Use Of Nonionic Contrast Media Research Articles

Frequency of Acute and Late Reaction of Non-Ionic Iodinated Contrast Media in Contrast Enhanced Computed Tomography

Introduction: A contrast agent is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, and enhance the radio density in a target tissue or structure. Contrast agents are commonly used to improve the visibility of blood vessels and the gastrointestinal tract. Several types of contrast agent are in use in medical imaging and they can roughly be classified based on the imaging modalities where they are used and the purposes of this study to find out the frequency of adverse reactions of non-ionic iodinated contrast media in contrast enhanced Computed Tomography. Material Methods: It was cross-sectional observational study conducted on 133 patients who visited Al-Razi healthcare hospital, Lahore for a CT (computed Tomography) scan. 36 of them got adverse reactions to the non-ionic contrast media. The frequency of adverse reactions happening with the non-ionic contrast usage was determined Results: In this study, one hundred and thirty-three patients who fulfilled the criteria were included in the study. 36 of the patients had adverse reactions to the non-ionic contrast media which included shivering, fatigue, headache, nausea and rashes. All of the patients had no previous history of allergies or contrast reactions. The mean age of patients ranged from 51.49 ± 16.19years. Conclusion: In conclusion, the use of non-ionic contrast media as a CT contrast agent has a safety profile. It is concluded that a non-ionic iodinated contrast media reaction rarely results in long-term sequelae as it is less severe and easily treatable. Keywords: Non-Ionic Iodine Contrast Media, Computed Tomography, Adverse Reactions DOI: 10.7176/JHMN/88-05 Publication date: April 30 th 2021

Contrast-induced acute kidney injury – A review focusing on prophylactic strategies

Contrast-induced acute kidney injury is the third leading cause of intrahospital acute kidney disease, accounting for 11% of all cases. It is associated with a worse prognosis on the short- and long-term, as well as with extended hospital stay and increase in health-care costs. As the number of diagnostic and interventional angiographies and computerized tomography increases in clinical practice and higher doses of contrast media are administered to sicker and older patients, contrast-induced acute kidney injury is an increasing problem. Contrast-induced acute kidney injury is a unique form of acute kidney injury in that its risk factors are known and its timing predictable. This makes room for the implementation of prophylactic measures in patients at risk.Several articles were searched in nephrology journals (“American Journal of Kidney Disease”, “Journal of the American Society of Nephrology”, “Clinical Journal of the American Society of Nephrology”, “Kidney International” and “Nephrology Dialysis Transplantation”) for a global view on contrast-induced acute kidney injury and prophylactic strategies. Subsequently, individual searches were made on MEDLINE® database for randomized controlled trials and meta-analyses on each prophylactic strategy encountered.Several approaches to contrast-induced acute kidney injury prevention have been reported, of which vigorous hydration and the use of non-ionic contrast media are the most important. The administration of oral N-acetylcysteine is also a popular strategy in virtue of its favorable risk/benefit profile. Statins have also been reported as protective against contrast-induced acute kidney injury. The authors review the disease and studied prophylactic interventions, presenting a practical approach to the prevention of contrast-induced acute kidney injury.

破裂内頚動脈瘤塞栓術後にPosterior reversible encephalopathy syndrome（PRES）を発症した1例

We report a case of posterior reversible encephalopathy syndrome (PRES) after coil embolization for a ruptured internal carotid artery aneurysm. A 37-year-old man suffered from subarachnoid hemorrhage. A 3D-CT angiogram and catheter angiogram revealed a saccular aneurysm at the right internal carotid artery. Coil embolization for the ruptured aneurysm was successfully performed with the use of high-dose nonionic contrast medium. Hypervolemia was started prophylactically in the postoperative course for treatment of vasospasm. He complained of severe headache two days after the coil embolization. A FLAIR MR imaging and apparent diffusion coefficient (ADC) map revealed multiple vasogenic edema in the parietal, occipital and frontal lobes bilaterally. Under the diagnosis of PRES, we successfully treated his disease using edaravone. A follow-up MR imaging 26 days after the coil embolization revealed disappearance of the vasogenic edema. The causative factors of PRES in our case were suspected to be frequent use of nonionic contrast medium and hypervolemia.

