Nonionic X-ray Contrast Media Research Articles

Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity

Free AccessCorrespondenceLetter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivityIngrid BöhmIngrid BöhmSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/bjr/65388056SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutThe Editor,It was with great interest I read the article by Garcia-Ortega et al [1] who presented a case with immediate reaction after iodinated contrast medium (ICM) injection. First of all I would like to congratulate the authors who published this interesting case; however, some facts remain unclear to me.First, what kind of hypersensitivity did the patient have? Angio-oedema of trunk and limbs is an unknown condition. Angio-oedema occurs in the face and involves the eyelids and lips [2]. I presume that the authors mean a generalised urticaria.Description of the clinical features is of great importance in the understanding of the pathological background, and planning of diagnostic procedures.Second, why was coronary angiography repeated 4 days later? Angiographic procedures with ICM at short intervals may be problematic, particularly in a patient with a previous immediate hypersensitivity reaction. Why was magnetic resonance angiography not considered as an alternative in this instance?Third, why was iodixanol used again? On one hand the authors present “new diagnostic tools”, and on the other the management is very old fashioned. Currently, radiologists do not usually use the ICM that has induced the hypersensitive reaction. Moreover, it is well known that pre-medication with antihistamines and corticosteroids do not prevent hypersensitive reactions. Furthermore, the doses of the drugs given 24 h before the start of the second angiography are missing in the case report.Fourth, why was the allergological work up started after the second hypersensitivity reaction?Hypersensitivity reactions after ICM reaction continue to be a challenge in radiological routine. To improve the safety of ICM application both clinical studies and case reports are of great importance. Case reports should be used to exactly describe the clinical features of adverse reactions in general, and of hypersensitivity reactions in particular [3].To conclude, in patients at high risk of hypersensitivity reaction, intradermal testing and the basophil degranulation test are of significant clinical impact, but other strategies such as avoidance of causative ICM should also be taken into account [4].References1 Garcia-Ortega P , Marin A , Quilez E , Rodriguez-Leor O . New tools for allergy diagnosis and clinical advice after immediate reactions to ICM. Br J Radiol 2010;83:632–3. Link ISI, Google Scholar2 Böhm I , Schild HH . A practical guide to diagnose less known immediate and delayed contrast media-induced adverse effects. Eur Radiol 2006;16:1570–9. Crossref Medline ISI, Google Scholar3 Böhm I , Medina J , Prieto P , Block W , Schild HH . Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence. Eur Radiol 2007;17:485–9. Crossref Medline ISI, Google Scholar4 Böhm I , Schild HH . KM-bedingte Anaphylaxie und Prävention durch Auswahl eines verträglichen Kontrastmittels. Fortschr Röntgenstr RöFo 2008;180:1127–8. Crossref Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 84, Issue 1003July 2011Pages: 581-e150 2011 The British Institute of Radiology History ReceivedNovember 23,2010AcceptedJanuary 04,2011Published onlineJanuary 28,2014 Metrics Download PDF

Serine‐ and mannose‐modified liposomal contrast agent for computed tomography: evaluation of the enhancement in rabbit liver VX‐2 tumor model

Kupffer cell imaging is a powerful tool for the detection of liver cancer. This diagnostic procedure depends on the faculty of the reticuloendothelial system (RES) which takes up foreign bodies, including small particles. The current study aimed to develop a novel RES targeting liposomal contrast agent that functionalized with serine or mannose, the moiety specifically binding to a corresponding receptor on phagocytic cells. Liposomes loaded with non-ionic X-ray contrast media, Iohexol, were prepared by supercritical carbon dioxide reverse-phase evaporation method and were intravenously injected to healthy rabbits in order to evaluate the liver parenchymal enhancement in X-ray computed tomography (CT). From 10 to 40 min after injection, the mean enhancement value of the liver parenchyma approached 45 and 34 Hounsfield units (HU) when serine-modified iodinated liposomal contrast agent (ILCA) and mannose-modified ILCA were applied, respectively. The tumor-to-liver contrast values were also evaluated after the administration of the prepared ILCA to rabbits with VX-2 carcinoma. For serine-modified ILCA, tumor-to-liver contrast was 82 HU at 1 min and >24 HU at 10-40 min; for mannose-modified ILCA, the values were 58 HU at 0.5 min and >21 HU at 10-40 min. These vales estimated from the region of intrest and the imaging figures of liver indicate the potential of ILCA for clinical use.

