these two conditions remains unclear.ObjectiveThe current study investigated the relationship between acute kidney injury and coronary heart disease prior to coronary angiography.MethodsAll patients were evaluated after undergoing coronary angiography in the cardiac catheterization laboratory of the Vinzentius Hospital in Landau, Germany, in 2011. The study group included patients with both acute coronary heart disease and acute kidney injury (as defined according to the classification of the Acute Kidney Injury Group); the control group included patients without acute coronary heart disease. Serum creatinine profiles were evaluated in all patients, as were a variety of demographic and health characteristics.ResultsOf the 303 patients examined, 201 (66.34%) had coronary artery disease. Of these, 38 (18.91%) also had both acute kidney injury and acute coronary heart disease prior to and after coronary angiography, and of which in turn 34 (16.91%) had both acute kidney injury and acute coronary heart disease only prior to the coronary angiography. However, the occurrence of acute kidney injury was not significantly related to the presence of coronary heart disease (P = 0.95, Chi-square test).ConclusionThe results of this study indicate that acute kidney injury is not linked to acute coronary heart disease. However, physicians should be aware that many coronary heart patients may develop kidney injury while hospitalized for angiography.

Welche Nachkontrolle ist bei endovaskulärer Versorgung von abdominellen Aortenaneurysmen empfehlenswert?

In the past, multislice computed tomography angiography (CTA) with arterial and venous phase was recommended as the gold standard in follow-up after endovascular abdominal aneurysm repair (EVAR). Iodine-containing contrast agents and frequent radiation exposure are limitations for use in elderly patients with chronic renal insufficiency. Colour-coded Doppler sonography (CCDS) and, especially, contrast-enhanced ultrasound (CEUS) are non-invasive methods that are time and cost effective. Both provide a reliable alternative to CTA in surveillance after EVAR. CEUS seems to be superior in characterisation of the type of endoleaks and can be established in order to reduce iodine-containing contrast agent and radiation exposure in follow-up. In contrast to CTA scans, CEUS can be offered to patients with chronic renal insufficiency and allows a dynamic examination and perfusion analysis (e. g., in fenestrated and branched stentgrafts). Routine combination with X-ray allows control of stentgraft material and location of the branches.

Semiautomatic Landmark-Based Two-Dimensional—Three-Dimensional Image Fusion in Living Mice: Correlation of Near-Infrared Fluorescence Imaging of Cy5.5-Labeled Antibodies with Flat-Panel Volume Computed Tomography

Connecting fluorescence signals with anatomic structures enhances our ability to monitor biologic processes in mice. Here, we present a semiautomated approach to correlate two-dimensional (2D) noninvasive near-infrared fluorescence (NIRF) imaging with three-dimensional (3D), high-resolution, flat-panel volume computed tomography (fpVCT). We developed an algorithm to colocalize fluorescence signals of NIRF-labeled antibodies directed against matriptase and urokinase plasminogen activator receptor (uPAR) to orthotopic carcinomas in mice visualized by fpVCT. For this purpose, mice were anesthetized and fixed on a multimodality animal bed containing fiducial markers filled with iodine-containing contrast agent and fluorescent dye. After intravenous administration of contrast agent and Cy5.5-labeled antibodies, NIRF and fpVCT images were obtained, without repositioning the mice. Binding of Cy5.5-labeled matriptase-specific antibody to pancreatic tumors and Cy5.5-labeled uPAR-specific antibody to mammary carcinomas was assessed by time-domain NIRF imaging measuring the location of fluorescence intensity and its lifetime. In summary, we developed a novel 2D-3D registration technique for image fusion with NIRF imaging and fpVCT to provide complementary information in tumor models on the in vivo association of functional information with anatomic structures. The combination of fpVCT with NIRF imaging will now allow targeted and effective monitoring of preclinical tumor therapies.