AS-143: Predictors of Contrast-Induced Nephropathy after Use of Nonionic Contrast Media during Percutaneous Coronary Intervention

AS-143: Predictors of Contrast-Induced Nephropathy after Use of Nonionic Contrast Media during Percutaneous Coronary Intervention

Adverse reactions to intravenous iodinated contrast media: a primer for radiologists

Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be subclassified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. Non-ionic contrast media have lower risk of mild and moderate adverse reactions. However, the risk of fatal reactions is similar for ionic and non-ionic contrast media. Adequate preprocedure evaluation should be performed to identify predisposing risk factors. Prompt recognition and treatment of acute adverse reactions is crucial. Risk of contrast induced nephrotoxicity can be reduced by use of non-ionic contrast media, less volume of contrast, and adequate hydration. The radiologist can play a pivotal role by being aware of predisposing factors, clinical presentation, and management of adverse reactions to contrast media.

Chronic Thromboembolic Pulmonary Hypertension

Since the last World Symposium on Pulmonary Hypertension in 2008, we have witnessed numerous and exciting developments in chronic thromboembolic pulmonary hypertension (CTEPH). Emerging clinical data and advances in technology have led to reinforcing and updated guidance on diagnostic approaches to pulmonary hypertension, guidelines that we hope will lead to better recognition and more timely diagnosis of CTEPH. We have new data on treatment practices across international boundaries as well as long-term outcomes for CTEPH patients treated with or without pulmonary endarterectomy. Furthermore, we have expanded data on alternative treatment options for select CTEPH patients, including data from multiple clinical trials of medical therapy, including 1 recent pivotal trial, and compelling case series of percutaneous pulmonary angioplasty. Lastly, we have garnered more experience, and on a larger international scale, with pulmonary endarterectomy, which is the treatment of choice for operable CTEPH. This report overviews and highlights these important interval developments as deliberated among our task force of CTEPH experts and presented at the 2013 World Symposium on Pulmonary Hypertension in Nice, France.

Repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents

To compare the findings of a survey undertaken by us in 2002 regarding steroid premedication given in radiology departments to reduce the risk of adverse reactions in patients at increased risk of intravascular contrast media reactions with a similar survey published in 1994 by R. Seymour et al. The high risk patients considered in our survey were patients with history of asthma, drug allergies, hay fever and eczema. A total of 225 questionnaires were sent to the consultant in charge for audit for radiology departments from the list given by the Royal College of Radiologists. 175 of the 225 questionnaires were returned (response rate 77.8%) and of these 172 were analysed with respect to the type, dose and duration of steroids. Compared to the survey in 1994, it was found that the number of departments who use steroid cover for all category of risk factors had increased compared to previous survey (73.8% in 2002 versus 55.3% in 1994 (p=0.001). There is now almost universal use of non-ionic contrast 98.8% versus 82.4% in 1994 (p=0.001). There is no agreed policy among radiology departments for the need or the dose or duration of steroid cover. Despite the more widespread use of non-ionic contrast media, the use of steroid premedication has increased which is contrary to what is expected as the incidence of adverse reaction to non ionic media is less than ionic contrast media.

Acute occlusion of coronary artery bypass graft with nonionic contrast medium

The use of nonionic contrast media should be beneficial in patients with cardiac disease because such media are less chemotoxic. Using iopamidol under heparinization, we treated 4 cases of acute thromboembolic occurrence including occlusion of coronary artery bypass grafts and associated native coronary arteries. While the majority of patients do not experience this complication, care must be taken to avoid major adverse effects.

Réactions anaphylactoïdes et cutanées tardives aux produits de contraste iodés : état actuel de la question – évolution des idées

Purpose. – Adverse reactions to iodinated contrast media (ICM) share various mechanisms. Anaphylactoid reactions are among the most serious reactions when they are characterized by the elevation of seric tryptase. Pretreatment with corticosteroids and anti-H1 or the use of non-ionic contrast media do not prevent anaphylaxis. Late skin reactions could be mostly related to delayed hypersensitivity. Previous reactions to contrast media, cardiovascular disorders, beta-blockers, asthma, and atopy are risk factors. Female gender and age increase the severity. Current knowledge and key points. – Anaphylaxis can be demonstrated by intradermal tests and the identification of specific IgEs. Delayed hypersensitivity is shown by the results of epicutaneous tests and the immunohistology of the skin. Future prospects and projects. – Allergologic tests are advised in the case of previous reactions. In case of emergency, gadopentetate dimeglumine can be alternatively used. The other risk factors lead to the combination of pretreatment and use of non-ionic monomeric contrast media. Immediate hypersensitivity to iodinated media might increase in the near future with the use of divalent molecules.

Deaths related to iodinated contrast media reported spontaneously to the U.S. Food and Drug Administration, 1978-1994: effect of the availability of low-osmolality contrast media.