Immediate and non-immediate reaction after non-ionic X-ray contrast medium injection: Case report and review of the literature

Maculopapular rush (exanthema) is the most common contrast medium (CM)-induced non-immediate (delayed) reaction, accounting for over 50% of affected patients. In this article, we describe the clinical course of a 50-year-old female patient who underwent CM-enhanced computer tomography (CT). During non-ionic CM-injection (iopromide) she developed dyspnoea and itching. 24 h afterwards the patient presented with generalized small red macules that tended to confluence (maculopapular exanthema) and itching. Because in vivo testing was not possible, we analyzed blood cells by the cellular allergen stimulation test (CAST), and found slightly increased leukotriene production in the presence of iopromide, while another CM (iotrolan) did not induce leukotriene production. In addition we reviewed available literature for CM related maculopapular exanthema. This clinical feature due to CM is a characteristic delayed (non-immediate) reaction that usually occurs 24 h after CM administration and has been preferentially reported due to non-ionic dimeric CM. Laboratory tests like the CAST that are used in parallel with in vivo skin tests would be of great relevance but are currently not validated. As to whether intra-individual reactions with both immediate and delayed symptoms after CM-injection occur seldom or have been only rarely reported is currently unknown.

Fixed drug eruption induced by an iodinated non-ionic X-ray contrast medium: a practical approach to identify the causative agent and to prevent its recurrence

We describe the case of a 61-year-old physician who developed a fixed drug eruption (FDE) after i.v. administration of a non-ionic monomeric iodinated X-ray contrast medium (CM) (iopromide). During CM injection, a sensation of heat occurred, which was most intense in the right inguinal region. Four hours later, the FDE arose with a red macule of approximately 2 cm in diameter covering a dermal infiltration in the right inguinal region, and enlarged up to a final size of 15 x 8 cm, accompanied by a burning sensation. The patient's history revealed a similar reaction in the same localization and of the same clinical appearance after CM injection 1 year before. Patch testing 4 months later revealed positive reactions to iomeprol and iohexol. Iopamidol injection for another CT examination 23 months later was well tolerated. Based on these results, we suggest patch testing after CM-induced FDE, which could help to select a CM for future CT examinations. Late onset of adverse CM reactions may manifest as FDE. Patch testing within the previous skin reaction area is the diagnostic tool that should be used to confirm the suspected agent, possible cross-reacting agents and well-tolerated agents.

A Simple Radiological Technique for Demonstration of Incorrect Positioning of a Foley Catheter with Balloon Inflated in the Urethra of a Male Spinal Cord Injury Patient

In a male patient with cervical spinal cord injury, the urinary bladder may go into spasm when a urethral catheter is removed and a new Foley catheter is inserted. Before the balloon is inflated, the spastic bladder may push the Foley catheter out or the catheter may slip out of a small-capacity bladder. An inexperienced health professional may inflate the balloon of a Foley catheter in the urethra without realizing that the balloon segment of the catheter is lying in the urethra instead of the urinary bladder. When a Foley balloon is inflated in the urethra, a tetraplegic patient is likely to develop autonomic dysreflexia. This is a medical emergency and requires urgent treatment. Before the incorrectly placed Foley catheter is removed, it is important to document whether the balloon has been inflated in the urinary bladder or not. The clinician should first use the always available tools of observation and palpation at the bedside without delays of transportation. A misplaced balloon will often be evident by a long catheter sign, indicating excessive catheter remaining outside the patient. Radiological diagnosis is not frequently required and, when needed, should employ the technique most readily available, which might be a body and pelvic CT without intravenous contrast. An alternative radiological technique to demonstrate the position of the balloon of the Foley catheter is described. Three milliliters of nonionic X-ray contrast medium, Ioversol (OPTIRAY 300), is injected through the side channel of the Foley catheter, which is used for inflating the balloon. Then, with a catheter-tip syringe, 30 ml of sterile Ioversol is injected through the main lumen of the Foley catheter. Immediately thereafter, an X-ray of the pelvis (including perineum) is taken. By this technique, both the urinary bladder and balloon of the Foley catheter are visualized by the X-ray contrast medium. When a Foley catheter has been inserted correctly, the balloon of the Foley catheter should be located within the urinary bladder, but when the Foley catheter is misplaced with the balloon inflated in the urethra, a round opaque shadow of the Foley balloon is seen separately below the urinary bladder. This radiological study takes only a few minutes to perform, can be carried out bedside with a mobile X-ray machine, and does not require special expertise or preparations, unlike transrectal ultrasonography. When a Foley balloon is inflated in the urethra, abdominal ultrasonography will show an absence of the Foley balloon within the bladder. The technique described above aids in positive demonstration of a Foley balloon lying outside the urinary bladder. Such documentation proves valuable in planning future treatment, education of health professionals, and settlement of malpractice claims.