Effective Methods to Correct Contrast Agent-Induced Errors in PET Quantification in Cardiac PET/CT

In combined PET/CT studies, x-ray attenuation information from the CT scan is generally used for PET attenuation correction. Iodine-containing contrast agents may induce artifacts in the CT-generated attenuation map and lead to an erroneous radioactivity distribution on the corrected PET images. This study evaluated 2 methods of thresholding the CT data to correct these contrast agent-related artifacts. PET emission and attenuation data (acquired with and without a contrast agent) were simulated using a cardiac torso software phantom and were obtained from patients. Seven patients with known coronary artery disease underwent 2 electrocardiography-gated CT scans of the heart, the first without a contrast agent and the second with intravenous injection of an iodine-containing contrast agent. A 20-min PET scan (single bed position) covering the same axial range as the CT scans was then obtained 1 h after intravenous injection of (18)F-FDG. For both the simulated data and the patient data, the unenhanced and contrast-enhanced attenuation datasets were used for attenuation correction of the PET data. Additionally, 2 threshold methods (one requiring user interaction) aimed at compensating for the effect of the contrast agent were applied to the contrast-enhanced attenuation data before PET attenuation correction. All PET images were compared by quantitative analysis. Regional radioactivity values in the heart were overestimated when the contrast-enhanced data were used for attenuation correction. For patients, the mean decrease in the left ventricular wall was 23%. Use of either of the proposed compensation methods reduced the quantification error to less than 5%. The required time for postprocessing was minimal for the user-independent method. The use of contrast-enhanced CT images for attenuation correction in cardiac PET/CT significantly impairs PET quantification of tracer uptake. The proposed CT correction methods markedly reduced these artifacts; additionally, the user-independent method was time-efficient.

High-resolution ex vivo imaging of coronary artery stents using 64-slice computed tomography—initial experience

The aim of the study was to evaluate the potential of new-generation multi-slice computed tomography (CT) scanner technology for the delineation of coronary artery stents in an ex vivo setting. Nine stents of various diameters (seven stents 3 mm, two stents 2.5 mm) were implanted into the coronary arteries of ex vivo porcine hearts and filled with a mixture of an iodine-containing contrast agent. Specimens were scanned with a 16-slice CT (16SCT) machine; (Somatom Sensation 16, Siemens Medical Solutions), slice thickness 0.75 mm, and a 64-slice CT (64SCT, Somatom Sensation 64), slice-thickness 0.6 mm. Stent diameters as well as contrast densities were measured, on both the 16SCT and 64SCT images. No significant differences of CT densities were observed between the 16SCT and 64SCT images outside the stent lumen: 265+/-25HU and 254+/-16HU (P=0.33), respectively. CT densities derived from the 64SCT images and 16SCT images within the stent lumen were 367+/-36HU versus 402+/-28HU, P<0.05, respectively. Inner and outer stent diameters as measured from 16SCT and 64SCT images were 2.68+/-0.08 mm versus 2.81+/-0.07 mm and 3.29+/-0.06 mm versus 3.18+/-0.07 mm (P<0.05), respectively. The new 64SCT scanner proved to be superior in the ex vivo assessment of coronary artery stents to the conventional 16SCT machine. Increased spatial resolution allows for improved assessment of the coronary artery stent lumen.

Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption

To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis. Within a prospective pilot study, 18 disc segments of 11 patients with radicular or pseudoradicular pain prior to anteroposterior spondylodesis were evaluated. After injection of a mixture of non-ionic iodine-containing contrast agent and gadolinium-based contrast medium into the disc spaces, all patients underwent conventional fluoroscopy, as well as low-dose CT and MRI. The occurrence of memory pain during contrast injection was recorded. CT, MRI and fluoroscopic images were analyzed independently by two readers blinded to the clinical findings. There was 100% agreement between CT and MRI discography in the detection, localization and grading of degenerative changes. In contrast, conventional fluoroscopy identified only 9 of the 12 abnormal segments. Memory pain following puncture was identified in 3 of the 12 affected segments. Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.