To determine whether reports of iodinated contrast medium-related deaths have decreased since low-osmolality contrast media (LOCM) became widely available in the United States. With use of reports to the U.S. Food and Drug Administration Spontaneous Reporting System, data on iodinated contrast medium-related deaths after LOCM became available (1987-1994) were compared with data on deaths in the period before (1978-1986) and with data on deaths in an even earlier period (1967-1977). In 1967-1994, more than 1,000 contrast medium-related deaths were reported, 850 occurring during 1978-1994. Excluding 22 myelography-related deaths, 37% [corrected] more deaths were reported each year in 1987-1994 than in 1978-1986. Most of this increase was associated with the use of nonionic contrast media. In 1966-1977, 228 deaths were reported; in 1978-1986, 376; and in 1987-1994, 474. In 1987-1994, 220 deaths were associated with use of high-osmolality contrast media alone, 32 with ionic LOCM alone, 214 with nonionic LOCM alone, and eight with combinations of contrast media. Despite the availability of LOCM in the United States, data for 1978-1994 do not show a marked decrease in contrast medium-related deaths. Since 1990, more deaths have been associated with LOCM than with conventional contrast media. Although these data have substantial limitations, they shed some light on contrast medium use and safety.

Kontrastmittelapplikation bei der Spiral-Computertomographie: Ergebnisse einer Konsensuskonferenz

The rapidity of spiral (helical-) computed tomography requires new protocols for i.v. contrast media administration. Flow rate, volume and delay are discussed controversially in the literature. Hence, a consensus meeting was initiated. In this meeting, problem related questions were designed, discussed and answered using a digital vote system. Spiral-CT-technology was found to be the ideal examination technique for thorax, liver, pancreas, kidney and the retroperitoneal space with an overall agreement between 89 and 97%. The exclusive use of nonionic contrast media and power injectors was recommended by 100% of the participants. More than 90% of the contributors did not accept native scans only for examinations of the neck, thorax, liver, pancreas, kidney and the retroperitoneal space. Regarding volume, flow rate, delay and physical CT-parameters the agreement laid between 50 and 100%. The meeting concluded that randomised controlled studies should be performed to evaluate detailed contrast media protocols for helical CT.

Transient global amnesia following cerebral angiography with non‐ionic contrast medium

Transient global amnesia (TGA) is an uncommon syndrome of recent memory deficit and inability to learn new data, usually resolving within 24 h. Two cases following use of non-ionic contrast media in cerebral angiography are described. The neuroanatomy of memory is reviewed. Possible aetiologies of TGA in relation to cerebral angiography include ischaemia (embolic, arterial spasm), epilepsy that may be primary or tumour-related and direct toxic effects of contrast media.

Use of Non-ionic Contrast Media for Bronchography

Use of Non-ionic Contrast Media for Bronchography

Safety of Nonionic Agents in Visceral Angiography

To compare the safety of ionic and nonionic contrast agents in visceral angiography. Beginning in 1989, a prospective, open trial was begun, and 1,890 patients who have undergone contrast injection were enrolled. Patients considered to be high risk were graded according to Palmer and received nonionic contrast media, while all other patients received ionic contrast media. Because of the small number of visceral angiography procedures performed (38), no definitive conclusions could be drawn as to the differences between ionic and nonionic agents regarding grade-2 and grade-3 adverse events. However, a difference in grade-1 events was apparent in favor of nonionic agents. More than 10 years ago, the Department of Radiology staff at Aker Hospital began using iohexol, first in infants, then in children, pregnant women, patients undergoing leg phlebography, and patients with serious, previously documented reactions from contrast media. Currently, the department staff administers nonionic agents exclusively for coronary angiography and other cardiac procedures in approximately 300 patients per year. Today, use of nonionic contrast media is the standard for almost all procedures requiring intra-arterial or intravenous application.

Omnipaque (iohexol).

The largest nationwide comparative clinical study evaluated 337,647 patients receiving high-osmolar ionic contrast media or low-osmolar nonionic contrast media and the incidence of adverse drug reactions. The overall prevalence of adverse drug reactions was 12.66% in the ionic contrast media group and 3.13% in the nonionic contrast media group. Severe adverse drug reactions occurred in 0.22% of examinations in the ionic contrast media group and in 0.04% of examinations in the nonionic contrast media group. Thus, the use of nonionic contrast medium significantly reduces the frequency of severe and potentially life-threatening adverse drug reactions to contrast media.