Effect of X-Ray Contrast Media on Blood Flow Properties after Coronary Angiography

In vitro studies suggest that ionic and nonionic X-ray contrast media have different effects on rheological parameters. The risk of thrombotic complications in coronary interventions was reported to be lower using ionic contrast media. The aim of the present study was to compare the effects of different types of contrast media on rheological parameters after coronary angiography. Sixty patients were randomized to four groups: ioxaglate 320 (dimeric, ionic, n=18), iomeprol 400 (monomeric, nonionic, n=12), iobitridol 350 (monomeric, nonionic, n=12), and iodixanol 320 (dimeric, nonionic, n=18). Blood samples were collected via the side port of the arterial sheath immediately before and at the end of coronary angiography. In our study, all types of contrast media caused a significant decrease in haematocrit (Hct), plasma viscosity (PV), erythrocyte aggregation (EA), and in the platelet reactivity index (PRI). The most pronounced decrease in Hct was found using the ionic dimer ioxaglate. There were no significant differences between the contrast media with respect to their effects on PV, EA, and PRI.

Effect of furosemide or mannitol before injection of a non-ionic contrast medium on intrarenal oxygen tension.

Oxygen tension (pO2) in rat renal cortex and outer medulla was studied after an intravenous injection of mannitol or furosemide, followed 10 minutes later by an intravenous injection of the non-ionic X-ray contrast medium (CM) iopromide (370 mg iodine/ml). Ten minutes after mannitol injection, before injection of CM, pO2 in the medulla had decreased from a control level of 32 +/- 3 to 28 +/- 4 mm Hg. The addition of CM caused a further decrease, to 24 +/- 5 mm Hg, which was a significant reduction. Ten minutes after furosemide injection the pO2 in the medulla had increased significantly, from a control value of 32 +/- 2 to 44 +/- 4 mm Hg. Injection of CM caused a significant decrease in pO2 to 37 +/- 3 mm. Ringer's solution (n = 6) caused no changes. We conclude that pretreatment with mannitol or furosemide does not prevent the CM-induced decrease in pO2 in the outer medulla.

Drug Eruption due to Nonionic x-Ray Contrast Medium, Iotrolan-Cases with Immediate or Delayed Onset of Skin Rash.

Four cases of drug eruption caused by iotrolan (Isovist 280®) were reported. In the first three cases, the skin eruption appeared 4 to 7 days after the administration of iotrolan for the i.v. pyelography. Sensitization might have occurred after the administration. In the fourth case, the patient developed the eruption on the next day after i.v. pyelography. It is considered that the patient had been sensitized by the i.v. pre-test 15 days before the pyelography.

Influence of new nonionic x-ray contrast media on water balance in serum albumin and blood plasma γ-globulin solutions studied by the method of NMR-relaxometry

Influence of new nonionic x-ray contrast media on water balance in serum albumin and blood plasma γ-globulin solutions studied by the method of NMR-relaxometry

Cardiac hemodynamic effects of iodixanol, iopamidol, and ioxaglate following left coronary injections in anesthetized dogs

Iodixanol, a dimeric, nonionic X-ray contrast medium, has been formulated at 320 mg iodine per milliliter and supplemented with Na+, Ca2+, and Cl- to produce an osmolality that approximates that of plasma. We compared the effects of left main coronary artery injections of iodixanol, ioxaglate, and iopamidol on cardiac mechanical function in dogs. Six mixed-breed dogs were anesthetized and prepared for recordings for electrocardiogram, aortic and left ventricular pressures, and the first derivative of left ventricular pressure, dP/dt. The test solutions and saline were injected into the left coronary artery in a randomized order. The series of four injections were repeated three times in each animal for a total of 12 injections per dog. Iodixanol caused significantly lower (p < .05) reduction in peak left ventricular pressure (-1.7 +/- 0.9% vs -0.7 +/- 2.0%), in diastolic aortic pressure (-1.3 +/- 1.1% vs -9 +/- 1.3%), and in left ventricular dP/dt (0.3 +/- 1.3% vs -13.2 +/- 2.4%) than did ioxaglate. Iodixanol also produced smaller cardiovascular effects than did iopamidol, but the differences were not statistically significant. Injections of both iopamidol and ioxaglate caused significant decreases from baseline parameter values; however, the changes with iodixanol were not significant. The isotonic formulation of iodixanol caused smaller cardiovascular hemodynamic effects than did iopamidol and ioxaglate and may offer increased safety in patients with severe cardiac disease.

Safety and tolerability of iodixanol in healthy volunteers with reference to two monomeric X-ray contrast media

The low osmolar, non-ionic X-ray contrast media have shown a lower frequency of adverse events than the older ionic ones. In this study changes in routine clinical-chemical parameters in blood and urine, vital signs and adverse events were recorded in six groups of 10 healthy male volunteers receiving either iodixanol, a new non-ionic, dimeric X-ray contrast medium for general vascular use, or one of the two non-ionic, monomeric contrast media iopentol and iopamidol. Minor decreases were observed in the values for haemoglobin, haematocrit and erythrocytes 5 min and 3 days after injection of iodixanol. A minor increase was seen in platelets and total protein after 3 days. A transient increase in serum osmolality was seen 5 min after the injections of iopentol and iopamidol. This was not seen in any iodixanol group. The level of thyrotropin showed an increase in all groups at 3 days. It was back to normal within 21 days. No changes of clinical importance were seen regarding blood pressure, heart rate or ECG in any volunteer. No severe adverse events were reported. All events were of short duration, and of mild or moderate intensity. The results, however, may indicate a lower frequency of adverse events/discomfort after the administration of the dimeric iodixanol than the 2 monomeric contrast media iopentol and iopamidol.

Cellular Toxicity of X-ray Contrast Media for Two Renal Epithelial Cell Lines (MDCK and LLC-PK1)

The two renal cell lines, MDCK (distal tubule) and LLC-PK1 (proximal tubule), have been used for toxicity testing of three different X-ray contrast media: the ionic monomer Isopaque, the ionic dimer Hexabrix and the non-ionic monomer Omnipaque. The cells were grown to confluency in monolayer cultures in a chemically-defined serum-free medium before the contrast media were added, to give final concentrations corresponding to 0–100mg iodine/ml. Toxicity was assessed by cell viability and by biochemical assays of marker enzymes. The results demonstrate a concentration-dependent toxic effect from the contrast media on cellular appearance, and on the activity of brush border and lysosomal enzymes. The non-ionic X-ray contrast media appeared to be less toxic than the ionic contrast media investigated.

The effects of different ionic and non-ionic X-ray contrast media on the morphological and rheological properties of human red blood cells

The effects of different ionic and non-ionic X-ray contrast media on the morphological and rheological properties of human red blood cells

Separation of Leucocytes: Improved Cell Purity by Fine Adjustments of Gradient Medium Density and Osmolality

This paper briefly reviews commonly used procedures for separation of mononuclear cells (MNC) and granulocytes from human blood with X-ray contrast media as gradient material, and also presents new and modified procedures for leucocyte preparation. Standard techniques for human blood do not always yield satisfactory results with blood from other species. In general pure MNC are easily obtained (top fraction), but often the granulocyte fraction has a low purity, due to contamination with MNC that move to the bottom during centrifugation and contaminate the granulocyte suspension. Obviously the density distribution of MNC differs between species. However, the separation can be improved by fine adjustment of gradient medium osmolality. For this purpose we have used Nycodenz, a non-ionic X-ray contrast medium. A favourable property of Nycodenz solutions is that the osmolality and density can easily be varied over a broad range. The cells react promptly to a change of medium osmolality. In hypertonic medium the cells expel water, shrink, their density increases and they sediment faster, in spite of a smaller radius. Further, the cells may pass what was initially a density barrier. A hypotonic environment has the opposite effect. In the present work we were able to show that a slight change of medium osmolality clearly improved different techniques for separation of leucocyte subgroups. For instance, the Isopaque-Ficoll (IF) technique consistently yielded MNC and granulocytes of high purity with human blood. However, with blood from rabbits, rats and mice the granulocyte suspensions were contaminated by 40-60% MNC. By utilizing Nycodenz, and lowering the osmolality by 10-12 per cent (at constant density--1.077 g/ml) we obtained satisfactory separation of MNC as well as granulocytes with blood from these species. A problem in the routine separation of granulocytes (IF) is a high contamination of erythrocytes (2-5 per cell) in the granulocyte suspension. With a two-layer technique with Nycodenz solutions of different densities it was possible to separate granulocytes almost devoid of erythrocytes, after proper adjustment of osmolality. By appropriate combination of density and osmolality, Nycodenz was a suitable gradient material in other separation procedures as well, e.g. the separation of monocytes and mast cells. To facilitate the use of Nycodenz as a versatile gradient material, a computer program providing recipes for various Nycodenz solutions is included as an appendix.