Comparison of Iopromide versus Iohexol in Aortobifemoral Arteriography

A double-blind randomized, clinical trial was conducted in 9 hospitals comparing the use of non-ionic contrast media (CM) iopromide 300 (Ultravist) and iohexol 300 (Omnipaque) during peripheral arteriography in a total of 446 patients. After premedication with morphine-scopolamine each patient was given two consecutive injections of 50 ml CM at a rate of 12 ml/s above the aortic bifurcation. Both CM were well tolerated. There were no differences between the two substances as far as general tolerance, pulse rate, blood pressure, sensation of heat or pain after CM injection were concerned.

Comparison of Iopromide versus Iohexol in Aortobifemoral Arteriography

A double-blind randomized, clinical trial was conducted in 9 hospitals comparing the use of non-ionic contrast media (CM) iopromide 300 (Ultravist) and iohexol 300 (Omnipaque) during peripheral arteriography in a total of 446 patients. after premedication with morphine-scopolamine each patient was given two consecutive injections of 50 ml CM/at a rate of 12 ml/s above the aortic bifurcation. Both CM were well tolerated. There were no differences between the two substances as far as general tolerance, pulse rate, blood pressure, sensation of heat or pain after CM injection were concerned.

Use of non-ionic contrast media for tracheobronchography in neonates and young infants

The paper describes the experience gained with tracheobronchography in 11 neonates and young infants with severe pulmonary disease — most of them on artificial respiration - using isotonic solutions of iopromide (17 series) and iotrolan (14 series). Both contrast agents were tolerated without any obvious problems when instilled into the lungs. Because of its higher content of iodine and greater viscosity, iotrolan was superior to iopromide as regards both the demonstration even of the more peripheral bronchial morphology and the duration of the contrast coating.

Diagnostic Imaging Evaluation of Benign Prostatic Hyperplasia

The optimal evaluation of the patient with symptomatic BPH should include the diagnostic testing necessary to supplement the clinical examination and select a suitable medical, surgical, or interventional therapeutic option. A variety of imaging modalities offer unique but often unnecessary, superfluous, or very expensive information. Rarely is therapeutic intervention for symptomatic BPH denied a patient because of lesions detected with screening imaging tests; it may be only delayed rather than withheld. Virtually all pretreatment IVUs in patients with BPH are normal. Estimates range from 73 to 93 per cent of the studies as normal or having only insignificant findings. Significant pathology, either life-threatening or sufficient to alter or delay treatment, is found between 0.5 and 10 per cent of the time. Upper tract hydronephrosis is the most common finding (3 to 13 per cent). Renal or urothelial cancer prevalence in the patient population with BPH is really no different than in the general population. If signs or symptoms are not present to alert the clinician to some risk factor other than the symptoms of BPH, there is no benefit for routine urography solely for upper tract cancer detection. Furthermore, with the growing use of nonionic contrast media for elderly patients, the cost of the preoperative routine IVU will increase even further as the added charge for contrast ($100 or more) is tacked onto the cost of the study. Azotemic patients are best served by diagnostic ultrasound or by Foley catheter drainage prior to urography when indicated. Ultrasound remains an operator-dependent and technology-limited examination that cannot measure renal function, but the sensitivity and specificity, as well as the overall diagnostic accuracy, are equal to or greater than those of urography for the detection of hydronephrosis, cystic renal masses, and bladder or prostate abnormalities. False-positive ultrasound scans do occur secondary to reflux caused by bladder diverticula, megacalicosis, or other congenital abnormalities. However, these lesions are distinctly rare. Sensitivity for urothelial malignancy is not good, but endoscopic, clinical, and laboratory evaluations should provide adequate pretherapy diagnostic screening. In spite of the preoperative comfort that a normal IVU may give the patient and the operating surgeon, routine intravenous urography for all BPH patients should no longer be considered necessary. Diagnostic ultrasound, either transabdominal or transrectal, also offers the ability to evaluate the kidneys, ureters, and bladder, effectively replacing routine intravenous urography.(ABSTRACT TRUNCATED AT 400 WORDS)

Ventricular fibrillation in coronary angiography: what is the role of contrast medium?

A retrospective review of patients with coronary angiography was undertaken to establish the incidence of ventricular fibrillation and other serious arrhythmias and to identify possible causative factors, in particular whether the use of non-ionic contrast medium increased the risk of a serious arrhythmia. Out of 3660 patients reviewed there were 10 cases of ventricular fibrillation. In all cases, there were identifiable technical factors thought to have accounted for the arrhythmia. There were no cases of ventricular fibrillation complicating a technically satisfactory injection of ionic or non-ionic contrast medium. There was no significant difference in the incidence of serious arrhythmias between patients given ionic and those given non-ionic contrast medium.