Nonionic X-ray contrast media and ions: Inotropic effects of calcium addition to iodixanol

Nonionic X-ray contrast media and ions: Inotropic effects of calcium addition to iodixanol

Intraoperative myocardial contrast echocardiography for assessment of regional bypass perfusion

The intraoperative determination of the success of surgical myocardial revascularization remains problematic because of major limitations in all currently used methods. To assess the regional blood flow of the bypass graft-dependent myocardial segments, 2 ml of sonicated iopromid (a nonionic x-ray contrast medium) was injected into the bypass graft in the beating heart. Simultaneously electromagnetic flow measurements were performed. Eleven graft injections in 8 men (mean age ± standard deviation 60 ± 4 years) were performed without any adverse effects. Excellent 2-dimensional cross-sectional views of the left ventricle were obtained in all cases. Ten of 11 injections resulted in adequate myocardial opacification. Computer-assisted evaluation by videodensitometry resulted in time-intensity curves with contrast decay half-times ( T 1 2 ) from 2.2 to 6.9 seconds (mean 4.3 ± 1.4). The corresponding electromagnetic flow ranged from 55 to 100 ml/min (mean 80.0 ± 16.2). There was no correlation between contrast 2-dimensional echocardiography-derived T 1 2 and electromagnetic flow (r = −0.32; p = 0.38). Thus, myocardial contrast echocardiography is a feasible and safe method for intraoperative evaluation of the success of bypass graft surgery. It offers online visualization of perfusion of revascularized myocardium and may allow immediate intraoperative revision of unsuccessful bypass graft placement.

In vitro models for testing the metabolic effects of myelographic contrast media.

Water-soluble nonionic x-ray contrast media have greatly improved the quality and safety of myelography. Toxic side effects are still observed however. The side effects are generally worse with the first nonionic agent, metrizamide, which has a glucoselike side group. Two in vitro models were developed to examine the effects of contrast media on glucose metabolism. Using rat hippocampus slices, the authors observed significant depression of carbon dioxide production by metrizamide and by deoxyglucose, a known metabolic inhibitor. Iohexol and iopamidol did not cause significant depressions. In rat brain synaptosomes the authors did not observe a depression of the uptake of deoxyglucose 14C by any media tested. These studies indicate that metrizamide can create metabolic depression but that it does not compete with glucose for the membrane glucose carrier.

Synthesis and Biological Testing of Nonionic Iodinated X-ray Contrast Media

A series of nonionic x-ray contrast media containing novel linkages between the triiodobenzene and polyhydroxy moieties have been prepared and screened against established criteria. Of the coupler groups examined (amide including dipeptide, carbamate, ureido, and ester), amide showed the greatest overall utility in terms of safety, solubility, stability, and ease of synthesis. Acute toxicity, solubility and stability data are summarized for each series. In the CNS, certain compounds were well tolerated and some were devoid of any excitatory effects. Intrathecal tissue irritant effects were also unremarkable. Most agents exhibited relatively high osmolalities, raising questions as to the influence of this factor on the safety of myelographic agents. Intravascularly, nonionic media appear also to offer advantages over classical ionic media. However, nonionic media can exert positive inotropic effects and exhibit high viscosity at higher iodine concentrations. Nevertheless, overall results continue to demonstrate the radiographic potential of nonionic contrast media.